A uterine ultrasonographic scoring system as a method for the prognosis of embryo implantation

Abstract

Purpose: The objective of the present study was to evaluate an ultrasonographic uterine scoring system as a method for the prognosis of embryo implantation in patients submitted to ICSI. Methods: A total of 562 patients submitted to an ICSI program were prospectively evaluated on the day of hCG administration in terms of the following ultrasonographic uterine parameters: A. Endometrial thickness (<7.0 mm = 0; 7 a 14 mm = 3; ≥14 mm = 1); B. Endometrial layering (three lines = 2; absence of three lines = 0); C. Myometrial contractions in 2 min (<3 = 0; ≥3 = 3); D. Uterine artery Doppler flow (>3 = 0; 2.2 a 3 = 2; ≤2.19 = 3); E. Endometrial power Doppler (The endometrium was divided into four equal quadrants and classified as grade I = 1; II = 2; III = 3; IV = 4, according to the visualization of the power Doppler in the quadrants). The colour Doppler signal was considered to be positive when it reached at least the basal layer of the endometrium; F. Myometrial power Doppler (absent = 0; weakly present = 2; strongly present = 3); G. Myometrial echogenicity (homogeneous = 2; inhomogeneous = 0). The patients were divided into 4 groups according to total score: Group I, score <10; Group II, score 10-14, Group III, score 15-17 and Group IV, score 18-20. Results: The uterine parameters using an ultrasonographic scoring system are inversely correlated with patient age (p < 0.0001). The number of days of stimulation with FSH did not differ (p = 0.10) between groups. The number of follicles measuring ≥16 mm was different (p = 0.01) between groups. The number of metaphase II oocytes also did not differ significantly between groups (p = 0.45). The fertilization rate was also similar (p = 0.10) for all groups. The number of transferred embryos was different between groups (p = 0.02). The rate of embryo implantation did not differ (p = 0.60) between groups. Finally, the pregnancy rates did not differ significantly (p = 0.93) between groups. Conclusions: The ultrasonographic evaluation of uterine parameters on the day of hCG administration using a scoring system is inversely correlated with patient age. In the present study, the use of this ultrasonographic score method could not identify a population with greater uterine receptivity.