الفهرس 
Doppler UltrasoundOnly 14 pages are availabe for public view
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Abstract
The implantation potential of good quality embryos remains low during in vitro fertilization/embryo transfer (IVF/ET) treatment, despite advances in ovarian stimulation regimens, the method of assisted fertilization and improved culture conditions. Successful implantation depends on a close dialogue between the blastocyst and the receptive endometrium ( Horcajadas et al., 2007). In the menstrual cycle, the endometrium has no adhesive qualities until the implantation window phase, during which for a very short time, the endometrium allows the implantation of gestational sacs. This feature is referred to as endometrial receptivity (Dominguez et al,2003) The term ”uterine receptivity” refers to a state when endometrium allows a blastocyst to attach, penetrate and induce changes in the stroma, which results in the so-called process of implantation. It appears that a favourable endometrial milieu is necessary for successful implantation (Horcajadas et al., 2009). With the advent of three-dimensional power Doppler ultrasound, it became possible to perform a reliable and reproducible sonographic evaluation to the role of endometrial and subendometrial vascularization for predicting uterine receptivity. Power Doppler ultrasound is better suited to the study of endometrial and subendometrial perfusion as it is more sensitive to low flow and thus overcomes the problems of angle dependence and background noise associated with both color and pulsed wave Doppler. In addition, the power Doppler signal can be subsequently analysed to produce quantitative information through one of several computer software packages. In combination with three-dimensional ultrasound, power Doppler offers a tool with which one may not only demonstrate but also quantify total endometrial, subendometrial and regional uterine blood flow (Raine-Fenning et al., 2004).
The current study was conducted on fifty (50) infertile patients undergoing long protocol for ovulation induction Then HCG (Pregnyl) 10000 I.U. intramuscular administration when the size of leading follicles reached or exceeded 18 mm. These patients were below 35 years old, with normal uterine cavity and with no previous uterine surgery. On the day of HCG administration, trans-vaginal 3D power Doppler ultrasound was performed at Ultrasound Unit in Benha University Hospital by the same operator after the patients had emptied their bladders. Measurements included: pulsatility index (PI) and resistance index (RI) of the uterine arteries. It also included endometrial / subendometrial vascularization index (VI), flow index (FI), vascularization flow index (VFI). Subendometrial region was defined as 2 mm outer from endometrial defined borders. Two weeks after HCG administration, serum B-HCG was estimated. The results of the study showed that there were no statistically significant differences in pulsatility index (PI) and resistance index (RI) of the uterine arteries , endometrial vascular indices (VI, FI and VFI) and subendometrial vascular indices ( VFI) between pregnant group and non pregnant group.There is only statistically significant differences in the pregnancy rate between the patients with and without endometrial and subendometrial blood flow. As all cases with absent blood flow show no pregnancy but not all patient with blood flow show pregnancy.