Three Dimensional Imaging of the Endometrium

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Three-dimensional (3D) ultrasonography first became available in the late 1990s and 3D is now a part of almost all high-end imaging systems. There are several methods used to provide 3D information and there are no studies comparing the same endpoints with different imaging systems (105). The prospects for predicting the probability of implantation in IVF programs have now extended into 3D exploration of endometrial receptivity (106).

When endometrial volumes were compared among women who conceived and those who did not, pregnancy and implantation rates were significantly lower in women with volumes of less than 2mL, and no pregnancies were established when endometrial volumes were less than 1 mL. A contemporary study found no relationship between 3D volume of the endometrium and conception (106,107). Nor was a correlation found among estradiol levels, endometrial thickness, or endometrial volume, leading the authors to conclude that there was no predictive value for conception in assessing endometrial volume. Endometrial thickness and endometrial volumes were not correlated with probability of pregnancy; however, 3D power flow Doppler indices used to measure endometrial perfusion may have some predictive value (101,102,108,109). Spiral artery blood flow measurements in 3D had positive predictive value when performed on the first day of ovarian stimulation, whereas women who became pregnant had lower RI and a higher 3D flow index than those that did not (101,102). Taken together, these observations provide rationale for further investigation, although it is clear that a predictive index is beyond the limits of our current technology.

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