Microvascular Density as a Parameter of Endometrial Assessment in Infertile Women

Background: A good blood flow towards the endometrium is an essential prerequisite for its development and differentiation, for the implantation of blastocyst and continuation of pregnancy. Diminished endometrial perfusion may be the one of the important reason behind the patients with unexplained infertility. The present study was carried out to estimate the cut-off of microvascular density determinative of good endometrial receptivity. Methods: The study included 60 patients who qualified the exclusion and inclusion criteria. Transvaginal Doppler ultrasonographic examination was performed for all patients prior to the scheduled premenstrual biopsy to determine sub endometrial blood flow. The biopsied endometrial tissue was processed. The blood vessels were identified in endometrial tissue and counted in 5 high power fields/slide. Total area of the field was calculated using stage micrometer. The density of the vessels was calculated as number of vessels/mm 2 of the fields. Results: Three vascular penetration zones based on Doppler ultrasonographic examination were identified as zone 1, zone 2, and zone 3 i.e. poor, intermediate and good vascularity respectively. The endometrial microvascular density in patients with vascularity falling in zone 1, zone 2, and zone 3 were 14.18 ± 4.07 vessels/mm 2 , 24.53 ± 4.65 vessels/mm 2 and 42.3 ± 6.1 vessels/mm 2 respectively. Comparative observation between Doppler and microvascular density revealed that in all patients with zone 3 vascularity, the microvascular density was more than 35 vessels/mm ² . Conclusions: A quantitative parameter was obtained from this study which identifies good endometrial receptivity and predicts the fertility of the patient which can be used as a prognostic marker in infertile patients particularly in developing countries. doi: http://dx.doi.org/10.4021/jcgo168w