Background and aim
The aim of this study was to evaluate ovarian reserve, uterine artery blood flow, and
endometrial and subendometrial blood flow in women with unexplained recurrent
miscarriage compared with normal fertile women.
Patients and methods
The study design was a case–control one. The study was conducted in the
Department of Obstetrics and Gynaecology, Benha University, Benha, Egypt.
Women were divided into two groups: those with a history of unexplained
recurrent miscarriage (the study group, n=50), and those who had no history of
miscarriage and had at least one child born at term (the control group, n=50). At
days 3–4 of the cycle, ovarian reserve testing was performed for all women by
measuring follicle-stimulating hormone, luteinizing hormone and oestradiol levels.
Thereafter, two-dimensional (2D) and 3D transvaginal ultrasonography and power
Doppler were performed to detect antral follicle count, ovarian volume, and ovarian
stromal Vascularization Index (VI), Flow Index (FI) and Vascularization Flow Index
(VFI). Between days 18 and 23 of the cycle, transvaginal ultrasonography was
performed for all women using 2D, pulsed Doppler and 3D-power Doppler mode to
detect endometrial thickness, Uterine Artery Pulsatility Index, endometrial volume
and endometrial and subendometrial blood flow presented by the indices VI, FI and
VFI. The indices between the two groups were compared.
Results
Uterine Artery Pulsatility Index was significantly higher in the study group
(P=0.001), whereas endometrial VI (P≤0.001), FI (P=0.01) and VFI (P≤0.001)
and subendometrial VI, FI and VFI (P≤0.001) were significantly lower in the study
group. The ovarian reserve tests, endometrial thickness and endometrial volume,
however, were not significantly different between the two groups.
Conclusion
The presence of good uterine and endometrial blood flow is an important
prerequisite for successful implantation and continuation of pregnancy as shown
by higher uterine artery blood flow resistance and lower endometrial and
subendometrial blood flow in recurrent unexplained miscarriage cases. We
could not find any cutoff values that could predict the occurrence of miscarriage,
and hence larger prospective studies are needed to confirm such results and
reaching values that can accurately predict the occurrence of miscarriage. |
