Marga M. IJland

Endometrial wavelike movements during the menstrual cycle

OBJECTIVE To qualify and quantify endometrial waves in regularly cycling women. DESIGN A prospective transvaginal ultrasound study was performed throughout 23 cycles of 16 healthy women. Wave type and wave frequency were evaluated. SETTING Normal human volunteers in an academic research environment. PATIENTS Sixteen healthy regularly cycling women. RESULTS Of 23 cycles, 19 proved to be ovulatory. Five types of endometrial waves could be distinguished. Waves from cervix to fundus and opposing waves were seen predominantly periovulatorily. Waves from fundus to cervix were absent in the postovulatory phase. Endometrial wavelike activity was most pronounced in the periovulatory phase. CONCLUSIONS Standardized qualification and quantification of endometrial waves, as described in this study, might shed new light on the underlying mechanisms in selected cases of hitherto unexplained subfertility.

Relation between endometrial wavelike activity and fecundability in spontaneous cycles

OBJECTIVE To determine whether endometrial activity is related to the occurrence of pregnancy in spontaneous menstrual cycles. DESIGN Prospective observational ultrasound evaluation of endometrial activity during fertility screening cycles. SETTING University hospital-based infertility clinic. PATIENT(S) Fifty-nine fertility screening cycles (ultrasound monitoring of follicle growth and ovulation, postcoital test, semen analysis, midluteal P, Chlamydia antibody determination, and tubal patency testing) were performed in 47 couples complaining of infertility. In 33 couples (37 cycles), no fertility impairing factors were found. Endometrial activity was analyzed in these cycles. INTERVENTION(S) Ultrasound examination was performed transvaginally throughout the cycle. MAIN OUTCOME MEASURE(S) Endometrial activity, wave pattern, pregnancy. RESULTS(S) Nine women conceived within the cycle studied. Conception cycles showed less-activity compared with nonconception cycles. Endometrial wavelike activity increased throughout the follicular phase and decreased after ovulation in conception and nonconception cycles. CONCLUSION(S) Endometrial activity is related to fecundability in a spontaneous cycle.

Endometrial wave direction switch and the outcome of in vitro fertilization

OBJECTIVE To describe endometrial wavelike activity, endometrial thickness and texture in IVF cycles, and to relate them to IVF outcome. To evaluate wave patterns on the day of hCG administration as a predictor of IVF outcome. DESIGN Ultrasound study. SETTING University hospital-based infertility clinic. PATIENT(S) Twenty-eight women undergoing IVF. INTERVENTION(S) Ultrasound examinations were performed at five fixed moments (start ovarian stimulation, hCG administration, ovum pickup (OPU), ET, and 7 days after hCG administration) and at three variable moments in the stimulation period in the cycle. The OPU was performed 2 days after hCG administration; ET was performed 2 or 3 days after that. MAIN OUTCOME MEASURE(S) Endometrial wave pattern, thickness, texture, IVF outcome. RESULT(S) Embryo transfer was performed in 22 cycles. In 73% of the cycles a wave direction switch (WDS) from fundus to cervix (FC) to cervix to fundus (CF) occurred before OPU. Eleven (50%) patients became pregnant. Significantly more FC waves persisted until hCG administration in the cycles in which the patients conceived. Endometrial thickness and texture were unrelated to IVF outcome. CONCLUSION(S) Endometrial wave pattern is associated with pregnancy in IVF. The persisting presence of FC waves until hCG administration (a late WDS) predicts a favorable IVF outcome.

Velocity of endometrial wavelike activity in spontaneous cycles.

OBJECTIVE To analyze the velocity and wave intervals of endometrial wavelike activity in spontaneous menstrual cycles. DESIGN Prospective observational ultrasound (US) evaluation of endometrial wavelike activity. SETTING University hospital. MAIN OUTCOME MEASURE(S) Endometrial wavelike activity, wave velocity, wave intervals. PATIENT(S) Twenty-three menstrual cycles were evaluated by frequent US investigations in 16 healthy, regularly cycling female volunteers. INTERVENTION(S) Transvaginal US examination of endometrial wavelike activity. RESULT(S) Nineteen cycles proved to be ovulatory. Wave velocity and wave intervals were calculated in waves from fundus to cervix and in waves from cervix to fundus. The velocity of waves from fundus to cervix increased from the midfollicular phase to the late follicular phase. Waves from cervix to fundus showed their highest velocity in the periovulatory period. CONCLUSION(S) Velocity of endometrial wavelike activity reached a peak in the periovulatory phase, whereas the wave intervals were shortest in that phase.

Endometrial wavelike activity, endometrial thickness, and ultrasound texture in controlled ovarian hyperstimulation cycles

OBJECTIVE To describe endometrial wavelike activity, endometrial thickness, and texture in controlled ovarian hyperstimulation (COH) cycles. DESIGN Prospective observational ultrasound study. SETTING University hospital-based infertility clinic. PATIENT(S) Thirty-five COH cycles in 19 women with unexplained infertility. INTERVENTION(S) Transvaginal ultrasound examination was performed throughout COH cycles. Intrauterine insemination was performed after hCG administration. MAIN OUTCOME MEASURE(S) Endometrial wavelike activity, wave frequency, wave velocity, endometrial thickness, and endometrial texture. RESULT(S) Endometrial wavelike activity increased from menstruation to ovulation and decreased in the luteal phase. On day hCG+2, endometrial wave-like activity was observed in all cycles. Waves from cervix to fundus prevailed in the periovulatory phase. Endometrial wavelike activity was related significantly to endometrial thickness at the start of ovarian stimulation and in the luteal phase. Endometrial thickness increased throughout the cycle. Endometrial texture showed periovulatory a triple-line aspect. CONCLUSION(S) In COH cycles, endometrial wavelike activity is more pronounced than in spontaneous cycles. The number of follicles and endometrial wavelike activity were not correlated significantly. This is the first prospective study to provide longitudinal observational evidence that endometrial thickness increases throughout the COH cycle and that a triple line pattern develops.

Subendometrial contractions in the nonpregnant uterus: an ultrasound study

Endometrial wavelike activity was studied by ultrasound, throughout 19 ovulatory cycles in 16 healthy female volunteers. Analysis was focused on the presence of endometrial activity and the wave types. Five activity patterns were distinguished, which varied throughout the cycle. Endometrial activity was most striking during the periovulatory phase.

Intrauterine manipulation does not adversely influence the direction and frequency of endometrial waves

OBJECTIVE To investigate whether intrauterine manipulation affects the direction or alters the frequency of endometrial wavelike activity. DESIGN Prospective observational study. SETTING University hospital-based fertility clinic. PATIENT(S) Thirty-six patients undergoing intrauterine insemination (IUI). INTERVENTION(S) Ultrasound observation before and after IUI. MAIN OUTCOME MEASURE(S) Endometrial wave type and endometrial wave frequency before and after IUI. RESULT(S) There was no difference in the direction and frequency of endometrial waves before and after IUI in 36 patients. CONCLUSION(S) Although the induction of uterine contractions by intrauterine manipulation has been suggested in the literature, the present study shows no contractions or induction of unfavorable (fundus to cervix) endometrial wavelike activity in 36 patients undergoing IUI.