Elastography Assessment of The Endometrial Changes During the Menstrual Cycle of Fertility Treatment

Introduction

Sonoelastography is an ultrasound technique that measures stiffness of tissue, during real time ultrasound examination, and is represented by color changing ranging from black (representing stiff tissue) to red (representing elastic tissue). We studied how endometrial biochemical changes throughout the cycle are reflected by this method.

Aim

_{To explore the feasibility of sonoelastography in evaluating the endometrium throughout the menstrual cycle.}

Materials and methods

Women treated in our fertility clinic underwent three elastographic examinations throughout the cycle: early follicular, midcycle, and midlutheal phases. Elastographic results were correlated to hormonal levels and pregnancy tests. Our ultrasound technicians described the dominant color viewed in the endometrium during examination. We translated the dominant color to a numerical value on a scale from 1-4. Statistical analysis was done by the Mann-Whitney and Friedman tests.

Results

Significant changes were found in elastographic results throughout the menstrual cycle. Early follicular phase demonstrated a solid and firm endometrium. As the cycle progressed we got elastographic results that reflected softer elastic tissue, and with a greater liquid component (P<0.001). Midcycle examinations that were preovulatory showed a softer endometrium than midcycle examinations that were actually still in the follicular phase, which demonstrated a firm and solid endometrium (P=0.003).

Cycles which resulted in pregnancy demonstrated a softer and liquid rich endometrium, compared with cycles which did not (P=0.042)

Conclusions

The elastograhic examination reflects the endometrial biochemical changes throughout the menstrual cycle. The examination demonstrates the preovulatory phase in the endometrium, and may help in predicting fertility treatment outcome.