The Role of Low-Intensity Pulsed Ultrasound in Enhancing Endometrial Receptivity for Implantation in Infertile Women: A Randomized Controlled Trial

Hutham Tariq Al-Yaseen; Marwah Sadiq Mustafa

doi:10.54133/ajms.v10i1.2510

المؤلفون

Hutham Tariq Al-Yaseen College of Medicine, University of Basrah, Basrah, Iraq
Marwah Sadiq Mustafa Al-Zahraa College of Medicine, University of Basrah, Basrah, Iraq https://orcid.org/0000-0002-2957-6447

DOI:

https://doi.org/10.54133/ajms.v10i1.2510

الكلمات المفتاحية:

Endometrial receptivity، Endometrial thickness، Infertile women، IVF، LIPUS

الملخص

Background: Endometrial receptivity is a crucial factor for embryo implantation, and its deficiency is a major contributor to infertility and failure of in vitro fertilization (IVF). Low-Intensity Pulsed Ultrasound (LIPUS) has emerged as a promising non-invasive treatment for improving endometrial receptivity, with interest due to its affordability and minimal side effects. Objective: To assess the efficacy of LIPUS in enhancing endometrial receptivity for embryo implantation in infertile women with thin endometria. Methods: The study included sixty infertile women undergoing IVF treatment. The participants were randomly assigned to receive either LIPUS or traditional estrogen therapy (4 mg/day orally) for 14 days. The study assessed changes in endometrial thickness, blood flow, implantation, and pregnancy rates following treatment as indicators of endometrial receptivity. Results: LIPUS treatment significantly improved endometrial thickness (6.1-9.5mm), compared to a lesser increase in the estrogen group (6.2- 8.6mm, p=0.02). Doppler ultrasound parameters, including peak systolic velocity (PSV) and end-diastolic velocity (EDV), also displayed significant improvements in the LIPUS group (PSV: 36.4 vs. 31.3cm/s, p=0.01; EDV: 13.5 vs. 11.5cm/s). Although implantation and pregnancy rates were higher in the LIPUS group (60% vs. 40% and 53.3% vs. 33.3%, respectively), the differences were statistically insignificant. Conclusions: LIPUS may provide a feasible non-invasive alternative approach to traditional estrogen therapy for enhancing endometrial receptivity in IVF patients, potentially improving implantation and pregnancy outcomes, although further studies with larger sample sizes are required.

التنزيلات

بيانات التنزيل غير متوفرة بعد.

المراجع

Obidniak D, Gzgzyan A, Niauri D, Kogan I. Randomized controlled trial evaluating efficacy of autologous platelet-rich plasma therapy for patients with recurrent implantation failure in frozen-thawed embryo transfer after PGT-A. Fertil Reprod. 2023;05(04):353–353. doi: 10.1142/s2661318223741589. DOI: https://doi.org/10.1142/S2661318223741589

Tej P, More A, Kalbande A, Nair N. Impact of hysteroscopic instillation of autologous platelet-rich plasma on pregnancy outcomes in patient with recurrent implantation failure: A case report. Cureus. 2024;16(9):1–6. doi: 10.7759/cureus.68449. DOI: https://doi.org/10.7759/cureus.68449

Kim MK, Song H, Lyu SW, Lee WS. Platelet-rich plasma treatment in patients with refractory thin endometrium and recurrent implantation failure: A comprehensive review. Clin Exp Reprod Med. 2022;49(3):168–174. doi: 10.5653/cerm.2022.05407. DOI: https://doi.org/10.5653/cerm.2022.05407

Sharara FI, Lelea LL, Rahman S, Klebanoff JS, Moawad GN. A narrative review of platelet-rich plasma (PRP) in reproductive medicine. J Assist Reprod Genet. 2021;38(5):1003–1012. doi: 10.1007/s10815-021-02146-9. DOI: https://doi.org/10.1007/s10815-021-02146-9

Nandita P, Hrishikesh P, Rohan P, Jiteeka T, Krutika K, Srinivas C, et al. P-305 Enhancing endometrial thickness and implantation rates: a study on the effectiveness of autologous blood cell derivative- endosera in infertile women with thin endometrium. Hum Reprod. 2024;39(1):33–34. doi: 10.1093/humrep/deae108.275. DOI: https://doi.org/10.1093/humrep/deae108.275

Long L, Zhou L, Zhu J, He X. The effect of low intensity pulsed ultrasound on endometrial receptivity in infertile patients with adenomyosis. Res Sq. 2022;2022:1–20. doi: 10.21203/rs.3.rs-1197813/v1. DOI: https://doi.org/10.21203/rs.3.rs-1197813/v1

Berber R, Aziz S, Simkins J, Lin SS, Mangwani J. Low intensity pulsed ultrasound therapy (LIPUS): A review of evidence and potential applications in diabetics. J Clin Orthop Trauma. 2020;11(4):S500–505. doi: 10.1016/j.jcot.2020.03.009. DOI: https://doi.org/10.1016/j.jcot.2020.03.009

Wei Y, Guo Y. Clinical applications of low-intensity pulsed ultrasound and its underlying mechanisms in dentistry. App Sci. 2022;12(23):11898. doi: 10.3390/app122311898. DOI: https://doi.org/10.3390/app122311898

Ji X, Duan H, Wang S, Chang Y. Low-intensity pulsed ultrasound in obstetrics and gynecology: advances in clinical application and research progress. Front Endocrinol. 2023;14:1–8. doi: 10.3389/fendo.2023.1233187. DOI: https://doi.org/10.3389/fendo.2023.1233187

Xu M, Wang L, Wu S, Dong Y, Chen X, Wang S, et al. Review on experimental study and clinical application of low- intensity pulsed ultrasound in inflammation. Quant Imaging Med Surg. 2021;11(1):443–462. doi: 10.21037/qims-20-680. DOI: https://doi.org/10.21037/qims-20-680

Lue T, Tan Y, Guo Y, Reed-Maldonado A, Li Z, Lin G, et al. Low-intensity pulsed ultrasound stimulates proliferation of stem/progenitor cells: what we need to know to translate basic science research into clinical applications. Asian J Androl. 2021;23(6):602–610. doi: 10.4103/aja.aja_25_21. DOI: https://doi.org/10.4103/aja.aja_25_21

Penzias A, Azziz R, Bendikson K, Cedars M, Falcone T, Hansen K, et al. Fertility evaluation of infertile women: a committee opinion. Fertil Ssteril. 2021;116(5):1255-1265.‏ doi: 10.1016/j.fertnstert.2021.08.038. DOI: https://doi.org/10.1016/j.fertnstert.2021.08.038

Guschina M, Zhumanova E, Korchazhkina N, Kolgaeva D. Efficacy of pulsed magnetic therapy, high-intensity magnetic stimulation of the pelvic floor muscles and intrauterine plasma therapy to restore endometrial receptivity after intrauterine interventions: a randomized trial-Reference. Glob Authori. 2024;1(1):1-7. DOI: https://doi.org/10.33920/med-14-2401-01

Ibrahim NA, Abdulhameed WA, Abood MS. Effect of vaginal sildenafil on endometrial receptivity and pregnancy outcome in IUI cycles. Dele J. 2021;24(02). doi: 10.36295/asro.2021.24409. DOI: https://doi.org/10.36295/ASRO.2021.24409

Mohammed BQ, Hussaini HA, Abdulhameed WA. The effect of aspirin and sildenafil on endometrial thickness, oocyte characteristic, embryo quality and pregnancy test in Iraqi infertile women undergoing intracytoplasmic sperm injection. Iraqi J of Embryos and Infertil Res. 2022;12(2):40–61. doi: 10.28969/ijeir.v12.i2.r4.22. DOI: https://doi.org/10.28969/IJEIR.v12.i2.r4.22

Bosch E, Broer S, Griesinger G, Grynberg M, Humaidan P, Kolibianakis E, et al. ESHRE guideline: ovarian stimulation for IVF/ICSI†. Hum Reprod Open. 2020;2020(2):hoaa009. doi: 10.1093/hropen/hoaa009. DOI: https://doi.org/10.1093/hropen/hoaa009

Wang L, Lv S, Mao W, Pei M, Yang X. Assessment of endometrial receptivity during implantation window in women with unexplained infertility. Gynecol Endocrinol. 2020;36(10):917–921. doi: 10.1080/09513590.2020.1727433. DOI: https://doi.org/10.1080/09513590.2020.1727433

Choi YJ, Lee HK, Kim SK. Doppler ultrasound investigation of female infertility. Obstet Gynecol Sci. 2023;66(2):58–68. doi: 10.5468/ogs.22131. DOI: https://doi.org/10.5468/ogs.22131

Farooq SY, Zulfiqar N, Zulfiqar M, Gilani SA, Fatima Z, Hanif A, et al. Use of uterine and ovarian arteries doppler parameters for the prediction of infertility in females. Middle East J Fam Med. 2023;21(5):60–65. doi: 10.5742/MEWFM.2023.95256113. DOI: https://doi.org/10.5742/MEWFM.2023.95256113

Arora A, Goel JK, Goel R, Arya SB, Prajapati N. Ultrasonography and doppler study to predict uterine receptivity in infertile patients undergoing embryo transfer and its correlation with pregnancy rate. J SAFOG. 2021;13(3):142–146. doi: 10.5005/jp-journals-10006-1897. DOI: https://doi.org/10.5005/jp-journals-10006-1897

Smart AE, Obajimi GO, Adekanmi AJ, Obajimi MO. A comparative study of uterine artery doppler parameters and endometrial characteristics in women with unexplained infertility and fertile women at a Nigerian teaching hospital. West Afr J Med. 2022;39(5):451–458. doi: 10.55891/wajm.v39i5.104. DOI: https://doi.org/10.55891/wajm.v39i5.104

Mahmoud M, Taha A, Abd El-Fattah A, Abd El-Azeim M. Transvaginal doppler assessment of ovarian and endometrial blood flow during ovulation. Al-Azhar Med J. 2022;51(3):1495–1510. doi: 10.21608/amj.2022.240678. DOI: https://doi.org/10.21608/amj.2022.240678

Xiong L, Cheng W, Wang Z, Shi Q. Pregnancy outcomes of adenomyotic patients with primary infertility after high-intensity focused ultrasound treatment. Inter J Hyperth. 2023;40(1). doi: 10.1080/02656736.2023.2264547. DOI: https://doi.org/10.1080/02656736.2023.2264547

Tang H, Liu Y, Fan Y, Li C. Therapeutic effects of low-intensity pulsed ultrasound on premature ovarian insufficiency. Ultrasound Med Biol. 2021;47(8):2377–2387. doi: 10.1016/j.ultrasmedbio.2021.04.022. DOI: https://doi.org/10.1016/j.ultrasmedbio.2021.04.022

Hung TH, Liu Y, Wu CH, Chen CC, Chao H, Yang F, et al. Antenatal low‐intensity pulsed ultrasound reduces neurobehavioral deficits and brain injury following dexamethasone‐induced intrauterine growth restriction. Brain Pathol. 2021;31(6). doi: 10.1111/bpa.12968. DOI: https://doi.org/10.1111/bpa.12968

Qin J, Chen J, Xu H, Xia Y, Tang W, Wang W, et al. Low-intensity pulsed ultrasound promotes repair of 4-vinylcyclohexene diepoxide-induced premature ovarian insufficiency in SD rats. J Gerontol Ser A. 2021;77(2):221–227. doi: 10.1093/gerona/glab242. DOI: https://doi.org/10.1093/gerona/glab242

Gao QQ, Wang J, Li DS, Dai YT, Li ZR, Zhao XZ. Efficacy and safety of low-intensity pulsed ultrasound (LIPUS) combined with tadalafil in the treatment of severe erectile dysfunction: a retrospective cohort study. Trans Androl Urol. 2024;13(9):2045–254. doi: 10.21037/tau-24-154. DOI: https://doi.org/10.21037/tau-24-154