Specialized ultrasound screening can be key to predicting implantation odds

 

 

Each year, hundreds of couples undergoing various IVF protocols face the same, seemingly inexplicable heartbreak: Despite cycles that seem perfect and great-looking embryos, they fail to get pregnant.

Michael Applebaum, M.D., director of ultrasonography and associate director of reproductive medicine at the Finch University of Health Sciences/The Chicago Medical School and a radiologist in private practice, has developed an ultrasound screening process that is extremely accurate in predicting when implantation will fail.

"The significance of this," explains Applebaum, "is that couples can choose not to proceed with a transfer of precious embryos when it is clear that the endometrium (lining of the uterus) is unlikely to support a pregnancy. They can freeze those embryos and wait to attempt transfer until a cycle when they have a greater chance of success."

Applebaum's technique involves evaluating blood flow to the endometrium during mid-cycle, and may be performed prior to aspiration, insemination or transfer. Using spectral and color Doppler equipment, he evaluates four "Zones," or endometrial layers. If blood flow into Zone 3, as he calls it, is not visualized at the time of the ultrasound exam, then implantation is unlikely. "I would say this technique appears close to 100 percent predictive of failure," says Applebaum, who has been performing these studies for more than five years. "In my experience, I've never seen a uterine pregnancy without these specific levels of endometrial blood flow."

Applebaum's work was confirmed by Dr. Stuart Campbell's group at King's College in London. Campbell led studies that evaluated endometrial factors that might have contributed to implantation failure in IVF cycles. According to Campbell's study, the only parameter that could consistently predictive of failure was endometrial blood flow.

In addition to examining the endometrium, Dr. Applebaum fully evaluates the ovaries to ensure that they are synchronized with endometrial preparedness.

Applebaum's screening process takes up to one hour. "The reason many sonologists (M.D.s) and sonographers (technicians) don't develop the skills to evaluate the endometrium for implantation readiness is that it is so time consuming," Applebaum says. "While the screens can be performed by a trained person with standard ultrasound equipment that is properly configured for this purpose, it is a very time consuming process."

Ultimately, performing these scans becomes an art. "The ability to recognize reality on an ultrasound image becomes an intuitive process gained through experience," he says.

If and when more radiologists become familiar with this screening process, couples will have more options and greater chances for success.

"When there's evidence that implantation will fail, IVF protocols can be changed prior to transfer," says Applebaum. "Steps can be taken to improve the endometrium for a future cycle, and couples go on to achieve success despite many previous losses or failures.