Application of Transvaginal Three-Dimensional Ultrasound in Assessing Endometrial Receptivity in Patients with Ovulation Disorder Infertility and the Impact on Subendometrial Vascular Index (VI) and Vascular Flow Index (VFI) Level

Abstract

Objective: To analyze the diagnostic value of transvaginal three-dimensional ultrasound (3D-TVS) in evaluating endometrial receptivity (ER) for ovulation disorder infertility (ODI), and to investigate the impact of subendometrial endometrial vascular index (VI) and endometrial vascular flow index (VFI) levels on ODI. Methods: A total of 110 patients diagnosed with ODI admitted between January 2023 and June 2024 were selected. All patients underwent ovulation induction therapy, 3D-TVS examination, and sex hormone testing. Based on pregnancy outcomes, patients were divided into a successful pregnancy group (73 cases) and an unsuccessful pregnancy group (37 cases). ER parameters, sex hormone levels, and endometrial blood flow patterns were compared between the two groups. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of ER for ODI. Results: The spiral artery peak systolic velocity (PSV), endometrial volume (EMV), endometrial flow index (FI), and VFI in the successful pregnancy group were significantly higher than those in the unsuccessful pregnancy group (p < 0.05). No significant differences were observed in other ER parameters between the two groups (p > 0.05). There was no significant difference in sex hormone levels between the two groups on the day of human chorionic gonadotropin (hCG) treatment (p > 0.05). Among the endometrial blood flow classifications in the pregnant group, the proportion of Type II was lower than that in the non-pregnant group (p < 0.05). The Receiver Operating Characteristic (ROC) curve demonstrated that the area under the curve (AUC) for Endometrial Volume (EMV) in predicting pregnancy after Ovarian Dysfunction Infertility (ODI) treatment was 0.854, with a sensitivity of 92.61% and a specificity of 71.75%. The AUC for Vascularization Index (VI) was 0.771, with a sensitivity of 52.18% and a specificity of 88.70%. The AUC for Vascularization Flow Index (VFI) of the endometrium was 0.887, with a sensitivity of 80.01% and a specificity of 69.20%. Conclusion: Three-dimensional transvaginal sonography (3D-TVS) assessment of endometrial receptivity (ER) can effectively detect ODI, and the levels of subendometrial VI and VFI demonstrate superior predictive performance for pregnancy outcomes in this condition, serving as commonly used predictive indicators for the disease.