The Role of Endometrial and Myometrial Elastography in Predicting Pregnancy Outcomes in Frozen and Fresh ICSI Cycles

To evaluate the potential role of myometrial and endometrial ultrasonographic elastography prior to embryo transfer in predicting pregnancy and live birth outcomes in frozen and fresh intracytoplasmic sperm injection cycles.

This prospective single-center study was conducted at a tertiary university hospital between January and June 2024. A total of 111 eligible patients scheduled for embryo transfer in frozen and fresh intracytoplasmic sperm injection cycles underwent myometrial and endometrial elastography 1 h before transfer. Measurements were performed in the sagittal plane using Acoustic Radiation Force Impulse point shear wave elastography by a single operator. The anterior and posterior myometrium and endometrium were evaluated, with three measurements obtained per region and the mean value calculated.

The anterior myometrial/endometrial elastography ratio was significantly lower in patients who achieved live birth in the overall population (P = .036); in fresh embryo transfer cycles (P = .014); and in fresh cycles where two embryos were transferred (P = .004). Endometrial elastography values were significantly higher in patients with live births in fresh cycles (P = .028) and in fresh cycles where two embryos were transferred (P = .001). In frozen cycles where two embryos were transferred, anterior myometrial elastography values were also significantly lower in patients who achieved live birth (P = .030).

Endometrial and myometrial elastography measurements, particularly the anterior myometrial/endometrial elastography ratio and endometrial elastography values, may be clinically useful in predicting pregnancy outcomes. These findings suggest a potential role for elastographic evaluation in assessing endometrial receptivity prior to embryo transfer.