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

Objectives: 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.

Methods: 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.

Results: 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).

Conclusions: 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.