Original Research Paper
STUDY OF ROLE OF COLOR FLOW PULSED DOPPLER AND ENDOMETRIAL BIOPSY FOR DETECTION OF LUTEAL PHASE DEFECT IN INFERTILITY AND RECURRENT SPONTANEOUS ABORTION
BACKGROUND: Infertility is defined as Inability of a couple to achieve conception following one year or more of regular, unprotected intercourse. WHO estimates that approximately 8-10% of couples experience some form of infertility. Luteal phase defect (LPD) is one of the causes of unexplained infertility and recurrent pregnancy loss. It is defined as inadequate production of progesterone by the corpus luteum resulting in insufficient maturation of endometrium. Endometrial biopsy is the gold standard for diagnosis of luteal phase defect which is based on the characteristic histologic changes resulting from the action of progesterone. Introduction of Color Doppler imaging and pulsed Doppler analysis has provided a non-invasive method of assessing the vascular and morphological changes in the ovary and the endometrium.METHODS: This prospective study included 50 women with history of infertility or history of recurrent abortions attending the Obstetrics & Gynecology OPD at PMCH. Another group of 50 women were taken as control. All the women had normal Complete Blood Count, Mantoux Test, Chest X-Ray, Hysterosalpingography, and their husbands had normal seminogram. There was no Rh incompatibility, normal TORCH titre, normal Blood sugar studies, and HIV & VDRL were negative for both partners. The patients had normal menstrual cycles and the date of their last menstrual period was known. They were not taking any medication and had not undergone any prior ovarian or adnexal surgery.RESULTS: The incidence of luteal phase defect was 32.8% in infertile population and 12% in the fertile women. When the LPD group of patients were compared with the fertile group of women, a significantly higher pulsatility index in ovarian artery was found in mid luteal and late luteal phases with p0.001.The resistance index of ovarian artery was also significantly higher in the luteal phase defect group in late follicular, mid luteal and late luteal phases with p0.001. In our study, endometrial biopsy was 60% sensitive with 56.2% positive predictive value for the diagnosis of luteal phase defect in patients with history of infertility or recurrent pregnancy losses.CONCLUSION: Although timed endometrial biopsy has been the gold standard for diagnosing luteal phase defect, introduction of color Doppler imaging and pulsed Doppler analysis, has provided a new non-invasive method for assessing the vascular and morphological changes in the ovary and endometrium implicated in luteal phase defect.
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