Decreased endometrial vascularity in patients with antiphospholipid antibodies associated recurrent miscarriage during midluteal phase

We found a decrease in endometrial-subendometrial vascularity as shown by three-dimensional ultrasonography and power Doppler angiography in antiphospholipid antibodies–associated recurrent miscarriage patients during the peri-implantation period.


Leining Chen, M.D., Song Quan, M.D., Xiang-hong Ou, M.D., Ph.D., Lingheng Kong, M.D., Ph.D.

Volume 98, Issue 6, Pages 1495-1502.e1, December 2012



To explore uterine arterial impedance and endometrial-subendometrial vascularity determined by two-dimensional Doppler ultrasonography (2D-DU) and three-dimensional ultrasonography and power Doppler angiography (3D-PDA) between patients with antiphospholipid antibodies-associated recurrent miscarriage (aPL-RM) and normal fertile women and further to investigate the relationship between these parameters and endometrial microvessel density (MVD).


Prospective observational study.


Tertiary-care fertility center.


A total of 109 aPL-RM patients (aPL-RM group) and 49 normal fertile women (control group).


Uterine measurement by transvaginal ultrasonography and endometrial MVD in the mid-luteal phase was assessed for both groups.

Main Outcome Measure(s):

Endometrial thickness, volume and MVD, uterine arterial pulsatility index (PI) and resistance index (RI), and the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of endometrial and subendometrial regions were measured on day 7 of a natural cycle after ovulation.


Both groups had similar endometrial thickness, volume and MVD, uterine arteries PI and RI. Endometrial VI (P=.042), FI (P=.000), VFI (P=.000) and subendometrial FI (P=.000) were significantly reduced in the aPL-RM group, when compared with the control group. None of the uterine arterial 2D-DU and endometrial-subendometrial 3D-PDA parameters correlated with the endometrial MVD in both groups.


Endometrial and subendometrial vascularity was significantly impaired in aPL-RM patients during natural mid-luteal phase, when compared with normal fertile women, and endometrial MVD did not correlate with any of the acquired vascularity parameters.

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