Association of Pre-Implantation Uterine Artery Doppler with Clinical Pregnancy in Assisted Reproductive Technology: A Systematic Review and Meta-Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection Criteria
2.3. Investigated Outcomes
2.4. Data Extraction
2.5. Quality and Risk of Bias Assessment
2.6. Data Synthesis and Statistical Analysis
2.7. Sensitivity Analyses
2.8. Subgroup Analyses
3. Results
3.1. Meta-Analyses on the Association Between Uterine Artery Doppler and Clinical Pregnancy
3.2. Subgroup Analysis Based on the Timing of the UtA Doppler Measurement
3.3. Publication Bias
4. Discussion
4.1. Primary Findings
4.2. Interpretation of the Findings
4.3. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ART | Assisted Reproductive Technology |
BMI | Body Mass Index |
CENTRAL | Cochrane Central Register of Controlled Trials |
CI | Confidence Interval |
ET | Embryo Transfer |
hCG | Human Chorionic Gonadotropin |
ICSI | Intracytoplasmic Sperm Injection |
IVF | In Vitro Fertilization |
I2 | Higgins’ I-squared heterogeneity statistic |
MD | Mean Difference |
NOS | Newcastle–Ottawa Scale |
PI | Pulsatility Index |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
PSV | Peak Systolic Velocity |
QUIPS | Quality In Prognosis Studies tool |
RI | Resistance Index |
UtA | Uterine Artery |
References
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Study, Year | Study Period | Study Type | Country | Inclusion Criteria | Exclusion Criteria | UtA Doppler Measurement | Time of the Measurements |
---|---|---|---|---|---|---|---|
Adibi et al., 2015 [25] | January 2013 to January 2014 | Prospective cohort study | Iran | Age < 40 years, infertile women with frequent abortions, regular menstrual cycle, non-polycystic ovaries at enrollment, follicle stimulating hormone (FSH) < 10 IU/L on day 3. | Tubal factor infertility, history of uterine surgery and/or apparent endometrial pathology, clinically relevant systemic diseases (diabetes, ulcerative colitis, Crohn’s disease, connective tissue diseases, hypertension). | PI, RI, PSV | Day of hCG injection |
Cacciatore et al., 1996 [26] | December 1993 to December 1994 | Prospective cohort study | Finland | Infertile patients undergoing IVF. | Not reported | PI, RI | Day of ET |
Chiang, 2000 [33] | December 1997 to December 1998 | Prospective cohort study | Taiwan | Age ≥ 40 years, normal uterine cavity, IVF–ET. | Not reported | PI | During the menstrual cycle |
Crosby et al., 2022 [17] | October 2016 to February 2018 | Prospective cohort study | Ireland | Age < 38 years, no previous pregnancy, regular menstrual cycles, no steroid hormone use within three months, normal transvaginal ultrasound. | Not reported | PI, RI | During the menstrual cycle |
Fan et al., 2023 [16] | April 2021 to September 2021 | Retrospective cohort study | China | Age < 38 years, first FET, voluntary uterine artery Doppler monitoring during the implantation window, infertility due to fallopian tube abnormality or mild oligoasthenospermia. | Preimplantation genetic testing, endometriosis or adenomyosis, polycystic ovarian syndrome, ovarian reserve decrease, ovulation disorders, uterine malformations, severe oligospermia/azoospermia/necrozoospermia, ≥2 pregnancy losses, serious medical diseases. | PI, RI, PSV | Day of ET |
Haapsamo et al., 2009 [34] | - | Randomized double-blind study | Finland | Less than four previous ovarian stimulations and no contraindications for aspirin. | Not reported | PI | Day of ET |
Hoozemans et al., 2008 [27] | March 2002 to December 2003 | Prospective cohort study | Netherlands | Age < 39 years, regular menstrual cycle, two normal (non-polycystic) ovaries, FSH < 10 IU/L on day 3. | Tubal factor infertility, history of uterine surgery/endometrial pathology, clinically relevant systemic diseases, smoking, body mass index >28 kg/m2. | PI | Day of hCG injection, day of ET |
Khan et al., 2016 [28] | June 2011 to April 2014 | Prospective cohort study | India | Age 24–43 years, infertility duration 2–20 years. | Patients with secondary infertility and patients with associated male subfertility and infertility | PI | During the menstrual cycle |
Li et al., 2024 [29] | October 2019 to September 2020 | Retrospective cohort study | China | Age < 40 years, women undergoing FET. | Chromosomal abnormalities, congenital uterine dysplasia, intrauterine adhesions, hydrosalpinx, comorbid medical diseases (hypertension, diabetes, thyroid dysfunction, liver dysfunction, thrombocytopenia), acute hemorrhagic diseases (peptic ulcer), missing cycle data | PI | Day of endometrial transformation before ET |
Salle et al., 1998 [30] | 1996 | Prospective cohort study | France | Women undergoing IVF, normal serum follicle stimulating hormone on day 3 of the cycle | Older than 38 years old | PI | During the menstrual cycle |
Zaidi et al., 1996 [31] | 1994 | Prospective cohort study | London | Infertile women undergoing IVF | Not reported | PI | Day of hCG injection |
Zollner et al., 2012 [32] | - | Prospective cohort study | Germany | Couples were included only if at least one fertilized oocyte could be transferred | Women with fibroids of the uterus or with uterine abnormalities were excluded | PI, RI, PSV | Day of ET |
Study | Study Type | S1 | S2 | S3 | S4 | C | O1 | O2 | O3 | Total |
---|---|---|---|---|---|---|---|---|---|---|
Adibi et al., 2015 [25] | Prospective cohort study | b * | a * | a * | a * | a * | b * | a * | a * | 8 |
Cacciatore et al., 1996 [26] | Prospective cohort study | b * | a * | a * | a * | - | b * | a * | a * | 7 |
Chiang, 2000 [33] | Prospective cohort study | b * | a * | a * | a * | a * | b * | a * | a * | 8 |
Crosby et al., 2022 [17] | Prospective cohort study | b * | a * | a * | a * | a * | b * | a * | a * | 8 |
Fan et al., 2023 [16] | Retrospective cohort study | b * | a * | a * | a * | a * | b * | a * | a * | 8 |
Haapsamo et al., 2009 [34] | Randomized double-blind study | b * | a * | a * | a * | - | b * | a * | a * | 7 |
Hoozemans et al., 2008 [27] | Prospective cohort study | b * | a * | a * | a * | a * | b * | a * | a * | 8 |
Khan et al., 2016 [28] | Prospective cohort study | b * | a * | a * | a * | - | b * | a * | a * | 7 |
Li et al., 2024 [29] | Retrospective cohort study | b * | a * | a * | a * | a,b ** | b * | a * | a * | 9 |
Salle et al.,1998 [30] | Prospective cohort study | b * | a * | a * | a * | a * | b * | a * | a * | 8 |
Zaidi et al., 1996 [31] | Prospective cohort study | b * | a * | a * | a * | - | b * | a * | a * | 7 |
Zollner et al., 2012 [32] | Prospective cohort study | b * | a * | a * | a * | - | b * | a * | a * | 7 |
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Siargkas, A.; Faka, A.; Kripouri, P.; Papanikolaou, E.; Stavros, S.; Domali, E.; Sioutis, D.; Christodoulaki, C.; Mamopoulos, A.; Tsakiridis, I.; et al. Association of Pre-Implantation Uterine Artery Doppler with Clinical Pregnancy in Assisted Reproductive Technology: A Systematic Review and Meta-Analysis. Medicina 2025, 61, 1004. https://doi.org/10.3390/medicina61061004
Siargkas A, Faka A, Kripouri P, Papanikolaou E, Stavros S, Domali E, Sioutis D, Christodoulaki C, Mamopoulos A, Tsakiridis I, et al. Association of Pre-Implantation Uterine Artery Doppler with Clinical Pregnancy in Assisted Reproductive Technology: A Systematic Review and Meta-Analysis. Medicina. 2025; 61(6):1004. https://doi.org/10.3390/medicina61061004
Chicago/Turabian StyleSiargkas, Antonios, Areti Faka, Panagiota Kripouri, Evangelos Papanikolaou, Sofoklis Stavros, Ekaterini Domali, Dimos Sioutis, Chrysi Christodoulaki, Apostolos Mamopoulos, Ioannis Tsakiridis, and et al. 2025. "Association of Pre-Implantation Uterine Artery Doppler with Clinical Pregnancy in Assisted Reproductive Technology: A Systematic Review and Meta-Analysis" Medicina 61, no. 6: 1004. https://doi.org/10.3390/medicina61061004
APA StyleSiargkas, A., Faka, A., Kripouri, P., Papanikolaou, E., Stavros, S., Domali, E., Sioutis, D., Christodoulaki, C., Mamopoulos, A., Tsakiridis, I., & Dagklis, T. (2025). Association of Pre-Implantation Uterine Artery Doppler with Clinical Pregnancy in Assisted Reproductive Technology: A Systematic Review and Meta-Analysis. Medicina, 61(6), 1004. https://doi.org/10.3390/medicina61061004