{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:17:57Z","timestamp":1789751877809,"version":"4.0.1"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"abstract":"\n Objectives<\/jats:title>\n Uterine artery Doppler is widely used to gauge endometrial receptivity in In Vitro Fertilization (IVF)\/Intracytoplasmic Sperm injection (ICSI), but a single pulsatility index (PI) measurement from bilateral uterine arteries at a single time point captures neither the full extent of inter\u2010side asymmetry nor the cycle\u2010to\u2010cycle variability that may better reflect a hostile peri\u2010implantation environment. We defined a Uterine Artery Doppler Disturbance index (UADD\u2010PI and UADD\u2010RI) as the coefficient of variation of bilateral pulsatility and resistance indices measured across 3 consecutive cycles and tested its association with 3\u2010D power\u2010Doppler endometrial perfusion and clinical pregnancy in a retrospective single\u2010center cohort.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively reviewed the electronic medical records of 437 consecutive first IVF\/ICSI cycles (173 fresh embryo transfer, 264 frozen embryo transfer) treated at a single tertiary reproductive medicine center between January 2023 and April 2026. As part of routine pre\u2010transfer evaluation at our center, bilateral uterine artery PI and RI were obtained on hCG\u2010trigger day (fresh) or progesterone day 5 (FET), and on the corresponding day of 2 preceding natural or stimulated cycles. UADD was calculated as 100\u2009\u00d7\u2009SD\/mean of the 6 measurements obtained from both uterine arteries across 3 consecutive cycles (2 sides\u2009\u00d7\u20093 cycles). Endometrial vascularization index (VI), flow index (FI), and vascularization\u2010flow index (VFI) were obtained by 3\u2010D power\u2010Doppler with VOCAL and retrieved from the picture\u2010archiving system. Primary outcome was clinical pregnancy; ongoing pregnancy and live birth were secondary. Multivariable logistic regression, restricted cubic splines, and 1000\u2010resample bootstrap internal validation were used.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n UADD\u2010PI was inversely correlated with VI (Spearman\n \u03c1<\/jats:italic>\n \u2009=\u2009\u22120.46), FI (\n \u03c1<\/jats:italic>\n \u2009=\u2009\u22120.28), and VFI (\n \u03c1<\/jats:italic>\n \u2009=\u2009\u22120.56; all\n p<\/jats:italic>\n \u2009<\u2009.001). Each 5\u2010percentage\u2010point increment in UADD\u2010PI was independently associated with lower clinical pregnancy (adjusted OR 0.75, 95% CI 0.64\u20130.89,\n p<\/jats:italic>\n \u2009<\u2009.001) after controlling for age, BMI, log\u2010AMH, endometrial thickness, embryo grade, cycle type, and 3\u2010D VI. Adding UADD\u2010PI to a baseline model raised the AUC from 0.657 to 0.762 (\u0394 0.105,\n p<\/jats:italic>\n \u2009<\u2009.001); calibration was acceptable (Hosmer\u2013Lemeshow\n p<\/jats:italic>\n \u2009=\u2009.349; calibration slope 0.94; Brier 0.173 versus null Brier 0.207). The dose\u2013response relationship was monotonic and statistically linear (non\u2010linearity LR\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20091.44,\n p<\/jats:italic>\n \u2009=\u2009.487).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A bilateral, cycle\u2010aggregated UADD index captures information that a single PI measurement misses and is independently associated with endometrial perfusion and pregnancy outcome. Because the analysis is retrospective and single\u2010center, these findings are hypothesis\u2010generating; UADD is best viewed as a potential complement to\u2014rather than a replacement for\u2014conventional Doppler indices and requires external prospective validation before any clinical application.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jum.70404","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:57:41Z","timestamp":1786625861000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Uterine Artery Doppler Disturbance Index Is Associated with Endometrial Perfusion and Clinical Pregnancy in\n IVF<\/scp>\n \/\n ICSI<\/scp>"],"prefix":"10.1002","author":[{"given":"Anli","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Ultrasound Dongyang People's Hospital Dongyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zehao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Dongyang People's Hospital Dongyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiqiang","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Dongyang People's Hospital Dongyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifang","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Dongyang People's Hospital Dongyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengping","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Dongyang People's Hospital Dongyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3975-8657","authenticated-orcid":false,"given":"Liyan","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Dongyang People's Hospital Dongyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/humupd\/dmy044","article-title":"Conventional and modern markers of endometrial receptivity: a systematic review and meta\u2010analysis","volume":"25","author":"Craciunas L","year":"2019","journal-title":"Hum Reprod Update"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1093\/humrep\/dex285","article-title":"Frozen embryo transfer: a review on the optimal endometrial preparation and timing","volume":"32","author":"Mackens S","year":"2017","journal-title":"Hum 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Study"],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":23,"alternative-id":["10.1002\/jum.70404"],"URL":"https:\/\/doi.org\/10.1002\/jum.70404","archive":["Portico"],"relation":{},"ISSN":["0278-4297","1550-9613"],"issn-type":[{"value":"0278-4297","type":"print"},{"value":"1550-9613","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"assertion":[{"value":"2026-06-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jum.70404"}}