4. EL PERIODO DE OPERACIONES FORMALES
4.1. EL PENSAMIENTO FORMAL.
Two hundred patients, consisting of 100 infertile women whose cause of infertility is outside the hypothalamic pituitary ovarian axis and are spontaneously menstruating (group A) and another 100 infertile women that are on ovarian stimulating drug (group B) met the set criteria and were seen during the course of this study. The mean age for both groups is 33.9(21-47± 4.9) years. Table 1 shows the age distribution. 4.5% of the patients (n=9) were 20-25 years, 24.5% (n=49) were in the age 26-31years, 46.5% (n=93) in the 32-37years, 23.5% (n=47)in the 38-43years and 1%(n=2) were in the age 44-49 years. Figure 11 is a graphical representation of the above distribution.
Table 2 shows age and the mean dominant follicular diameter distribution obtained by TA and TV sonographic technique for unstimulated and stimulated groups. There is no significant difference in the mean dominant follicle diameter obtained with TA and TV technique in both study groups (p-value is
> 0.05) and the mean dominant follicle diameter obtained with both technique in the unstimulated group is consistently less than what was obtained in the stimulated group and the mean dominant follicle diameter also decreased with each decade from the <25years group in the unstimulated and the stimulated groups. Subjects age above 45years had the lowest mean follicle diameter in both study groups. There was no statistical significance to this result since P-value is >0.05.
Table 1: Age frequency distribution for the study
Figure 11: Doughnut chart showing age frequency and percentage distribution for the study.
9
49
93 47
2 4.50%
24.50%
46.50%
23.50%
1%
20-25years 26-31years 32-37years 38-43years 44-49years
Age Frequency Percentage Cum Percentage
20-25 9 4.5% 4.5%
26-31 49 24.5% 29%
32-37 93 46.5% 75.5%
38-43
44-49 47
2
23.5%
1%
99%
100%
Total 200 100% 100%
Table 2: Age and mean dominant follicular size (mm) distribution for each sonographic technique within each study group.
TA: Transabdominal, TV: Transvaginal SD: Standard deviation, P: P-value, X2: Chi square Unstimulated Stimulated
TA TV TA TV AGE(yrs)
<25 26-35 36-45
>45
Mean 14.55 13.30 12.93 6.7
SD(±) 2.78 3.94 3.78 4.73
Mean 14.60 13.07 12.76 8.7
SD(±) X2 P Mean 4.00 0.12 0.7335 19.38 3.84 0.16 0.6859 18.40
3.86 0.16 0.6859 18.63 4.70 0.1 0.9257 _
SD(±) 4.39 4.12 4.16 _
Mean 19.32 18.66 18.37 _
SD(±) 3.78 3.82 3.56 _
X2
0.15 0.15 0.15 _
P 0.6972 0.6958 0.6972 _
Table 3 shows age and the mean endometrial thickness obtained by TA and TV sonographic technique for unstimulatd and stimulated groups. There is no significant difference in the mean endometrial thickness obtained with TA and TV technique in both study groups(p-value is > 0.05) and the mean endometrial thickness obtained with both technique in the unstimulated group is consistently less than what was obtained in the stimulated group, this is however not statistically significant (p-value is >0.05) and the mean endometrial thickness also decreased with each decade from the <25years group in the unstimulated and the stimulated groups. Subjects age above 45years had the lowest mean endometrial thickness in both study groups.
There was no statistical significance to this result since P-value is > 0.05.
Table 4 shows BMI and FIQ distribution for each sonographic technique within each study group. For both TA and TV technique in the unstimulated group, the frequency of follicles that demonstrate well defined borders decreased as BMI increased. Subjects that are within the BMI range of 18.94-25.96 were observed to have highest frequency for follicles that demonstrate a well defined follicular margin (84.0% and 71.7% for TA and TV technique respectively) while with the use of TA technique frequency of follicles' that demonstrate poorly defined borders increased as BMI increased and there are no observable follicle with poorly defined border with the use of TV technique. This result is statistically significant (p-value = 0.01).
For both TA and TV technique in the stimulated group, the frequency of follicles that demonstrate well defined borders also decreased as BMI increased. Subjects that are within the BMI range of 18.94-25.96 were observed to have highest frequency for follicles that demonstrate a well defined follicular margin (86.6.0% and 74% for TA and TV technique respectively) while with the use of TA technique frequency of follicles' that demonstrate poorly defined borders increased as BMI increased and there are no observable follicle with poorly defined border with the use of TV technique. . This result is statistically significant since P-value is < 0.05.
Table 3: shows age and ET (mm) frequency distribution for each imaging modality within each study group.
Unstimulated Stimulated
TA TV TA TV
AGE(YRs) Mean SD(±) Mean SD(±) X2 P Mean SD(±) Mean SD(±) X2 P
<25 9.43 1.69 9.50 1.47 0.39 0.5344 10.03 1.76 9.94 2.15 0.30 0.5839 26-35 8.57 1.70 8.89 1.42 0.01 0.9289 8.95 1.86 9.15 2.01 0.31 0.5804 36-45 8.55 1.66 8.68 1.35 0.01 0.9289 8.71 1.82 8.78 1.37 0.1 0.5375
>45 6.5 1.82 6.9 1.46 0.32 0.5707 7.00 1.26 6.00 1.07 0.44 0.5094
ET: Endometrial thickness, TA: Transabdominal, TV: Transvaginal SD: Standard deviation, P: P-value, X2 : Chi square
Table 4: BMI and FIQ distribution for each sonographic technique within each study group
UNSTIMULATED STIMULATED
TA TV TA TV
BMI(kg/m2) WD(%) PD(%) WD(%) PD(%) WD% PD(%) WD(%) PD(%) 18-25 42(84) 18(36.0) 75(75) 0(0.0) 58(86.6) 16(48.5) 74(74) 0(0.0) 26-30 8(30.8) 30(60.0) 25(25) 0(0.0) 9(13.4) 16(48.5) 25(25) 0(0.0) 31-35 0(0.0) 2(4) 0(0.0) 0(0.0) 0(0) 1(3.0) 1(1.0) 0(0.0) TOTAL 50(100) 50(100) 100(100) 0(0.0) 67(100) 33(100) 100(100) 0(0.0) Chi square 6.30 31.70
P-value 0.01 0.001
FIQ : Follicular image quality , TA : Transabdominal, TV : Transvaginal , BMI : Body mass index, WD : Well defined, PD : Poorly defined
A
B
Table 5 shows Body mass index (BMI) and endometrial image quality (EIQ) distribution for each sonographic technique within each study group. With the use of transabdominal (TA) and transvaginal (TV) technique in the stimulated and unstimulated groups, frequency of trilamilar endometrial echoe pattern decreased as BMI increased. While the frequency of uniform endometrial echoe pattern increased as BMI increased. For each BMI range, endometrium with uniform echo pattern has the highest frequency distribution with the use of TA technique compared with TV technique. While trilamilar echo pattern has the highest frequency distribution with TV technique. Subjects that are within the BMI range of 18 - 25 were observed to have highest frequency for follicles that demonstrate trilamilar echoe pattern (87.2% and 71.7% for TA and TV technique respectively) TA technique had the highest frequency (58.5%) of endometrium that demonstrate uniform echoe pattern within the BMI range of 26 - 30 while there are no observable endometrial uniform echoe pattern within the same BMI range with the use of TV technique. This result is statistically significant (p-value is < 0.05).
Table 6 shows general pattern of frequency distribution of FIQ for each sonographic technique within each study group, while figure 9 is a graphical representation of the above distribution. Follicles' that has a well defined follicular margin has the highest frequency distribution with the use of transvaginal technique in both study groups (99% respectively) compared to 53% and 40% obtained with transabdominal technique in both study groups (figure3). While follicles that has poorly defined margin has the highest frequency distribution with the use of transabdominal technique in both group (47% and 60% respectively) compared to 1% each obtained with the use of transvaginal technique in both study groups .This finding is statistically significant p- value is < 0.05.
Table 5: BMI and EIQ distribution for each sonographic technique within each study group.
UNSTIMULATED STIMULATED
TA TV TA TV
BMI TL UE TL UE TL UE TL UE 18-25 41(87.2) 20(37.7) 71(71.7) 1(100) 51(85.0) 17(42.5) 74(75.5) 0(0.0) 26-30 6(12.8) 31(58.5) 26(26.3) 0(0.0) 8(13.3) 23(57.5) 23(23.5) 2(100) 31-35 0(0.0) 2(3.8) 2(2.0) 0(0.0) 1(1.7) 0(0.0) 1(1.0) 0(0.0) TOTAL 47(100) 53(100) 99(100) 1(100) 60(100) 40(100) 98(100) 2(100)
Chi-square 37.70 P-value 0.000001
ET: Endometrial thickness, TA: Transabdominal, TV: Transvaginal,
TL: Trilaminal, UE: Uniformly echoic, BMI: Body mass index, EIQ: Endometrial image quality
Table 6: Follicular image quality by transabdominal and transvaginal sonographic technique
FIQ: Follicular image quality, TA: Transabdominal, TV: Transvaginal, WD: Well defined, PD: Poorly defined, X
2: Chi square, p : p- value.
UNSTIMULATED STIMULATED
TA TV TA TV
FIQ Freq(%) Freq(%) X2 P Freq(%) Freq(%) X2 P
WD 53(53) 99(99) 5.17 0.023 40(40) 99(99) 6.30 0.013
PD 47(47) 1(1) 7.53 0.014 60(60) 1(1) 10.40 0.001
TOTAL 100(100) 100(100) 0.1 0.9203 100(100) 100(100) 0.1 0.9203
Figure 12: Cone chart showing the frequency of well defined and poorly defined sonographic pattern for transabdominal and transvaginal technique in unstimulated and stimulated groups
Table 7 shows pattern of frequency distribution of EIQ for each imaging modality within each study group, while figure 13 is a graphical representation of the above distribution. Endometrium that demonstrate trilamilar sonographic pattern' has the highest frequency distribution with the use of transvaginal technique in both study groups (99% and 98% respectively) compared to 53%
and 40% obtained with transabdominal technique in both study groups. While endometrium that are uniformly echoic has the highest frequency distribution with the use of transabdominal technique in both group (53% and 40%
respectively) compared to 1% and 2% obtained with the use of transvaginal technique in both study groups . This finding is statistically significant (p <
0.05).
Table 8 and 9 shows the general overview of the mean dominant follicular diameter and endometrial thickness for transabdominal and transvaginal sonographic technique in unstimulated and stimulated groups. There is no statistical significant difference in the mean values obtained with each sonographic technique (p > 0.05).
Table 7: Endometrial image quality by transabdominal and transvaginal sonographic technique
UNSTIMULATED STIMULATED
TA TV TA TV
EIQ Freq(%) Freq(%) X2 P Freq(%) Freq(%) X2 P
TL 47(47) 99(99) 6.5 0.012 60(60) 98(98) 5.31 0.024
UE 53(53) 1(1) 8.23 0.002 40(40) 2(2) 7.68 0.0024
TOTAL 100(100) 100(100) 0.1 0.9203 100(100) 100(100) 0.1 0.9203
EIQ : Endometrial image quality , TA : Transabdominal, TV : Transvaginal, TL:
Trilamilar, UE : Uniformly echoeic , X2 : Chi square , P : P-value
Figure 13: Bar chart showing the frequency of trilamilar (TL) and uniformly echoic (UE) sonographic patterns for transabdominal and transvaginal technique in unstimulated and stimulated groups.
Table 8: Mean distribution of transabdominal (TA) and transvaginal (TV) dominant follicular diameter (LFD) measurements within each study group.
STUDY GROUP MEAN LFD ± SD(MM) X2 P-value
TA TV
UNSTIMULATED 13.16 ± 3.74 12.93 ± 3.76 0.16 0.6859
STIMULATED 18.30 ± 4.14 18.57 ± 3.54 0.15 0.7484
B
Table 9: Mean distribution of transabdominal (TA) and transvaginal (TV) endometrial thickness (ET) measurements within each study group
STUDY GROUP MEAN ET± SD(MM) X2 P-value TA TV
UNSTIMULATED 8.58 ± 1.71 8.80 ± 1.34 0.01 0.9289 STIMULATED 8.95 ± 1.82 9.04 ± 1.37 0.31 0.9289
Linear regression and correlation analysis of leading follicular size and endometrial thickness shows that there is positive relationship between leading follicule diameter and endometrial thickness measured with transabdominal and transvaginal sonographic techniques in both stimulated and unstimulated study groups. Figure 14 and 15 are line graphs showing a linear correlation between transabdominal and transvaginal leading follicular size and endometrial thickness in both study groups respectively.
Figure 14: Line diagram showing a linear correlation between leading follicle diameter (LFD) and endometrial thickness (ET) measurements from transabdominal (TA) and transvaginal (TV) sonographic techniques in unstimulated group. (R2 = 0.432, r = 0.656).
Figure 15: Line diagram showing a linear correlation between leading follicule diameter (LFD) and endometrial thickness (ET) measurements from transabdominal (TA) and transvaginal (TV) sonographic techniques in stimulated group. (R2 = 0.432, r = 0.656)