Objective To explore the value of transvaginal three-dimensional power Doppler imaging (3D-PDI) combined with two-dimensional real-time shear wave elastography (2D-SWE) in evaluating endometrial receptivity (ER) and predicting conception outcomes in planning pregnancy women. Methods A total of 87 planning pregnancy women undergoing follicular test in the hospital were enrolled between January 2020 and march 2022. All underwent 3D-PDI and 2D-SWE

and were tested for reproductive hormone on the 7th-8th day after ovulation (implantation window period). All were followed up for 3 month. According to conception outcomes

they were divided into conception group (31 cases) and non-conception group (56 cases). The levels of serum estradiol (E2)

testosterone (T)

progesterone (P)

luteinizing hormone (LH) and follicle stimulating hormone (FSH) during implantation window period

endometrial thickness

volume

types of endometrial echoes

classifications of endometrial blood flow

spiral artery pulsatility index (PI)

resistance index (RI)

peak systolic velocity/end-diastolic velocity (S/D)

vascularization index (VI)

flow index (FI)

vascularization flow index (VFI) and elasticity modulus during proliferation period were compared between the two groups. The predictive value of transvaginal 3D-PDI combined with 2D-SWE quantitative parameters for conception outcomes was analyzed by receiver operating characteristic (ROC) curves. Results There was no significant difference in age

BMI

reproductive history

planning pregnancy time

E2

P

T

LH or FSH between the two groups (P>0.05). The endometrial thickness in conception group was significantly thicker than that in non-conception group (P<0.05). There was no significant difference in uterine volume

types of endometrial echoes or classifications of endometrial blood flow between the two groups (P>0.05). S/D and elasticity modulus during proliferation period in conception group were significantly lower than those in non-conception group

while FI was significantly higher than that in non-conception group (P<0.05). There was no significant difference in PI

RI

VI or VFI between the two groups (P>0.05). ROC curves analysis showed that area under ROC curve (AUC) values of endometrial thickness

S/D

FI

elasticity modulus during proliferation period and combined detection for predicting conception outcomes were 0.789

0.851

0.853

0.840 and 0.895

respectively (P<0.05). Conclusion Transvaginal 3D-PDI combined with 2D-SWE quantitative parameters can evaluate ER in planning pregnancy women objectively and comprehensively

which can be applied to predict conception outcomes in clinical practice.