Untitled

ObjectiveTo evaluate the predictive value of endometrial and uterine artery blood flow parameters, combined with clinical indicators, for embryo implantation outcomes in PCOS patients undergoing IVF-ET across different BMI categories.MethodsWe retrospectively analyzed 129 PCOS patients who underwent IVF-ET at our hospital from June 2022 to June 2025. Participants were stratified into four BMI groups. Transvaginal ultrasound parameters and clinical data were statistically analyzed.ResultsSignificant differences were observed in endometrial thickness, morphological patterns, blood flow distribution, and uterine artery blood flow parameters across different BMI groups. The obese group exhibited a tendency toward thinner endometrium, a lower proportion of type A endometrial morphology, reduced endometrial perfusion, and a higher uterine artery resistance index. Logistic regression analysis identified high endometrial blood flow grade, abundant endometrial blood flow, and a greater number of high-quality embryos as protective factors for successful embryo implantation following IVF-ET in patients with PCOS (all P<0.05). Conversely, advanced age was associated with an increased risk of implantation failure (P<0.05). ROC curve analysis demonstrated that a multivariable model incorporating endometrial blood flow grade, endometrial blood flow quantity, number of high-quality embryos, and age had strong predictive performance for implantation success (AUC = 0.917).ConclusionWeight management before assisted reproduction is clinically important. Overweight patients should monitor endometrial and uterine artery blood flow parameters and receive targeted interventions to improve pregnancy outcomes.