Elastography in Reproductive Medicine, a Game-Changer for Diagnosing Polycystic Ovary Syndrome, Predicting Intrauterine Insemination Success, and Enhancing In Vitro Fertilization Outcomes: A Systematic Review

Abstract

Background: Elastography is an ultrasound-based imaging technology that allows for quantitative measurement of tissue stiffness and elasticity. In reproductive medicine, it is a potential non-invasive method for assessing ovarian activity, uterine contractility, and endometrial receptivity. While conventional ultrasound provides anatomical and vascular information, it does not assess biomechanical properties, which are important for understanding polycystic ovary syndrome (PCOS), predicting intrauterine insemination (IUI) success, and determining endometrial receptivity in in vitro fertilization (IVF). Methods: A systematic review was conducted in accordance with the PRISMA principles, and the protocol was recorded in PROSPERO. A comprehensive literature search was conducted across several databases to uncover studies that used real-time elastography (RTE) or shear wave elastography (SWE) for PCOS diagnosis, IUI result prediction, or endometrial receptivity evaluation in IVF. The risk of bias was assessed using the ROBINS-I technique. Results: Four studies fulfilled the inclusion criteria. One study indicated that PCOS patients had considerably increased ovarian stiffness, which supports elastography as a diagnostic marker. Another study found that increased uterine flexibility and decreased contractility were related with better IUI outcomes. A retrospective cohort research discovered that non-uniform endometrial echogenicity had no influence on IVF results. Furthermore, SWE successfully evaluated endometrial receptivity in unexplained infertility, with higher stiffness being related to reduced implantation potential. Conclusions: Elastography gives real-time, quantitative insights into reproductive biomechanics, with potential applications in infertility diagnosis and ART improvement. However, the absence of defined imaging procedures and confirmed clinical criteria prevent its broad use. More large-scale prospective investigations are required to improve elastographic parameters and define diagnostic cutoffs for clinical use. © 2025 by the authors