Comparison of two ultrasound-based scoring systems for predicting pregnancy outcomes in IVF-embryo transfer patients

Abstract Objective Endometrial receptivity is a critical determinant of embryo implantation and successful pregnancy in in vitro fertilization–embryo transfer (IVF-ET). Although ultrasound-based scoring systems have been proposed to improve its assessment, their predictive performance remains unclear. This study aimed to evaluate the diagnostic value of the Applebaum scoring system and its modified version in predicting clinical pregnancy outcomes. Methods This retrospective study included 341 patients undergoing IVF-ET. Transvaginal ultrasound was performed on the day of embryo transfer, and endometrial receptivity was assessed using the Applebaum scoring system (A) and a modified version (B). Clinical pregnancy, defined as the presence of a gestational sac with fetal cardiac activity, was evaluated 35 days after embryo transfer. Receiver operating characteristic (ROC) curve analysis was used to assess predictive performance. Results No statistically significant differences were observed in scores between the pregnancy and non-pregnancy groups for either scoring system ( P > 0.05). ROC analysis demonstrated poor discriminatory performance, with area under the curve (AUC) values of 0.54 (95% CI: 0.47–0.60) for system A and 0.56 (95% CI: 0.50–0.63) for system B. Conclusions Both scoring systems showed poor predictive performance, with AUC values close to 0.5. These findings suggest limited clinical utility, and ultrasound-based scoring systems should not be used as standalone predictors of IVF outcomes.