153 Materials and Methods: Study objectives: Evaluate uterine contraction features (frequency, amplitude, velocity, direction, and coordination) using a dedicated speckle-tracking algorithm by 2D transvaginal ultrasound measurement in healthy, women throughout the menstrual cycle. Study design & setting: Multi-centre observational prospective cohort study carried out in the outpatient gynaecology department of the Catharina Hospital in Eindhoven, the Netherlands, the University of Naples, Federico II Naples, Italy, and the Embryolab Fertility centre in Thessaloniki, Greece. Participants: Between September 2014 and January 2022, 74 healthy women were included from the gynaecological outpatient departments of the participating centres. Women were included if they were ≥18 years of age, premenopausal and had a normal, natural menstrual cycle. A normal cycle was defined as: regular (duration 28 ± 2 days), no dysmenorrhea, no menometrorrhagia. Exclusion criteria were: 1) pregnancy, 2) diagnosed with a mental disorder, 3) significant language barrier, 4) use of oral hormonal contraceptives or intrauterine device, 5) use of other (hormonal) medication affecting the uterus, or 6) uterine pathology (congenital or otherwise, e.g., leiomyomas, adenomyosis, based on (Morphological Uterine Sonographic Assessment (Morphological Uterine Sonographic Assessment, MUSA (183)) criteria. Ultrasound scans of the included women were also assessed retrospectively by experts to confirm the absence of uterine abnormalities. Seventy-four women were enrolled in the study, of which 64 ultimately underwent TVUS recording at different phases of the menstrual cycle. This resulted in a total of 96 completed TVUS recordings across cycle phases. Eighteen recordings were subsequently excluded due to insufficient ultrasound quality for the analysis. Reasons for exclusion due to recording quality included: shadow across the endometrial lining, out-of-plane motion, or insufficient resolution of the images. Additionally, recordings of eight recordings were excluded due to suspicion of uterine abnormalities, or use of hormonal contraceptive methods. Figure 6.1 presents a flow diagram of
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