167 Now that we are able to suggest normal preliminary reference values for uterine peristalsis in a normal menstrual cycle, it is possible to better assess how and if uterine contractile activity is abnormal in different populations. Previous work by this research group has assessed uterine peristalsis in IVF patients, which showed great promise with regards to prediction of IVF treatment success (226). Future works will be able to compare how uterine contractions differ between fertile and infertile populations, also relative to the preliminary reference values in a normal menstrual cycle presented here, potentially identifying treatment target points, and perhaps uncovering a new facet of infertility aetiological mechanisms. Although this study focused on healthy women with normal uteri, uterine peristalsis assessment and characterisation can also represent a valuable diagnostic tool in the context of common pathological conditions of the uterus, such as adenomyosis, endometriosis or uterine fibroids. The effect of these conditions on uterine function (and disease symptoms such as dysmenorrhoea and infertility) may in fact be reflected in altered uterine peristalsis patterns, such as coordination. Dedicated clinical trials can be designed to investigate the potential of the proposed features for the diagnosis of uterine diseases and dysfunctions. Differences in uterine contractions could be an explanatory factor for the symptomatology in certain uterine disorders, and thereby become a target for patient-tailored treatment. In summary, we suggest preliminary reference values of uterine contraction features in healthy women during the natural menstrual cycle. Our study serves as a standard to which uterine peristalsis in infertile women or women with abnormal uteri can be compared, potentially identifying treatment targets and aetiological mechanisms yet unexplored. Furthermore, we hereby present novel uterine contraction features which can be used to assess the presence (or absence) of normal uterine contractility, namely coordination, direction, and velocity. Funding: Unrestricted grant GE Healthcare Austria
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