A reduction in intraovarian arterial blood flow resistance after ovulation is necessary to achieve pregnancy in natural cycle

The reproductive endocrine feature and conception outcome of women with unknown etiological menstrual cycle (36-45 days) with long follicular phase

OBJECTIVE

To explore the reproductive endocrine feature and conception outcome of women with unknown etiological long menstrual cycle (LMC) (36-45 days) with long follicular phase.

METHODS

In the cohort study, we included 80 women with unknown etiological long menstrual cycle of biphasic basal body temperature (BBT) lasting for 36-45 days and 87 controls with normal cycle of biphasic BBT into LMC group and NMC group, respectively. Serum hormone levels, fasting glucose, and insulin of participants were tested, and ovulation was observed by ultrasound. The conception outcome was followed up within 12 menstrual cycles.

RESULTS

In the LMC group, the rate of abnormality of HOMA-insulin resistance index (40.0% vs. 20.7%, p < .01), luteal phase defect (30.9% vs. 13.8%, p < .05) and abnormality of FSH/LH ratio (15.6% vs. 5.7%, p < .05) were all significantly higher, but the serum estradiol level on the day before ovulation (261.10 pg/mL vs. 320.26 pg/mL, p < .01) was lower. The rate of poor ovulation quality (31.3% vs.15.4%, p < .05) in the LMC group was significantly higher than the NMC group. In the LMC group, the natural conception rate within 12 menstrual cycles was lower (41.9% vs. 66.2%, p < .01), whereas the spontaneous abortion rate in early pregnancy (29.0% vs. 9.8%, p < .05) and the conversion rate (21.6% vs. 5.2%, p < .01) to anovulation within 12 cycles were significantly higher.

CONCLUSIONS

Women with unknown etiological menstrual cycle (36-45 days) with long follicular phase have greater endocrine abnormality and higher risk of spontaneous abortion, infertility, and conversion to anovulation. Moderate early intervention may be advisable for these women, especially those who wish to get pregnant.

Color Doppler analysis of uterine, spiral, and intraovarian artery blood flow before and after treatment with cabergoline in hyperprolactinemic patients

Prolactin (PRL) may have stimulatory effects on vascular resistance. We aimed to analyze uterine, spiral, and intraovarian artery blood flow by Doppler ultrasonography in hyperprolactinemic patients prior to and after treatment with cabergoline. The study was conducted in Sisli Etfal Training and Research Hospital gynecology outpatient clinic between 1 March 2010 and 30 September 2011. Twenty-four women with symptomatic hyperprolactinemia in reproduction age were included in the study. All hyperprolactinemic patients were studied prior to and following the suppression of circulating PRL levels by cabergoline. Patients were examined by standard B-mod and color transvaginal ultrasonography. Pulsality index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) were recorded. The median PRL value was 86 (62-120) ng/ml before treatment and 4.0 (2.5-6.4) ng/ml after the treatment (p < 0.001). We found a significant association among PRL, uterine, spiral, and intraovarian artery RI with linear regression analysis (p < 0.001 for all three arteries). Uterine, spiral, and intraovarian artery PI (p = 0.021, p < 0.001, and p < 0.001, respectively) and RI (p = 0.001, p < 0.001, and p < 0.001, respectively) significantly decreased after cabergoline treatment. In conclusion, this is a pilot study which shows for the first time that PRL increases the uterine, endometrial, and intraovarian vascular resistance and cabergoline reverses this effect.

[Color Doppler imaging and measurements of intraovarian and intrauterine vascularization on basal ultrasound examination in spontaneous ovulatory and anovulatory cycles]

BACKGROUND/AIM

Any organs functioning directly depends on vascularization. It applies also to the uterus and ovary which go through changes of vascularization during a menstruation cycle. The aim of this investigation was to determine differences in intrauterine and ovarian stromal arterioral blood flow on basal ultrasound examination (day 2-4) between spontaneous ovulatory and anovulatory cycles.

METHODS

This prospective clinical investigation included 205 patients divided into two groups: with ovulatory and with anovulatory cycles.

RESULTS

Resistance to ovarian arterioral stromal blood flow was significantly lower in the patients with ovulatory cycles (pulsatile index--PI 0.97 +/- 0.4 vs 1.93 +/- 1.37; p = 0.001737; and (resistance index - RI 0.55 +/- 0.12 vs 0.68 +/- 0.14; p = 0.040033). There. were no statistically significant differences in arcuate arterioral blood flow in the pateints with ovulatory and anovulatory cycles (PI 1.21 +/- 0.34 vs 61 +/- 0,61 p = 0.136161 and RI 0.64 +/- 0.11 vs 0.74 +/- 0.07; p = 0.136649). The patients with ovulatory cycles had lower uterine radial arterioral blood flow than the patients with anovulatory cycles (PI 1.001 +/- 0.22 vs 1.61 +/- 0.23 p = 0.007501 and RI 0.55 +/- 0.08 vs 0.71 +/- 0.12; p = 0,0460113). The patients with ovulatory cycles had lower subendometrial arterioral blood flow resistance (PI 0.69 0.19 vs 1.385 +/- 0.09; p = 0.00622 and RI 0.44 +/- 0.09 vs 0.65 +/- 0.02; p = 0.027458).

CONCLUSION

Color Doppler ultrasuond imaging and measurements of intrauterine and ovarian stromal arterioral blood flow on basal ultrasound examination (day 2-4), showed lower resistance to blood flow in ovulatory than in anovulatory cycles.

Elevated basal FSH levels, if it is under 15 IU/L, will not reflect poor ART outcomes

PURPOSE

For this study, the impact of basal FSH levels on ART outcomes was assessed.

METHODS

From June 2003 to May 2006, 191 ART cycles were performed in our hospital. All cases were treated with GnRH-a long protocol. The patients were classified according to their basal FSH level as follows: group A: FSH <10 IU/l, group B: 10 <or= FSH <15 IU/l, and group C: 15 IU/l <or= FSH. ART outcomes were compared among the three groups.

RESULTS

The number of retrieved oocytes in group A was significantly higher than in group B, but fertilized oocytes and the pregnancy rates were comparable. The pregnancy rate in group C was not significantly lower than those found in either group A or B, but the trend was lower.

CONCLUSION

Oocytes retrieved from the patients who showed basal FSH levels below 15 IU/l were found to possess significant pregnancy potential.

Reduction of perifollicular arterial blood flow resistance after hCG administration is a good indicator of the recovery of mature oocytes in ART treatment

PURPOSE

To demonstrate our hypothesis that a correlation exists between oocyte maturity and a decrease in intraovarian blood flow resistance in assisted reproductive technology (ART) treatment cycles, oocyte maturity and total antioxidant status (TAOS) in follicular fluid was examined.

METHODS

A total of 59 cycles involving 51 infertile patients undergoing ART treatment in our hospital were recruited in this study. The ART cycles were divided into two groups: deeply decreased (DD) group and not-deeply decreased (NDD) group, according to the pulsatility index (PI) values for perifollicular arterial blood flow before and after hCG administration. The PI values that showed a decrease in their PI after hCG administration of 10% or more were defined "deeply decreased" and showed a decrease of less than 10% were considered "not-deeply decreased." The recovery rates of mature and immature oocytes and TAOS in follicular fluid were compared between the two groups.

RESULTS

Mature and immature oocyte recovery rates in the DD group (62.5% and 17.2%) were significantly higher and lower, respectively, than those in the NDD group (41.7% and 38.3%, p < 0.05). The TAOS (1.55 +/- 0.44 mmol/L) of the DD group was significantly lower than that in the NDD group (1.68 +/- 0.47 mmol/L, p < 0.05).

CONCLUSIONS

The decrease in intraovarian arterial blood flow resistance measured after hCG administration may be a good indicator of retrieving mature oocyte.

Intraovarian arterial blood flow resistance in oligomenorrheal infertile women

PURPOSE

Intraovarian arterial blood flows before and after follicular rupture in ovulation induced cycles were examined by transvaginal color flow Doppler imaging. The changes observed in the intraovarian arterial resistance before and after ovulation in relation to the regularity of menstruation and several other parameters were analyzed.

METHODS

In a prospective study, 22 patients undergoing infertility treatment in our center were recruited. Patients were divided into two subgroups, according to their menstrual regularity (regular menstrual group and oligomenorrheal group) and 42 cycles were studied. All patients received the same FSH low-dose stimulation treatment. The relationship between the post and preovulatory arterial pulsatility indexes (PI) was analyzed. Cycles that showed a decrease in their PI after ovulation of 10% or more were considered "profoundly decreased cycles." Cycles from the same patients without ovulatory stimulation (natural cycles) were used as control.

RESULTS

In the regular menstrual group the rate of profoundly decreased cycles during FSH stimulation was 63.2%, which was similar to the rate observed in natural cycles. In the oligomenorrheal group the rate of profoundly decreased cycles during natural cycles was 14.3%, but in FSH ovulation induction cycles this rate was significantly increased (47.6%, p < 0.05). In addition, the pregnancy rate per cycle in the oligomenorrheal group was significantly higher than that in the regular menstrual group (p = 0.03).

CONCLUSIONS

Oligomenorrheal patients presented a higher rate in the decrease of their PI values after FSH stimulation, which is essential to achieve pregnancy. This elevated rate of reduction implies that oligomenorrheal patients have increased incidence of disturbance in their ovulatory process when compared to normal cycling patients. Thus, ovulation induction with FSH, in oligomenorrheal patients resulted in a higher pregnancy rate in this group.