Effect of pituitary downregulation on antral follicle count, ovarian volume and stromal blood flow measured by three-dimensional ultrasound with power Doppler prior to ovarian stimulation

BACKGROUND: Despite the extensive use of gonadotrophin releasing hormone agonists (GnRH ag) for pituitary downregulation, the literature regarding their effect on ultrasound parameters for predicting ovarian responses are few and conflicting. The aim of this prospective study was to compare antral follicle count (AFC), ovarian volume and ovarian stromal blood flow measured by three-dimensional (3D) power Doppler ultrasound before and after pituitary downregulation. METHODS: All patients received a long protocol of intranasal Buserelin from the mid-luteal phase of the cycle. In the early follicular phase of the preceding cycle before downregulation and on the second day of the treatment cycle after downregulation, patients underwent a blood test for serum FSH, LH and estradiol and a transvaginal scanning with 3D power Doppler to determine AFC, ovarian volume and ovarian 3D power Doppler flow indices. RESULTS: Out of 104 women scanned, 85 women were analysed. Polycystic ovaries were encountered in 14 (16.5%) women. No significant differences in any of the ultrasound parameters were demonstrated before and after downregulation, in patients with normal ovaries or in those with polycystic ovaries. CONCLUSION: AFC, ovarian volume and ovarian 3D power Doppler flow indices did not significantly change after a short-term treatment of GnRH agonist for pituitary downregulation.     

Quantification of Doppler signal in polycystic ovary syndrome using three-dimensional power Doppler ultrasonography: a possible new marker for diagnosis.

BACKGROUND: Differences in the ovarian stromal blood flow of women embarking on an IVF treatment, as assessed on day 2 or 3 of the menstrual cycle, using three-dimensional (3D) power Doppler ultrasonography to quantify the blood flow and vascularization, were compared. METHODS: The women were divided into two groups: group 1, 54 women with regular, ovulatory menstrual cycles and normal ovaries on ultrasound scan; and group 2, 25 women with polycystic ovary syndrome (PCOS). RESULTS: The quantification of Doppler signal in the ovarian stroma appeared to be greater in the PCOS group compared with the normal group. The mean of ovarian volume was significantly higher (P < 0.05) in women with PCOS compared with the normal ovaries. The vascularization flow index (VFI), flow index (FI), and vascularization index (VI), were significantly higher (P < 0.05) in the women with PCOS compared with the women with normal ovaries. CONCLUSIONS: This observation may help to explain the excessive response often seen during gonadotrophin administration in women with PCOS. We believe that a quantification study of the vascular flow, including the VI, FI, and VFI of the entire ovarian stroma using 3D power Doppler, is more accurate than the previously reported quantification analysis using 2D imaging, and may be a new parameter to assist in the ultrasound diagnosis of PCOS.     

Factors affecting endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound during IVF treatment

BACKGROUND: No information exists in the literature regarding the factors affecting the blood flow towards the endometrial and subendometrial regions during IVF treatment. METHODS: We examined the effect of women's age, their smoking habits, their type of infertility (i.e. primary or secondary) and parity, causes of infertility and serum estradiol (E2) concentration on endometrial and subendometrial blood flows as measured by a three-dimensional (3D) power Doppler ultrasound during IVF treatment. All patients received a standard long protocol of ovarian stimulation and serum E2 concentration was determined on the day of hCG. 3D ultrasound examination with power Doppler was performed on the day of oocyte collection to determine vascularization index (VI), flow index (FI) and vascularization flow index (VFI) of endometrial and subendometrial regions. RESULTS: The age of women, their smoking habits, their types of infertility and parity and causes of infertility had no effect on the endometrial and subendometrial 3D power Doppler flow indices. There was a negative correlation between serum E(2) concentration and endometrial FI (r = -0.109; P = 0.006). CONCLUSIONS: Endometrial blood flow in IVF treatment was negatively affected by serum E2 concentration only.     

Assessment of reproductive ageing patterns by hormonal and ultrasonographic ovarian reserve tests

BACKGROUND: Tests to assess the change in ovarian reserve (OR) with age have been analysed only in monophasic or biphasic linear patterns. Our aim was to analyse an optimum curve that might define the relationship between different OR tests and age. METHODS: A total of 81 regularly menstruating women without a history of infertility were included in this prospective study. On cycle day 3, antral follicle (AF) counts, ovarian volume (OV), and serum FSH and estradiol levels were determined. Curve estimation was performed to determine the optimal relationship between age and OR tests. Optimum curves were also compared with monophasic and biphasic linear relationships. RESULTS: A quadratic model (y=a x x2+b x x+c) had the highest coefficient of determination for the AF count, OV and serum FSH level. The predictive power of this quadratic model was comparable with biphasic linear models for the OV and serum FSH level, but was better than that of the AF count. CONCLUSIONS: The pattern of reproductive ageing as assessed by hormonal and ultrasonographic OR tests does not appear to show an abrupt change at a certain age, but follows a continuously increasing rate of decline in the third decade of life. The changes in serum FSH levels and ultrasonographic OR tests follow a quadratic model in regularly menstruating women.     

Effect of age on ovarian stromal flow measured by three-dimensional ultrasound with power Doppler in Chinese women with proven fertility

BACKGROUND: Increasing age is associated with reduced ovarian stromal blood flow detected by three-dimensional (3D) power Doppler ultrasound in infertile patients. However, little information exists in the literature regarding the effect of age on the ovarian stromal blood flow in fertile women. METHODS: On the second to fourth day of their menstrual cycle, fertile Chinese women who had regular monthly cycles and no history of tubal and ovarian surgery underwent a transvaginal scan with 3D power Doppler to determine total antral follicle count (AFC), total ovarian volume, total ovarian vascularization index (VI)/flow index (FI)/vascularization flow index (VFI). Serum FSH and vascular endothelial growth factor concentrations were checked. RESULTS: Out of 177 women scanned, 138 women were included in the final analysis. Total AFC and serum FSH were significantly different among four age groups (< or = 30, 31-35, 36-40 and > or = 41 years). Total ovarian VI and VFI were significantly lower in women aged > or = 41 years. AFC had the best correlation with the age of women, followed by serum FSH concentration and ovarian 3D power Doppler indices. The rate of decline of total ovarian VI was 0.18% per year. CONCLUSION: Ovarian stromal blood flow was significantly reduced only in women aged > or = 41 years.     

The number of small antral follicles (2-6 mm) determines the outcome of endocrine ovarian reserve tests in a subfertile population

BACKGROUND: Ovarian reserve is related to age and can be estimated by ovarian reserve tests (ORTs), such as antral follicle count (AFC) and various endocrine parameters. The endocrine function of a follicle is related to its size. The aim of this study is to evaluate which sizes of antral follicles are most closely correlated with age and the outcome of endocrine ORTs. METHODS: In total 474 subfertile, ovulatory patients, recruited from two fertility centers in The Netherlands, participated in this prospective cohort study. The following ORTs were performed: AFC (follicles from 2 to 10 mm), basal FSH, basal inhibin B (bInhB), clomiphene citrate challenge test and inhibin B after stimulation with clomiphene citrate. RESULTS: The number of small follicles (2-6 mm) declined with age; the number of larger follicles (7-10 mm) remained constant. Independent of age, the number of small follicles was significantly related to all ORTs (P<0.001, except bInhB P=0.005). The number of larger follicles was only significantly related to bInhB (P=0.009). CONCLUSIONS: The number of small antral follicles (2-6 mm) is significantly related to age and also, independent of age, to all endocrine ORTs tested, suggesting the number of small antral follicles represents the functional ovarian reserve.     

Revisiting the ovarian volume as a diagnostic criterion for polycystic ovaries

BACKGROUND: This study revisited the ovarian volume (OV) as a diagnostic criterion for polycystic ovaries (PCO). Indeed, a threshold of 10 cm(3) for the OV, chosen at the polycystic ovary syndrome (PCOS) international consensus held at Rotterdam in 2003, was to date not based on appropriate studies such as receiver operator characteristic (ROC) curve analysis. METHODS: This prospective study included 154 women with PCOS, selected by using the former National Institutes of Health criteria, who were compared with 57 women with normal ovarian function. Ultrasound examination was performed between cycle days 2 and 7 with a 7 MHz transvaginal transducer. RESULTS: Mean OV, ovarian area (OA) and follicle number (FN) values were significantly higher in the PCOS group than in controls. The area under the ROC curve (AUC) was >0.9 for all three criteria, indicating a satisfactory diagnostic potency for each. Concerning the OV, setting the threshold at 7 cm(3) offered the best compromise between specificity (91.2%) and sensitivity (67.5%). In comparison, specificity and sensitivity were 98.2 and 45%, respectively, with a threshold at 10 cm(3). Nevertheless, the highest AUC was obtained for FN (0.956) and then for OA (0.941). CONCLUSIONS: OV is a good diagnostic criterion for PCO but, on the basis of the present data, we propose to lower its threshold to 7 cm(3). The FN >12 still appears as the best diagnostic criterion. The OA could be used as a surrogate for OV in difficult situations.     

Endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound in patients with small intramural uterine fibroids during IVF treatment

BACKGROUND: The impact of intramural fibroids on the success of IVF treatment is controversial and the mechanisms leading to poor treatment outcomes remain unknown. We compared endometrial and subendometrial blood flow between women with and without intramural fibroids during IVF treatment. METHODS: Three-dimensional (3D) ultrasound examination with power Doppler was performed on the day of oocyte retrieval in 50 patients with intramural fibroids not distorting the uterine cavity and in 50 matched controls to measure endometrial thickness, uterine pulsatility index (PI)/resistance index (RI), endometrial volume and vascularization index (VI)/flow index (FI)/vascularization flow index (VFI) of endometrial and subendometrial regions. Smokers, patients with serum estradiol concentrations > or =20,000 pmol/l on the day of HCG and previous history of myomectomy were excluded. RESULTS: Endometrial thickness and pattern, averaged uterine PI and RI and endometrial and subendometrial VI/FI/VFI were similar between the fibroid group and the control group. There was no correlation between the total volume of fibroids and endometrial and subendometrial 3D power Doppler flow indices in the fibroid group. CONCLUSION: Endometrial and subendometrial 3D power Doppler flow indices were similar in patients with and without small intramural fibroids.     

The significance of the number of antral follicles prior to stimulation in predicting ovarian responses in an IVF programme

Multiple follicular development plays a major role in the successful outcome of IVF and embryo transfer treatment. Prediction of ovarian responses prior to stimulation is useful in counselling patients and helpful in tailoring the dosage of gonadotrophin to individual patients. The objective of this study was to compare age of women, body mass index (BMI), basal FSH concentration, volume of both ovaries and the number of antral follicles of both ovaries in predicting the number of oocytes obtained. A total of 128 consecutive women, who had no history of ovarian surgery, were non-smokers and undergoing the first cycle using a standard regimen of ovarian stimulation were examined. The total number of antral follicles achieved the best predictive value, followed by basal FSH, BMI and age of women. In those women with fewer antral follicles, a longer duration and higher dosage of human menopausal gonadotrophin were required but the number of eggs obtained was significantly less than for those with more antral follicles. Significantly more cycles were cancelled before egg collection in women with < or =6 antral follicles while more cycles of embryo transfer were postponed in order to reduce the risk of ovarian hyperstimulation syndrome in women with >9 antral follicles.     

Repeated clomiphene citrate challenge testing in the prediction of outcome in IVF: a comparison with basal markers for ovarian reserve

BACKGROUND: The aim of this study was to investigate the predictive accuracy and clinical value of performing either a single or a repeated clomiphene citrate challenge test (CCCT) in predicting poor response in IVF, compared to that of currently used basal ovarian reserve markers. METHODS: Sixty-three patients undergoing their first IVF treatment were prospectively included. After measurement of basal markers on cycle day 3 (cd3) [FSH, inhibin B and antral follicle count (AFC)], a CCCT was performed. FSH and inhibin B levels were measured on day 10 (cd10). A second CCCT was performed after a washout period of one cycle. In all patients the tests were followed by an IVF treatment. Poor response (<4 oocytes or cancellation due to impaired (<3 follicles) or absent follicular growth) was used as primary outcome measure. RESULTS: Both the single as well as the repeated CCCT markers had a rather good discriminative potential for the prediction of poor response (area under the receiver operating characteristic curve (ROCAUC): FSH cd10=0.79, inhibin B cd10=0.79, mean FSH cd10=0.82 and mean inhibin B cd10=0.88). This compared well with the performance of the basal markers (FSH 0.82, inhibin B 0.72 and AFC 0.83). In a multivariate analysis on only the basal variables, FSH cd3 and AFC were selected (ROCAUC 0.89). Only stepwise forward analysis on the repeated CCCT variables revealed a better discriminating potential for the prediction of poor response (ROCAUC 0.92). At a specificity level of approximately 0.97, sensitivity and the positive predictive value were marginally improved in the CCCT models. CONCLUSIONS: Performing a CCCT (single or repeated) has a rather good ability to predict poor response in IVF. However, it appears that the predictive accuracy and clinical value of the CCCT is not clearly better than that of basal FSH in combination with an AFC. Therefore, the use of the CCCT as a predictor of outcome in IVF should not be advocated.     

Three-dimensional ultrasound features of the polycystic ovary and the effect of different phenotypic expressions on these parameters

BACKGROUND: The aim of this study was to quantify the three-dimensional (3D) ultrasound characteristics of ovaries in Caucasian women with polycystic ovarian syndrome (PCOS) and to examine if these values differed between different phenotypic forms. METHODS: 3D pelvic ultrasound was performed in 40 women with PCOS and in 40 controls. Total ovarian volume, stromal volume and echogenicity and antral follicle count (AFC) were measured and ovarian blood flow was quantified using both 3D power Doppler and two-dimensional pulsed-wave Doppler. RESULTS: Women with PCOS had a higher AFC (median 16.3 versus 5.5 per ovary, P < 0.001) and ovarian volume (12.56 versus 5.66 ml, P < 0.001). Stromal volume (10.79 versus 4.69 ml, P < 0.001) and stromal vascularization (VI: 3.85 versus 2.79%, P < 0.001; VFI: 1.27 versus 0.85, P < 0.001) were also increased in women with PCOS. There were no significant differences in stromal echogenicity or pulsed-wave Doppler indices between women with PCOS and the controls. Among the women with PCOS, ovarian vascularity was significantly higher in 30 women who were hirsute compared with normoandrogenic women (FI: 33.94 versus 29.30, P < 0.05) and in 14 women with PCOS who were of normal weight compared with obese women (VI: 4.51 versus 3.25%, P < 0.05; VFI: 1.56 versus 1.22, P < 0.05). CONCLUSIONS: Based on 3D ultrasound, women with PCOS have an increased stromal volume and vascularity. Stromal vascularity is significantly higher in women with PCOS who are hirsute and of normal weight.     

Three-dimensional assessment of ultrasound features in women with clomiphene citrate-resistant polycystic ovarian syndrome (PCOS): ovarian stromal volume does not correlate with biochemical indices

BACKGROUND: Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrine disorder affecting women of reproductive age. The syndrome is characterized by a combination of polycystic ovarian morphology, clinical features and biochemical indices. The objective of this prospective observational study was to investigate the relationship between the total ovarian volume and the ovarian stromal volume, measured using a three-dimensional (3D) ultrasound scan, with biochemical indices of PCOS. METHODS: Twenty-three infertile women (mean age +/- SD: 31 +/- 3.1 years; range: 26-37) with clomiphene citrate-resistant PCOS were examined. Early follicular phase (days 2-4) serum FSH, LH and testosterone concentrations were measured following a withdrawal bleed. Total ovarian volume, stromal volume, pre-antral follicle (<10 mm) number and total follicular volume were measured by 3D transvaginal ultrasound. RESULTS: Total ovarian volume, follicular volume and follicle number correlated positively with serum FSH and LH, but not testosterone, concentrations. Ovarian stromal volume correlated strongly with total ovarian volume only, but not with serum FSH, LH or testosterone concentrations. CONCLUSIONS: These findings demonstrate an association of the total ovarian volume, pre-antral follicle number and total follicular volume with some of the biochemical indices of PCOS, but no association was observed between ovarian stromal volume and these indices.     

Assessment of changes in volume and vascularity of the ovaries during the normal menstrual cycle using three-dimensional power Doppler ultrasound

BACKGROUND: Our aim was to describe changes in the volume and vascularization of both ovaries, the dominant follicle and the corpus luteum during the normal menstrual cycle using three-dimensional (3D) power Doppler ultrasound. METHODS: Fourteen healthy volunteers underwent serial transvaginal 3D ultrasound examinations of both ovaries on cycle day 2, 3 or 4, then daily from cycle day 9 until follicular rupture and 1, 2, 5, 7 and 12 days after follicular rupture. The volume and vascular indices of the ovaries, the dominant follicle and the corpus luteum were calculated off-line using virtual organ computer-aided analysis (VOCAL) software. RESULTS: The volume of the dominant ovary increased during the follicular phase, decreased after follicular rupture and then increased again during the luteal phase. Vascular indices in the dominant ovary and the dominant follicle/corpus luteum increased during the follicular phase, the vascular flow index (VFI) in the dominant follicle being on average (median) 1.7 times higher on the day before ovulation than 4 days before ovulation (P=0.003). The vascular indices continued to rise after follicular rupture so that VFI in the corpus luteum was on average (median) 3.1 times higher 7 days after ovulation than in the follicle on the day before ovulation (P=0.0002). The volume and vascular indices in the non-dominant ovary manifested no unequivocal changes during the menstrual cycle. CONCLUSIONS: Substantial changes occur in volume and vascularization of the dominant ovary during the normal menstrual cycle. 3D power Doppler ultrasound may become a useful tool for assessing pathological changes in the ovaries, for example, in subfertile patients.     

Antral follicle count and FSH concentration after clomiphene citrate challenge test in the prediction of ovarian response during IVF treatment

BACKGROUND: We compared: (i) antral follicle count (AFC) in the early follicular phase, after the clomiphene citrate challenge test (CCCT) and before ovarian stimulation following pituitary down-regulation; and (ii) age of women, body mass index, basal and stimulated serum FSH concentrations and AFC in predicting the ovarian response of infertile women aged <40 years with basal FSH <10 IU/l on recruitment in their first IVF cycle. METHODS: Two months prior to the treatment cycle, AFC and basal FSH concentration were determined on day 2-3 of a spontaneous period and on day 10 after CCCT. All women received a standard stimulation regimen. Ovarian response was represented by the number of oocytes, serum estradiol, the duration and dosage of gonadotrophins. RESULTS: There was no significant difference between basal, stimulated and down-regulated AFC. AFC achieved the best predictive value in relation to the number of oocytes, followed by combined FSH concentration (sum of the two FSH concentrations) and age of women. Both basal AFC and combined FSH concentration were predictive factors of serum estradiol concentration, whereas stimulated FSH concentration was predictive of the total dosage of gonadotrophins. CONCLUSION: Combined FSH concentration after CCCT provides additional information in predicting ovarian response.     

Impaired ovarian blood flow and reduced antral follicle count following laparoscopic salpingectomy for ectopic pregnancy

BACKGROUND: Whether salpingectomy affects ovarian function is controversial. In this study, ovarian function was assessed by antral follicle count, ovarian volume and ovarian stromal blood flow measured by three-dimensional (3D) power Doppler ultrasonography. The objectives of the study were to compare the ovarian function of the operated side with the non-operated side after unilateral salpingectomy performed through laparoscopy or laparotomy for ectopic pregnancy. METHODS: Thirty-two patients with unilateral salpingectomy performed for ectopic pregnancy were recruited: 18 through laparoscopy and 14 through laparotomy. Ultrasound scans were performed in the early follicular phase. RESULTS: Ovarian volume, antral follicle count and 3D power Doppler indices were comparable between the operated and the non-operated sides in the whole group and in the laparotomy group. The antral follicle count and 3D power Doppler indices were significantly reduced on the operated side in the laparoscopy group. CONCLUSIONS: Ovarian function seems to be impaired after laparoscopic unilateral salpingectomy at short-term assessment.     

The level of vascular endothelial cell growth factor,nitric oxide,and endothelin-1 was correlated with ovarian volume or antral follicle counts: A potential predictor of pregnancy outcome in IVF

The objective of this study was to investigate the correlation between the concentrations of vascular endothelial cell growth factor (VEGF), nitric oxide (NO), or endothelin-1 (ET-1) in follicular fluid with antral follicle counts (AFCs) or ovarian volume in order to predict the outcome of in vitro fertilization (IVF). One hundred and thirty-one patients were enrolled in this study, and the pregnancy rate was 37.4%. The concentration of VEGF or NO was significantly increased, while the concentration of ET-1 in follicular fluid was decreased in the group who became pregnant (P < 0.05). The ovarian volume or AFC was significantly higher in groups that became pregnant (P < 0.05). In addition, the ovarian volume or AFC was positively correlated with the concentration of VEGF or NO and negatively correlated with the concentration of ET-1 in follicular fluid. Our data suggest that these correlations may be associated with the successful pregnancies through IVF.     

The role of endometrial and subendometrial blood flows measured by three-dimensional power Doppler ultrasound in the prediction of pregnancy during IVF treatment

BACKGROUND: A good blood supply towards the endometrium is usually considered to be an essential requirement for implantation. We aimed to evaluate the role of endometrial and subendometrial blood flows in the prediction of pregnancy during IVF treatment. METHODS: Patients undergoing the first IVF cycle were recruited. A three-dimensional (3D) ultrasound examination with power Doppler was performed on the day of oocyte retrieval to determine endometrial thickness, endometrial pattern, pulsatility index (PI) and resistance index (RI) of uterine vessels, endometrial volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) of endometrial and subendometrial regions. RESULTS: Uterine RI, endometrial VI and VFI were significantly lower in the pregnant group than the non-pregnant group. There was a non-significant trend of higher implantation and pregnancy rates in patients with absent endometrial or subendometrial blood flow. The number of embryos replaced and endometrial VI were the only two predictive factors for pregnancy. Receiver operator characteristic curve analysis revealed that the area under the curve was approximately 0.5 for all ultrasound parameters for endometrial receptivity. CONCLUSION: Endometrial and subendometrial blood flows measured by 3D power Doppler ultrasound were not good predictors of pregnancy if they were measured at one time-point during IVF treatment.     

Comparison of ovarian stromal blood flow between fertile women with normal ovaries and infertile women with polycystic ovary syndrome

BACKGROUND: Conflicting information exists in the literature with respect to ovarian stromal blood flow in women with polycystic ovary syndrome (PCOS). We compared the ovarian stromal blood flow and serum vascular endothelial growth factor (VEGF) concentration between fertile women with normal ovaries and infertile women with PCOS. METHODS: In the second to fourth day of the menstrual period, they underwent transvaginal scanning with three-dimensional (3D) power Doppler to determine total antral follicle count (AFC), total ovarian volume, total ovarian vascularization index (VI), flow index (VFI) and vascularization flow index (VFI). Serum FSH, LH and VEGF concentrations were also checked. RESULTS: 107 fertile controls and 32 PCOS women were recruited. Fertile controls and PCOS women had similar total ovarian VI/FI/VFI after controlling for age of the woman, although PCOS women had significantly higher total AFC, total ovarian volume and serum LH concentration than fertile controls. Total ovarian VI/FI/VFI were significantly higher in normal weight (BMI < 25 kg/m2) PCOS women than their overweight (> or = 25 kg/m2) counterparts. CONCLUSIONS: Fertile controls and PCOS women had similar total ovarian 3D power Doppler flow indices. Normal weight PCOS women had significantly higher total ovarian 3D power Doppler flow indices than their overweight counterparts.     

Dynamic assays of inhibin B, anti-Mullerian hormone and estradiol following FSH stimulation and ovarian ultrasonography as predictors of IVF outcome

BACKGROUND: We evaluated basal and dynamic hormonal markers [(FSH, inhibin B, estradiol and anti-Mullerian hormone (AMH)] during the follicular phase and luteal phase of the menstrual cycle and ultrasonic ovarian morphology as predictors of IVF outcome. METHODS: Fifty-six women, aged <38 years, with normal day 3 FSH levels were included prospectively. Serum estradiol, inhibin B and AMH were measured before and 24 h after administration of 300 IU of recombinant FSH on cycle day 3-4 and during the luteal phase. Ovarian volume and antral follicle count (AFC) were evaluated on cycle day 3-4. The predictive value of oocyte number and pregnancy were assessed using uni- and multivariate analysis. RESULTS:Poor responders (<6 oocytes) had significantly lower luteal AMH levels, while high responders (>20 oocytes) had significantly higher AFC, AMH and luteal stimulated inhibin B and estradiol than normal responders. Multivariate regression analyses showed that the best models for predicting oocyte number included AFC, follicular phase AMH and stimulated inhibin B. Only AMH showed a significant difference between pregnant and non-pregnant women at both cycle phases. CONCLUSIONS: In young women (<38 years), AFC or basal AMH and stimulated inhibin B predict ovarian response for IVF. The only predictor for pregnancy is follicular or luteal phase AMH.     

Reproducibility of transvaginal three-dimensional endometrial volume measurements during ovarian stimulation.

Before estimating the clinical role of a method, the reproducibility has to be evaluated precisely. This study aimed to document the reproducibility of the endometrial volume measurement by three-dimensional (3D)-ultrasound. The volume measurements were done on 57 consecutive in-vitro fertilization (IVF) patients with either the full planar (contour) or the three distance method. A paired t-test provided no statistically significant difference between the two methods. Linear regression analysis, using the full planar method as independent and the other as dependent variables, yielded the following results: intercept = 0.348, not statistically different from 0; slope = 0.962, statistically different from 1 (P < 0.01). Interobserver reliability for the three distance method was 0.6667 and for the full planar method was 0.9565. Intra-observer reliability for the three distance method was 0.8426 and for the full planar method 0.9394. The correspondence between and within observers seemed to be good. Both methods are reliable, but the full planar method seems to provide slightly better reproducibility in regard to endometrium volume measurement.