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.     

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.     

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 endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound between stimulated and natural cycles in the same patients

BACKGROUND: Low implantation rates in stimulated IVF cycles may be related to suboptimal endometrial perfusion. Endometrial and subendometrial blood flow was compared between stimulated and natural cycles in the same patients undergoing IVF. METHODS: Three-dimensional (3D) ultrasound examination with power Doppler was performed in stimulated and natural cycles of 67 consecutive patients to measure endometrial thickness, uterine artery pulsatility index/resistance index, endometrial volume, vascularization index (VI)/flow index (FI)/vascularization flow index (VFI) of endometrial and subendometrial regions. RESULTS: Endometrial and subendometrial blood flow was absent in four (6.0%) patients in the stimulated cycle and two (3.0%) patients in the natural cycle. Endometrial and subendometrial VI/FI/VFI were significantly lower in stimulated cycles than those in natural cycles. The median (95% CI) decreases in endometrial VI/FI/VFI were 35.8% (-2.5, 216.8), 5.0% (0.1, 12.3) and 48.4% (2.5, 315.3) respectively whereas the corresponding decreases in the subendometrial region were 66.6% (-0.2, 220.5), 4.3% (0.8, 16.2) and 76.3% (41.0, 303.4) respectively. CONCLUSION: Endometrial and subendometrial blood flow was significantly lower in the stimulated cycle than that in the natural cycle.     

The role of endometrial and subendometrial vascularity measured by three-dimensional power Doppler ultrasound in the prediction of pregnancy during frozen-thawed embryo transfer cycles

BACKGROUND: A good blood supply to the endometrium is usually considered as an essential requirement for implantation. OBJECTIVE: The aim of this study was to evaluate the role of endometrial and subendometrial vascularity in the prediction of pregnancy during frozen-thawed embryo transfer (FET) cycles. METHODS: Women undergoing FET in natural or clomiphene-induced cycles after the first stimulated IVF treatment were recruited. A three-dimensional (3D) ultrasound examination with power Doppler was performed 1 day after the LH surge to determine endometrial thickness, endometrial pattern, pulsatility index (PI) and resistance index (RI) of uterine vessels, endometrial volume, vascularization index, flow index and vascularization flow index of endometrial and subendometrial regions. RESULTS: Women in the pregnant group were significantly younger and used less gonadotrophins in their stimulated cycle. Endometrial thickness, endometrial volume, endometrial pattern, uterine PI, uterine RI, endometrial and subendometrial 3D power Doppler flow indices were similar between the nonpregnant and the pregnant groups. The age of women was the only predictive factor for pregnancy. Receiver operating characteristic curve analysis revealed that the area under the curve was around 0.5 for all ultrasound parameters for endometrial receptivity. CONCLUSION: Vascularity of endometrial and subendometrial layers measured by 3D power Doppler ultrasound is not a good predictor of pregnancy in FET cycles if measured at one time point only.     

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.     

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.     

Endometrial and subendometrial vascularity is higher in pregnant patients with livebirth following ART than in those who suffer a miscarriage

BACKGROUND: Blood flow towards the peri-implantation endometrium may have effects on miscarriage and live birth following assisted reproduction treatment, in addition to its role in implantation. METHODS: Three-dimensional ultrasound examination with power Doppler was performed on the day of oocyte retrieval in stimulated IVF cycles and on LH + 1 day in frozen thawed-embryo transfer (FET) cycles to measure endometrial thickness, endometrial pattern, uterine artery Doppler flow indices, endometrial volume, vascularization index (VI), flow index (FI), vascularization flow index (VFI) of endometrial and subendometrial regions. RESULTS: In stimulated IVF cycles, 45 (28.0%) out of 161 pregnant patients subsequently miscarried. Patients in the live birth group had significantly higher endometrial VI and VFI and subendometrial VI, FI and VFI, when compared with those in the miscarriage group. In a multiple logistic regression analysis, only endometrial VI was significantly associated with the chance of live birth with an odds ratio of 1.384 [95% confidence interval (CI) 1.025-1.869, P = 0.034]. For FET cycles, patients in the live birth group had significantly higher endometrial VFI, subendometrial VI and VFI than those in the miscarriage group. CONCLUSIONS: Endometrial and subendometrial vascularity was significantly higher in pregnant patients with live birth following stimulated IVF and FET treatment than in those who suffered a miscarriage.     

Doppler ultrasound investigation of uterine and ovarian blood flow in infertility and early pregnancy

This review describes the current use of Doppler ultrasoundto examine blood flow in the uterus and ovaries in infertilepatients and during early pregnancy. The basics of Doppler ultrasoundand the different methods of measuring blood flow are discussedfrom the viewpoint of the clinician who may be unfamiliar withDoppler physics and terminology. Normal values in the menstrualcycle and the relationship of uterine and ovarian blood flowto infertility and to implantation following in-vitro fertilizationare presented. Normal values for uterine blood flow in the first16 weeks of pregnancy and the effect of sex steroids and ovulationinduction on their values are described. The possible relationshipof defective uterine blood flow, and the effect of drugs areexplored. The findings of this review indicate that Dopplerblood flow studies may provide significant information aboutpossible causes of some disorders of infertility and early pregnancyand methods of treatment for the same.     

三维能量多普勒超声对晚孕期胎盘植入的诊断价值

目的：探索三维能量多普勒超声对于晚孕期胎盘植入的诊断价值。方法：选取32例晚孕期可疑胎盘植入患者,分别采用二维彩色多普勒超声及三维能量多普勒超声两种方法进行检查,仔细观察胎盘后间隙、胎盘内部回声及血流情况,总结两种方法诊断胎盘植入的符合率。结果：二维超声联合三维能量多普勒超声诊断胎盘植入的符合率高于二维彩色多普勒超声(χ2=5.33,P<0.05)。结论：二维超声联合三维能量多普勒超声对胎盘植入的诊断优于二维彩色多普勒超声,具有非常重要的临床意义。     

MP-PCNN超声多普勒血流信号声谱图降噪去斑方法

为有效抑制超声多普勒血流信号声谱图中的背景噪声和多普勒斑点,提出了Matching Pursuit(MP)及单向衰减阈值脉冲耦合神经网络(MP-PCNN)模型。首先将分段的多普勒超声信号进行MP循环分解,分离噪声与信号,然后用单向衰减阈值PCNN模型计算声谱图在各个灰度等级上的点火时刻图并定位斑点,用中值滤波器抑制斑点。通过对各种信噪比的仿真超声多普勒血流信号处理,实验结果表明,MP-PCNN方法可有效地滤除声谱图中的噪声与斑点,并较好地保持边缘与细节信息,在主观及客观性能比较上优于同类降噪去斑方法。     

Differences in brain and liver blood flow during and after acute blood loss in rats with different resistance to circulatory hypoxia

Variations of blood flow and vascular resistance in the common carotid arteries and of blood flow in the hepatic artery and portal vein are examined during and after acute massive blood loss in rats with low and high resistance to circulatory hypoxia. In rats with low resistance, arterial pressure and the rates of cerebral and hepatic blood macro- and microflow, which have decreased during blood loss, continued to fall during the posthemorrhagic period. After cessation of bleeding, a transient arterial pressure rise to 70 mm Hg is observed in rats with high resistance, while the blood flow via carotid arteries increases to 65% of its initial value, being maintained at this level throughout the period of changes in carotid vascular resistance; intrinsic hepatic arterial blood flow increases to 115% of baseline value, while the portal vein blood flow and hepatic microflow increase to 75%. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 123, No. 3, pp. 253–257, March, 1997     

多普勒超声观察创伤性寰枢椎不稳手术前后椎动脉血流的变化

目的探讨创伤性寰枢椎不稳患者内固定手术前后椎动脉血流的变化。方法32例创伤性寰枢椎不稳患者,其中男性22例,女性10例;年龄22～57岁,平均年龄38岁。手术前及内固定术后,均应用彩色多普勒超声测量颈椎1、2间和颈椎5、6间椎动脉血流速度、阻力指数。并对检查结果进行对比分析。结果32例创伤性寰枢椎不稳患者术前椎动脉血流39侧异常,25侧正常。内固定术后39侧异常者中35侧恢复正常,4侧无变化,3侧术前正常变为术后异常。结论创伤性寰枢椎不稳可导致椎动脉血流变化,手术复位内固定后增加了寰枢椎稳定性,可改善椎动脉血液供应。     

Assessment of the ovarian volume, number and volume of follicles and ovarian vascularity by three-dimensional ultrasonography and power Doppler angiography on the HCG day to predict the outcome in IVF/ICSI cycles

OBJECTIVE: The aim of this prospective study was to investigate whether ovarian blood flow is related to embryological parameters and whether it could be a predictor of outcomes of IVF/ICSI. METHODS: Eighty infertile women underwent ovarian stimulation with gonadotrophins after a long protocol with GnRH agonists. The ovarian volume (OV), number of follicles (NF) and follicular volume (FV) of all follicles >10 mm and vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were obtained by three-dimensional (3D) ultrasonography and power Doppler angiography (PDA) on the day of HCG administration. These parameters were tested for their relation with IVF laboratory parameters. RESULTS: The OV, FV, VI, FI and VFI were significantly greater in the pregnant group. The NF and FV were the only independent predictors of the number of oocytes retrieved, mature and fertilized, and the number of embryos developed and their cumulative embryo score. Nevertheless, the number of grade 1 embryos depends on the NF and the VI. The ovarian FI and the number of transferred grade 1 embryos can predict gestation in 76% of IVF patients. A low FI and non-grade 1 embryo transferred are also associated with an increased pregnancy loss. CONCLUSION: 3D ultrasonography and PDA allow for an easier ovarian assessment in IVF cycles. The predictive value of IVF outcome suggests a high clinical usefulness of this new technique.