Comparison of uterine, endometrial and ovarian blood flow by transvaginal color Doppler ultrasound in ovulatory and anovulatory cycles

Abstract

Objectives: Blood flow to uterus and ovaries is demonstrated to be altered during mensturation. Studies has been published stating that blood flow differs also in ovulatory and anovulatory cycles. In this study, using color Doppler ultrasound, we aim to compare uterine, endometrial and ovarian blood flow during ovulatory and anovulatory cycles. Material and methods:Women volunteers who are aged between 18-40 had no endocrinological problem and not recieving exogenous hormone therapy were included to study. Blood levels of FSH, LH, E2, prolactine, DHEAS, free T4 were collected in early follicular phase. Uterina, subendometrial and intraovarian artery blood flow pulsatility and resistance indexes were analysed using Doppler USG technique. Patients were called out to control on 21st of cycle and progesterone levels were analysed. Patients who has ovulation signs in USG and progesterone level above 5 ng/mL were included to ovulatory cycle group. Patient who has no signs of ovulation in ultrasound and has not enough progesterone level were included to anovulatory cycle group.Results: LH and E2 levels were significantly higher in anovulatory patients. No correlation was found between endometrial blood flow resistance and basal E2, prolactine, testosterone levels. However, DHEAS levels were related to endometrial blood flow resistance in anovulatory cycles. No correlation was found between ovarian blood flow resistance/uterine blood flow resistance and basal E2, prolactine, testosterone, DHEAS levels. Conclusions:There is statistically significant difference between endometrial, ovarian, uterine artery blood flow resistance in ovulatory and anovulatory cycles. Blood flow resistance was found to be increased in anovulatory patients. Increased E2 levels in anovulatory cycles were related to endometrial linethickness and endometrial volume

Correlation Between Vascularity Index And Pregnancy Rate During Improve Endometrial Receptivity In Thin Poorly Vascularized Endometrium Therapy

“…Mean RI and PI was significantly higher in group 1 as compared to group 2, and since not all endometrial pathology could be assessed by ultrasound and since the endometrial pathology could decrease the receptivity of endometrium regardless the thickness, this may explain the poor pregnancy out come for some of the patients in the current study who had good endometrial thickness with high uterine arteries pulsatility and resistivity indeces (Sindhu, 2021), and based on that we could strongly recommend the uterine arteries doppler study as a predictor for endometrial receptivity and as an easy tool that help us dispense with the more complicated methods of diagnosis, and we can conclude that the drugs used in the current study that actively reduced the uterine arteries pulsatility and resistivity indeces may also minimize the effect of some undiagnosed endometrial pathology on the receptivity and overcomes it's effects. Regarding exogeneous estrogen supplements groups (esterofem and vagifem) who had the highest resistance and pulsatility indeces with poor pregnancy rates among study groups in spite of the good endometrial thickness that could be achieved especially for vaginal form, speaking about this finding, Dogan, Yildiz, Temizkan and Pulatoglu also found that there is statistically significant difference between endometrial, ovarian, uterine artery blood flow resistance in ovulatory and anovulatory cycles, blood flow resistance was found to be increased in anovulatory patients and increased E2 levels in anovulatory cycles were related to endometrial line thickness and endometrial volume, which support the current study finding and could explain the poor pregnancy rates for the estrogen supplement groups in the study by the anovulatory cycles, the uterine artery, and endometrial blood flow high resistance that combine the increased estrogen level (Dogan, et al, 2016), Dören, Rübig, Coelingh Bennink and Holzgreve on other had tested the effect tibolone (a synthetic estrogen replacement steroid) the vascular resistance and found that tibolone had increased the resistance index of arcuate arteries (Dören, Rübig, Coelingh Bennink and Holzgreve, 2000), Patil, Venkatappa and Patil used two forms of estrogen supplement oral and local (transdermal) and found that there was no statistical difference in the endometrial blood flow between the study groups which also agreed with the results of the current study since two estrogen forms in this study shows a comparable uterine arteries and subendometrial flow dynamics among other drugs used in the study (Patil, et al, 2021). Several other studies disagreed with the current study result regarding increase the resistance and pulsatility indeces after exogeneous estrogen supplement forms like De Ziegler, Bessis and Frydman, and Doren, Schwenkhagen, Schneider and Holzgreve, this may be due to most of these studies were carried out on either post-menopausal women or women with in active or nonfunctioning ovaries who have very low endogenous estrogen level unlike the women in the current study or could be due to the short course and lower dose of estrogen used in this study may be not enough to cause the sufficient vasodilation effect of estrogen supplement that improve the uterine and endometrial blood supply (De Ziegler, et al 1992; Doren et al, 1995).…”

Uterine artery blood flow and microvessel density by vaginal color Doppler ultrasonography in embryo implantation failure

“…Factors affecting endometrial receptivity include endometrial thickness, blood supply and other factors ( 4 – 6 ). Vaginal color Doppler ultrasonography is a non-invasive and easy to operate imaging method with great clinical application in the detection of endometrial receptivity that has attracted more attention lately ( 7 – 9 ). However, the blood flow parameters used in the evaluation of endometrial receptivity by vaginal color Doppler ultrasonography have not been determined ( 10 ).…”

A comparison between uterine artery blood flow in fertile and unexplained infertile women by Doppler ultrasound using pulsatility index and resistance index

“…23 menstrual cycle, the impedance to uterine artery reduces to the lowest values to increase endometrial perfusion and help implantation. 12,21,[24][25][26][27][28] Therefore, a high resistance during luteal phase can be a cause of unexplained infertility. 24 The cause of increased uterine artery impedance in infertile women may be explained by attenuation in the uterine artery response to the circulating ovarian hormones 12 .…”

“…11 In a normal cycle, there is a higher early and late uterine artery PI with lower levels during the mid-cycle or luteal phase. [12][13] In addition, some studies showed that there is low resistance to flow during late follicular and mid luteal phases which are the time when endometrium thickens and its vascularity increases. [13][14][15] The decreased PI during luteal phase with the increase of blood velocity and its vascularity indicates that there is increased uterine perfusion, and preparation for implantation and increased rate of pregnancy.…”