Power Doppler ultrasound assessment of follicular vascularity in the early follicular phase and its relationship with outcome of in vitro fertilization

Abstract

Objective : To determine whether ovarian perifollicular blood flow (PFBF) in the early follicular phase (EFP) was associated with treatment outcome. Design : Retrospective longitudinal cohort study. Setting : Tertiary referral centre/university hospital. Patients : Thirty-four women underwent 37 IVF cycles, which resulted in 35 embryo transfers. Interventions : Serial transvaginal scans using power Doppler ultrasound during the follicular phase. Ovarian PFBF of follicles ≥ 5 mm was subjectively assessed using a modified grading system (grades 0-4). Main outcome measures : Ovarian PFBF and pregnancy. Results : Treatment cycles were retrospectively divided into two groups: Group 1 (n = 20) had cycles with at least one small (5-10 mm) or medium (11-14 mm) size follicle(s) of high grade (2-4) PFBF on cycle day 5 or 6 or 7; and Group 2 (n = 17), had cycles that did not. Group 1 had a significantly higher proportion of high grade large follicles in the late follicular phase (35% vs. 21%) (OR 2.0; 95% CI 1.1-3.7) and higher clinical pregnancy rate (47% vs. 12%) (OR 6.3; CI 1.1-35.7) compared to Group 2. Conclusion : High grade ovarian PFBF in the EFP during IVF is associated with both high grade PFBF in the late follicular phase and a higher clinical pregnancy rate.

Relationship of vascular perfusion of the wall of the preovulatory follicle to in vitro fertilisation and embryo development in heifers

“…The positive effect of the extent of follicle vascularity on recovery of the oocyte was indicated by a greater increase in percentage of the follicular wall with colour Doppler signals of blood flow and by a decrease in spectral indices (decreased indicesZincreased vascular perfusion) between hours 0 and 26 in the follicles with oocyte recovery than with non-recovery. The greater vascularity of the follicular wall in association with oocyte recovery is a novel finding in cattle and agrees with findings in women (Bhal et al 2001, Du et al 2006, Shrestha et al 2006) and the tendency for a similar finding in mares . Preovulatory follicular vascular involvement in the subsequent in vitro cleavage of the recovered oocytes was indicated by the lower resistance indices (greater increase in vascular perfusion) at hour 26 than hour 0 (interaction) for a vessel of the follicular wall in the cleavage group.…”

“…Bhal et al (2001) reported that follicle vascularity is a factor in determining the success of pregnancy establishment after intrauterine insemination. Greater blood flow in the wall of the preovulatory follicle also has been associated with improved rates of in vitro fertilisation (IVF) and embryo development (Bhal et al 1999, Coulam et al 1999, Huey et al 1999, Du et al 2006, Shrestha et al 2006. These studies have indicated that colour Doppler ultrasonographic analysis of individual preovulatory follicles for collection of oocytes for IVF in women may favour selection of oocytes with better development and implantation potential of the embryos.…”

“…In summary, greater vascularity of the preovulatory follicle has been associated with greater follicular diameter (women: Bhal et al 1999, mares: Silva et al 2006, heifers: Siddiqui et al 2009b, retrieval rate of oocytes (women: Bhal et al 1999, mares: Ginther et al 2007, retrieval rate of mature oocytes (mares: Ginther et al 2007, Siddiqui et al 2009a, fertilisation rate (women: Bhal et al 1999Bhal et al , 2001) and pregnancy rate (women: Bhal et al 1999, Coulam et al 1999, Huey et al 1999, Du et al 2006, Shrestha et al 2006, mares: Silva et al 2006, heifers: Siddiqui et al 2009b, and lower incidence of triploidy (women: Bhal et al 2001). Studies on the relationship between blood-flow characteristics of the wall of the preovulatory follicle to oocyte retrieval and maturity have been done only in women and mares, and studies on fertilisation and embryo development of the oocyte after IVF have been done only in women.…”

Follicle and corpus luteum size and vascularity as predictors of fertility at the time of artificial insemination and embryo transfer in beef cattle

“…Follicle vascularity and its effects on fertility had been investigated in mares (Silva et al 2006) and cows (Shrestha et al 2006, Siddiqui et al 2008). Near ovulation, was shown that an extensive vascularity is formed in the follicular wall until the ovulation occurs (Geva & Jaffe 2000, Reisinger et al 2007).…”

Variations in vascular endothelial growth factor levels during ovarian superovulation and reduction of ovarian hyperstimulation incidence in young women: A prospective study

“…Several studies have been able to demonstrate an association between increases in perifollicular blood flow on power Doppler ultrasound [19] and follicular volume on three-dimensional ultrasonography [20] with higher clinical pregnancy rates. It has already been established that as the follicle size enlarges, the follicular blood flow and follicular fluid VEGF concentrations increase significantly [21].…”