Undetectable basal ovarian stromal blood flow in infertile women is related to low ovarian reserve

Abstract

To gain insight into the physiological significance of basal ovarian stromal blood flow and to assess whether its detection ability is related to ovarian reserve in infertility patients undergoing in vitro fertilization (IVF) - embryo transfer (ET) treatment. Thirty two consecutive infertile women scheduled for IVF-ET treatment were prospectively evaluated. Basal ovarian hormonal, ovarian volume and stromal blood flow studies were performed on day 3 of a natural cycle before treatment. The performer of the ultrasound studies was blinded to the clinical data. Women in the study were divided into two groups in accordance with estradiol level on the day of administration of human chorionic gonadotropin. Day-3 follicle-stimulating hormone and ovarian volume were significantly poorer in the women with low (group A) as compared with good (group B) ovarian reserve. Likewise, the numbers of follicles > or =14 mm in diameter, oocytes retrieved and embryos achieved were significantly lower in group A than group B. Six clinical pregnancies were obtained in group B, whereas no pregnancy was obtained in group A. Nine out of the 15 (60%) women in group A had undetectable basal stromal blood flow in at least one of the ovaries, whereas only one of the 17 (6%) women in group B had undetectable flow (p < 0.002). Basal stromal peak systolic blood flow velocity, pulsatility index and resistance index mean values did not differ significantly between the two groups. We conclude that undetectable basal ovarian stromal blood flow in at least one ovary is related to low ovarian reserve in infertile women undergoing IVF-ET. It seems that undetectable basal stromal blood flow is not solely a technical issue, but rather linked to the pathophysiology of ovarian aging.

Age-specific nomogram for the decline in antral follicle count throughout the reproductive period

“…The median age (25th-75th centile) of women was 38 (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42) and median (25th-75th centile) of the AFC was 8 (5)(6)(7)(8)(9)(10)(11)(12). The median, interquartiles, and lowest and highest values of ovarian AFCs for different age groups are illustrated in Figure 1.…”

“…Ovarian reserve tests include a variety of biochemical and ultrasound parameters (1)(2)(3)(4). Currently available ultrasound tests of ovarian reserve include antral follicular count (AFC), ovarian volume, and Doppler assessment of ovarian blood flow (5)(6)(7)(8)(9).…”

Prospective evaluation of basal stromal Doppler studies in women with good ovarian reserve and infertility undergoing in vitro fertilization–embryo transfer treatment: patients with polycystic ovary syndrome versus ovulatory patients

“…Decreased stromal flow has been reported in women with low ovarian response or reserve (12)(13)(14). Moreover, low ovarian reserve is a prevalent condition estimated to affect 9% to 24% of women undergoing IVF-ET (15).…”

“…Therefore, for the stromal flow in patients with PCOS to be assessed properly, women with low ovarian reserve should be excluded a priori from evaluation in the control group. Moreover, although the issue of ovarian response as related to ovarian stromal blood flow has been investigated (12)(13)(14), the issue of pregnancy achievement in women with PCOS as related to stromal flow in an assisted reproductive technologies (ART) setting has not been explored satisfactorily.…”

Current understanding of ovarian aging

“…Considering the ease of measurement, low cost and reliability, AFC has become one of the most commonly used ultrasonic markers of ovarian reserve in clinical practice [145]. In woman with poor ovarian reserve, stromal blood flow has been shown to be reduced or absent by Doppler assessment [146] . It is possible that ovarian stromal flow is used in the prediction of premature ovarian aging.…”