Perifollicular vascularity as a potential variable affecting outcome in stimulated intrauterine insemination treatment cycles: a study using transvaginal power Doppler

• Published in: Human reproduction (Oxford) Vol. 16; no. 8; pp. 1682 - 1689
• Main Authors: Bhal, P.S., Pugh, N.D., Gregory, L., O'Brien, S., Shaw, R.W.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.08.2001
• Subjects: Adult; Biological and medical sciences; Birth control; Buserelin - administration & dosage; Chorionic Gonadotropin - administration & dosage; Cross-Sectional Studies; Estradiol - blood; Female; Gynecology. Andrology. Obstetrics; Humans; Insemination, Artificial, Homologous; intrauterine insemination; Logistic Models; Luteinizing Hormone - blood; Medical sciences; Ovarian Follicle - blood supply; Ovarian Follicle - diagnostic imaging; perifollicular vascularity; power Doppler; Pregnancy; Pregnancy, Multiple; Prospective Studies; Sterility. Assisted procreation; stimulated cycles; Treatment Outcome; ultrasonography; Ultrasonography, Doppler; power Doppler; perifollicular vascularity; stimulated cycles; intrauterine insemination; ultrasonography; Doppler ultrasound study; Sonography; Human; Intrauterine administration; Assisted procreation; Stimulation; Result; Vascularization; Ovary; Treatment; Transvaginal route; Female genital system; Artificial insemination; Female; Ovarian follicle
• ISSN: 0268-1161; 1460-2350; 1460-2350
• DOI: 10.1093/humrep/16.8.1682

BACKGROUND: The aim of the present study was to assess any potential relationship between perifollicular vascularity and outcome in an in-vivo environment following human chorionic gonadotrophin (HCG) administration. METHODS: A total of 182 unselected consecutive patients undergoing stimulated intrauterine insemination (IUI) cycles was recruited where the perifollicular vascularity of follicles ≥16 mm was studied using a subjective grading system and transvaginal power Doppler ultrasonography, 36 h after HCG administration. RESULTS: A total of 601 follicles was studied. The incidence of follicles showing high-grade perifollicular vascularity (3 and 4) was higher than those with low-grade vascularity (1 and 2) (80 versus 20%). Treatment cycles were divided according to uniformity of vascularity grades of follicles ≥16 mm on the day of IUI [55% all high (3/4) grade; 33% mixed (1/2 and 3/4) and 12% all low (1/2) grade]. The mean age and duration of subfertility were significantly higher (P < 0.05), whereas the number of follicles ≥16 mm pre/post HCG, serum oestradiol and incidence of ultrashort gonadotrophin-releasing hormone (GnRH) agonist use were all significantly lower (P < 0.05) in treatment cycles with uniformly low follicular vascularity grades compared with mixed or uniformly high-grade cycles. However, on subjecting the data to multiple logistic regression analysis, the only independent variables that affected pregnancy rates appeared to be serum oestradiol (OR 1.28, 1.01–1.62) and high-grade follicular vascularity (OR 2.41, 1.08–5.40). CONCLUSION: These data would suggest that perifollicular vascularity has an important role to play in the outcome of IUI cycles, and that power Doppler has the potential to refine the management of assisted reproduction treatment cycles.