Blood flow changes in the ovarian and uterine arteries in women with polycystic ovary syndrome who respond to clomiphene citrate: correlation with serum hormone concentrations.

Abstract

Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels in women with polycystic ovary syndrome (PCOS) and to relate the vascular changes to hormonal indices. Six women with a history of previous anovulatory cycles and/or oligomenorrhea and/or elevated serum luteinizing hormone concentrations in addition to polycystic ovaries underwent induction of ovulation with clomiphene citrate. Serial transvaginal ultrasonography was performed on menstrual cycle day 2, daily from the estimated day of ovulation minus 6, 6-hourly from the estimated day of ovulation minus 2 or when the mean follicular diameter was greater than 16 mm (whichever was earlier) until 6 h after follicular rupture, and once 7 days after follicular rupture. At each scan, uterine and intraovarian blood flow was assessed by transvaginal color Doppler ultrasound, and serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone were assessed by fluoroimmunoassay. All six women demonstrated ultrasonographic features of ovulation. Follicular peak systolic blood flow velocity (Vmax) and ovarian stromal Vmax in the dominant ovary increased during the follicular phase of the menstrual cycle and reached a peak at 36 and 42 h after the onset of the LH surge of 30.7 +/- 4.6 cm/s and 37.0 +/- 3.9 cm/s, respectively. There was no significant change in the ovarian stromal Vmax of the non-dominant ovary. There was no significant change in the pulsatility index (PI) in either the follicular or the ovarian stromal vessels during the menstrual cycle. The changes in follicular Vmax correlated significantly with changes in serum concentrations of FSH, LH and progesterone. Uterine artery time-averaged maximum velocity (TAMX) declined to its lowest levels at LH surge minus 6 days, and thereafter increased. In contrast, the PI increased during the follicular phase of the cycle, reaching a peak at LH surge minus 4 days, and thereafter declined. The changes in uterine artery PI correlated inversely with serum estradiol and serum progesterone concentrations. Women with PCOS have significant differences in intraovarian and uterine artery hemodynamics, both at the baseline ultrasound scan and during the clomiphene-induced menstrual cycle, compared with women with normal ovaries. The intraovarian and uterine artery vascular differences are likely to be due to a primary disorder within the polycystic ovary and their different hormonal status. Clomiphene citrate may have an effect on uterine artery blood flow.