Comparison of follicular blood flow and follicular fluid concentrations of vascular endothelial growth factor and nitric oxide as prognostic factors in the outcome of in vitro fertilization

Abstract

Objectives: The aims of this prospective study were to investigate the relationship between the outcome of in vitro fertilization and follicular blood flow, ovarian blood flow, and the follicular fluid concentration of vascular endothelial growth factor and nitric oxide to determine whether these factors might be outcome predictors. Design: This study was performed in 47 cycles who underwent in vitro fertilization with tubal factor (25 cycles) and male factor (22 cycles) at infertility clinic of Pusan National University Hospital from Feb. 2002 to June 2002. Materials and Methods: Ultrasound images of follicular and ovarian blood flow were estimated on the day of hCG administration. Each follicular fluid (FF) was collected at the oocyte retrieval and FF concentrations of vascular endothelial growth factor (VEGF) and nitric oxide(NO) were assessed. FF VEGF concentrations were measured using an enzyme-linked immunosorbent assay (Quantikine Human VEGF Immunoassay, R&D Systems Inc., Minneapolis, MN, USA). FF concentrations of nitrite/nitrate were determined colorimetrically by the Griess reaction. The color reaction was allowed to develop for 5 min at room temperature, after which the absorbance at 540 nM was recorded. Results: Follicular blood flow was significantly increased in the pregnant group compared to the nonpregnant group. However, age, dosage of gonadotropin administered, estradiol on hCG day, the number of oocytes retrieved, fertilization rate, No. of embryos transferred, ovarian blood flow, and FF concentrations of VEGF and NO were not significantly different in two goups. There were no differences in any clinical and laboratory parameters including the number of oocytes retrieved, fertilization rate, No. of embryos transferred, pregnancy rate, FF concentrations of VEGF and NO, and follicular blood flow according to the causes of infertility or age. As folliclular size increases, follicular blood flow and FF concentration of VEGF concentration were increased, but FF concentration of NO were decreased. No correlation existed between FF concentrations of VEGF and NO. The number of oocytes retrieved, the number of mature oocytes, and fertilization rate were not correlated with ovarian blood flow and FF concentrations of VEGF and NO. Conclusions: These results suggest that follicular blood flow might be an effective prognostic marker of the pregnancy outcome of in vitro fertilization rather than FF concentrations of VEGF or NO, and demonstrate that follicular blood flow and FF concentration of VEGF and NO were correlated significantly with follicular size. However, these study do not show that age was correlated with FF concentrations of VEGF and NO, ovarian blood, or follicular blood flow.