Abstract
Objective: The aim of this study is to assess any potential relationship between perifollicular vascularity and occurrence of pregnancy in cases of stimulated IUI cycles using the subjective grading system by 2D transvaginal power Doppler ultrasonography. Design: A prospective cross sectional cohort study. Method: This is a prospective cross-sectional cohort study of 90 stimulated IUI treatment cycles. Selected women were prescribed clomiphene citrate combined with highly purified urinary follicle stimulating hormone. All patients underwent serial transvaginal ultrasound scans starting from day 6 to 7 of the cycle. Perifollicular Doppler blood flows were assessed in dominant follicles ≥18 mm. The patients then were categorized into 3 groups (high vascularity group {G3 & G4}, low vascularity group {G1 & G2} and mixed grades group). Other parameters measured included number of follicles ≥ 18 mm in both ovaries, endometrial thickness and estradiol (E2) level . Human chorionic gonadotropin (hCG) injection 10,000 IU IM was given to the patient when the dominant follicle reached 18 mm in diameter. At that time, the endometrium was evaluated as regards endometrial thickness. IUI was carried out using prepared/“washed” semen (husband). All patients received luteal support in the form of progesterone from day of IUI for 14 days. Serum Β-hCG was estimated 2 weeks after insemination. Results: In this study, from all 90 cases only 8 cases got pregnant with pregnancy rate of 8.88% (6 cases got pregnant in high grade vascularity group; 2 cases in mixed grades group and no cases got pregnant in low grade group). There was statistically significant difference among the 3 groups as regarding the pregnancy rate (P value = 0.02). There is statistically significant difference in perifollicular resistance index (RI) and pulsatility index (PI) between pregnant and non pregnant cases (P value = 0.016 and 0.047 respectively). In this study, there is no statistically significant difference between pregnant and non pregnant cases as regarding endometrial thickness and E2 level at the day of hCG administration (P value = 0.39 and 0.76 respectively). Conclusion: Perifollicular blood-flow assessment by 2D transvaginal power Doppler is a good predictive for the outcome of stimulated IUI cycles.
Highlights
Intrauterine insemination (IUI) has long been established as an alternative to other forms of assisted reproductive techniques (ART)
Greater blood flow in the wall of the preovulatory follicle has been associated with improved pregnancy rates of IUI [5] and in vitro fertilization (IVF) and embryo transfer [4]
The aim of this study is to assess any potential relationship between perifollicular vascularity and occurrence of pregnancy in cases of stimulated IUI cycles using the subjective grading system by transvaginal Doppler ultrasonography
Summary
Intrauterine insemination (IUI) has long been established as an alternative to other forms of assisted reproductive techniques (ART). Transvaginal color flow Doppler has been used in several studies to assess uterine and ovarian blood flow patterns in ART cycles [4]-[7]. Greater blood flow in the wall of the preovulatory follicle has been associated with improved pregnancy rates of IUI [5] and in vitro fertilization (IVF) and embryo transfer [4]. Follicular blood-flow assessment by transvaginal color flow Doppler has been used during oocyte retrieval for selection of oocytes with better development as the vascularity tended to be greater for preovulatory follicles that contained a mature oocyte [7]. The aim of this study is to assess any potential relationship between perifollicular vascularity and occurrence of pregnancy in cases of stimulated IUI cycles using the subjective grading system by transvaginal Doppler ultrasonography
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