Ovarian stromal vascularity evaluated by Doppler correlates with the dose of FSH used during in vitro fertilization(IVF) stimulation

Abstract

OBJECTIVE: Consistent with other biological models, the delivery of nutrients via the bloodstream to a developing ovum must have some impact on follicular growth. While direct measurement is experimentally difficult, ultrasound blood flow analysis has been suggested to be an acceptable surrogate. This study was designed to assess a correlation between ovarian blood flow prior to stimulation and the dose of FSH required for IVF stimulation.DESIGN: Prospective, observational, comparative, single center.MATERIALS AND METHODS: Reproductive endocrinology tertiary care private institution. Patients: Cohort of 59 patients undergoing 60 cycles of IVF stimulation enrolled between April and June 2008. Observational Data Collected: Ovarian Stromal Doppler was performed prior to IVF stimulation, and included Power Doppler Ultrasound (PDU) and Color Doppler Ultrasound (CDU) with pulsed Doppler (PW) Flow Velocity Waveform (FVW). Both semi-quantitative and quantitative evaluations were performed using a semi-quantitative grading system by PDU and calculation by CDU/PW/FVW of Resistance Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV) and Time Averaged Maximum Velocity (TAMX). Main Outcome Measures: The dose of FSH used during IVF stimulation in relation to the above parameters.RESULTS: Analysis of non-experimental background variables showed no significant differences between the pregnant and non-pregnant groups. Statistically significant correlations were noted between pre-stimulation ovarian stromal PSV, TAMX, PDU score and the dose of FSH administered during stimulation. The statistical significance of these findings was confirmed by multivariable regression analysis. Doppler findings were more predictive of FSH dose than was patient age.CONCLUSIONS: The pre-stimulation Ovarian stromal ultrasound vascular evaluation accurately predicts the dose of FSH required to achieve optimal IVF stimulation. OBJECTIVE: Consistent with other biological models, the delivery of nutrients via the bloodstream to a developing ovum must have some impact on follicular growth. While direct measurement is experimentally difficult, ultrasound blood flow analysis has been suggested to be an acceptable surrogate. This study was designed to assess a correlation between ovarian blood flow prior to stimulation and the dose of FSH required for IVF stimulation. DESIGN: Prospective, observational, comparative, single center. MATERIALS AND METHODS: Reproductive endocrinology tertiary care private institution. Patients: Cohort of 59 patients undergoing 60 cycles of IVF stimulation enrolled between April and June 2008. Observational Data Collected: Ovarian Stromal Doppler was performed prior to IVF stimulation, and included Power Doppler Ultrasound (PDU) and Color Doppler Ultrasound (CDU) with pulsed Doppler (PW) Flow Velocity Waveform (FVW). Both semi-quantitative and quantitative evaluations were performed using a semi-quantitative grading system by PDU and calculation by CDU/PW/FVW of Resistance Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV) and Time Averaged Maximum Velocity (TAMX). Main Outcome Measures: The dose of FSH used during IVF stimulation in relation to the above parameters. RESULTS: Analysis of non-experimental background variables showed no significant differences between the pregnant and non-pregnant groups. Statistically significant correlations were noted between pre-stimulation ovarian stromal PSV, TAMX, PDU score and the dose of FSH administered during stimulation. The statistical significance of these findings was confirmed by multivariable regression analysis. Doppler findings were more predictive of FSH dose than was patient age. CONCLUSIONS: The pre-stimulation Ovarian stromal ultrasound vascular evaluation accurately predicts the dose of FSH required to achieve optimal IVF stimulation.