P20.14: 3D power Doppler measurement of perifollicular vascularization in normal and polycystic ovaries during in vitro fertilization

Abstract

Ovarian angiogenesis and subsequent intrafollicular O2 content is a critical point IVF outcome. We wanted to evaluate the differences in ovarian perifollicular blood flow (PFBF) in normal and polycystic ovaries (PCOS) during IVF by using three-dimensional power Doppler (3D pD). 80 unexplained infertile women and 74 women with ultrasound evidence of PCOS were enrolled. Controlled ovarian hyperstimulation (COH) was induced by long or short protocol + rFSH (β-follitropin). A GE 730Voluson machine with a transvaginal volume transducer was used. 3DpD was used to assess total follicle number per ovary (FNPO), ovarian volume (OV) and ovarian vascularization indexes (OVI). Stored volumes were analyzed by the VOCAL™ program. Mean greyness-MG, vascularization index, flow index and vascularization flow index were serially calculated throughout the follicular phase of ovarian stimulation. Serum FSH, LH and insulin were also checked. We observed conflicting results in PCOS women as OVI appeared positively related to FNPO rather than OV or FSH/LH levels. In the presence of FNPO ≥ 20 OVI were all significantly higher in PCOS women, than in normal ones, in every step of stimulated cycles independently from pituitary down regulation, whereas in the presence of FNPO ≥ 12 but⩽20 (consensus standard) OVI were lower in PCOS women following pituitary suppression. MG values were similar in both groups but total stromal area was significantly increased in PCOS. Normoandrogenic ovulatory women needed a higher amount of β-follitropin to get the same PFBF vascularization indexes than the PCOS ones. Insulin resistance appeared positively related with OVI increasing. PCOS is a heterogeneous disease. FNPO better relate with ovarian vascularization and angiogenesis during COH than FSH/LH levels or OV. Women with a total FNPO ≥ 20 are at higher risk of ovarian hyperstimulation. Insulin resistance may play a role in ovarian hyper response in PCOS.