Blood Flow In Women Research Articles

Evaluation of Uterine Biophysical Profile in unexplained infertility and to assess its prognostic value in predicting pregnancy

OBJECTIVE: To evaluate Uterine Biophysical Profile (UBP), an ultrasonographic uterine scoring system in women with unexplained infertility and to assess its prognostic value in predicting pregnancy.DESIGN: Prospective, observational study.MATERIALS AND METHODS: 30 women with unexplained infertility were evaluated for morphometric and Doppler characteristics of the endometrium including endometrial thickness, endometrial layering, endometrial blood flow in zone 3, pulsatility index of the uterine artery and myometrial ecogenicity, using transvaginal sonography and color Doppler, on day 2-3(baseline), day 11-13(periovulatory) and day 21-23(midluteal) of spontaneous cycle. Each parameter was scored using modified Uterine Scoring System for Reproduction. A total score for each phase was calculated by adding the values of individual variables. The cohort was followed up for 3 months. The UBP of women who subsequently conceived was compared to those who failed to conceive, to determine the applicability of the score to predict pregnancy.Table 1Periovulatory UBP: mean scores and significance levelsParameterConceived(n=13)Not conceived(n=17)PEndometrial thickness2.312.24NSEndometrial layering2.772.71NSEndometrial blood flow3.772.290.031Pulsatility index1.771.000.026Myometrial echogenicity1.922.00NSPeriovulatory total score12.5410.240.017NS = Not significant. Open table in a new tab Eleven out of 20 women (55%) with PTS of 11-15 conceived. Only 2/9 (22.2%) with PTS of 6-10 resulted in pregnancy while none with a score<5. On ROC analysis, PTS emerged as the most important variable to predict pregnancy (p<0.04, OR 1.48). PTS cut off of 11 or above was identified as the best predictor of pregnancy (sensitivity 84%, specificity 47%, positive predictive value 84.6%, negative predictive value 47.6%).CONCLUSIONS: In the present study, UBP demonstrated decreased endometrial receptivity especially poor endometrial blood flow in women with unexplained infertility who failed to conceive. Thus, UBP can prove to be a simple, rapid and non invasive tool to predict the uterine environment. OBJECTIVE: To evaluate Uterine Biophysical Profile (UBP), an ultrasonographic uterine scoring system in women with unexplained infertility and to assess its prognostic value in predicting pregnancy. DESIGN: Prospective, observational study. MATERIALS AND METHODS: 30 women with unexplained infertility were evaluated for morphometric and Doppler characteristics of the endometrium including endometrial thickness, endometrial layering, endometrial blood flow in zone 3, pulsatility index of the uterine artery and myometrial ecogenicity, using transvaginal sonography and color Doppler, on day 2-3(baseline), day 11-13(periovulatory) and day 21-23(midluteal) of spontaneous cycle. Each parameter was scored using modified Uterine Scoring System for Reproduction. A total score for each phase was calculated by adding the values of individual variables. The cohort was followed up for 3 months. The UBP of women who subsequently conceived was compared to those who failed to conceive, to determine the applicability of the score to predict pregnancy. NS = Not significant. Eleven out of 20 women (55%) with PTS of 11-15 conceived. Only 2/9 (22.2%) with PTS of 6-10 resulted in pregnancy while none with a score<5. On ROC analysis, PTS emerged as the most important variable to predict pregnancy (p<0.04, OR 1.48). PTS cut off of 11 or above was identified as the best predictor of pregnancy (sensitivity 84%, specificity 47%, positive predictive value 84.6%, negative predictive value 47.6%). CONCLUSIONS: In the present study, UBP demonstrated decreased endometrial receptivity especially poor endometrial blood flow in women with unexplained infertility who failed to conceive. Thus, UBP can prove to be a simple, rapid and non invasive tool to predict the uterine environment.

Endometrial thickness and pattern, uterine and sub-endometrial blood flow in women with unexplained infertility undergoing COH and IUI

OBJECTIVE: Poor receptivity of the endometrium during the peri-implantation period may be one of the potential causes in women with unexplained infertilty. The objective of the study was to assess endometrial thickness and pattern, uterine and sub-endometrial blood flow and their changes during peri-implantation period in predicting pregnancy rate in women with unexplained infertility undergoing COH with IUI.

Low-dose aspirin and omega-3 fatty acids improve uterine artery blood flow velocity in women with recurrent miscarriage due to impaired uterine perfusion

To determine the effect of different therapeutic approaches on uterine artery blood flow in women with recurrent miscarriage (RM) and impaired uterine perfusion. Prospective, randomized study. Department of Obstetrics and Gynecology, University of Rome "Tor Vergata," Italy. Sixty women with unexplained RM and impaired uterine perfusion. Patients were randomly assigned to three different therapeutic regimens: 20 patients received a daily dose of 100 mg of aspirin (LDA); 20 patients were treated with omega-3 fatty acids (Omega(3)), 4 g daily; and 20 patients received LDA plus Omega(3). Doppler measurement of uterine artery pulsatility index (PI) was performed, in the midluteal phase of the cycle, before and after 2 months of therapy. All therapeutic regimens induced an improvement in uterine perfusion with a significant reduction of uterine artery PI values. LDA alone or in combination with Omega(3) was found to achieve the highest improvement of uterine blood flow. Omega-3 supplementation was less effective, as reflected by the lower PI values. LDA and Omega(3) are effective in improving uterine artery blood flow velocity in women with RM due to abnormal uterine perfusion. Further studies are needed to determine whether the improvement of uterine perfusion may lead to a better pregnancy outcome.

T01-O-08 Effects of surgery for stress urinary incontinence on the clitoral blood flow

Objectives To study the effects of the mini-invasive surgery using the tension free vaginal tape (TVT) procedure and the transobturator tape (TOT) procedure in modifying clitoral blood flow in women affected by stress urinary incontinence (SUI). Methods The setting of the prospective open clinical study was the Urogynecologic Service. Forty-two women (mean age 52.8 ys) and 63 women (mean age 53.9 ys) were treated with TVT and TOT, respectively. Each woman underwent translabial color Doppler sonography to measure the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV) and end diastolic velocity (EDV) of clitoral arteries, before and 6 months after surgery treatment. Results In the TVT women the mean PI and the mean PSV were significantly lower, and the mean RI was significantly higher compared with pre treatment values (p Conclusions The different vaginal approach for both of the surgical methods influence the clitoral blood-flow. Our data stimulate to study the sexual aspects after incontinence treatment, particularly, the possible impact of clitoral flow changes on sexual function.

Clitoral Blood Flow Changes After Surgery for Stress Urinary Incontinence: Pilot Study on TVT Versus TOT Procedures

To study the effects of mini-invasive surgery using the tension-free vaginal tape (TVT) procedure and the transobturator tape (TOT) procedure in modifying clitoral blood flow in women affected by stress urinary incontinence. The setting of the prospective open clinical study was the Urogynecologic Service of the Department of Microbiological and Gynecological Science, University of Catania School of Medicine (Catania, Italy). A total of 105 women underwent surgery; 42 (mean age 52.8 years) and 63 (mean age 53.9 years) were treated with TVT and TOT, respectively. Each woman underwent translabial color Doppler ultrasonography to measure the resistance index, pulsatility index, peak systolic velocity, and end-diastolic velocity of the clitoral arteries, before and 6 months postoperatively. In the TVT group, the mean pulsatility index and mean peak systolic velocity were significantly lower and the mean resistance index was significantly greater compared with the pretreatment values (P <0.5). In the TOT group, each color Doppler measurement was similar to that obtained at baseline (P = NS). The different vaginal approach for these two surgical methods influenced clitoral blood flow. Our data could add new information about sexual behavior after incontinence treatment, particularly the impact of clitoral blood flow changes.

Color doppler sonographic analysis of uterine and ovarian artery blood flow in women with polycystic ovary syndrome

To study the blood flow patterns of utero-ovarian circulation in polycystic ovary syndrome (PCOS) and to assess their relationship with clinical, metabolic, and hormonal data. Forty-three women with PCOS and 43 age-matched healthy controls underwent Doppler examination of the utero-ovarian circulation in the follicular phase. Demographic, hormonal, and metabolic parameters were determined. Student's t-test, chi(2)-test, and Spearman correlation test were used for statistical analysis. The ovarian artery pulsatility index (PI), resistance index (RI), and SD ratios were significantly lower in PCOS than in controls on the right side (p < 0.001, p = 0.02, p = 0.001, respectively) as well as on the left side (p < 0.001, p < 0.001, p < 0.001, respectively). The uterine artery systolic/diastolic (S/D) ratio was higher on both sides (p = 0.01) and the PI was higher on the left side (p = 0.02) in PCOS than in controls. The right uterine artery PI was positively correlated with luteinizing hormone and hemoglobin (r = 0.417, p = 0.043; r = 0.427, p = 0.033, respectively), the right uterine artery S/D was positively correlated with body mass index (r = 0.479, p = 0.015), and the left uterine artery PI was positively correlated with insulin (r = 0.458, p = 0.021). Doppler sonography of the utero-ovarian circulation may contribute to the evaluation of PCOS patients and a better understanding of the pathophysiology of this syndrome.

Power doppler ultrasound assessment of the relationship between age and ovarian perifollicular blood flow in women undergoing in vitro fertilization treatment

To examine the relationship between age and ovarian perifollicular blood flow (PFBF) in women undergoing IVF. Serial transvaginal power Doppler ultrasound (PDU) scans to assess ovarian PFBF were performed prospectively throughout the follicular phase of ovarian stimulation in women undergoing IVF. The ultrasound assessment days were categorized according to day of hCG trigger. A total of 1050 ovarian follicles from 34 women undergoing one IVF treatment cycle were used for data analysis. The median age of the women was 38.5 years, ranging from 28 years to 44 years. There was a significant negative correlation between age and ovarian PFBF on the day of hCG trigger or trigger day minus 1, but not beforehand during the follicular phase. There was a significant negative correlation between age and ovarian PFBF in women undergoing IVF which was only observed very late in the follicular phase of ovarian stimulation.

OP20.01: Ultrasonographic quantification of pelvic blood flow in women with variable manifestations of polycystic ovarian syndrome

OP20.01: Ultrasonographic quantification of pelvic blood flow in women with variable manifestations of polycystic ovarian syndrome

Endometrial, subendometrial, and ovarian stromal blood flow in patients treated with two different doses of recombinant human chorionic gonadotropin

The effects of two different doses of recombinant hCG on blood flow to the uterus and ovary on the day of oocyte retrieval were studied by three-dimensional Doppler ultrasonography in 60 women during IVF treatment. There were no differences in all the indices of endometrial, subendometrial, and ovarian stromal blood flow in women who had received 250 microg or 500 microg of recombinant hCG for final oocyte maturation.

Sexuality in women with epilepsy

Most women with epilepsy maintain normal reproductive cycles and sexual lives. However, a significant minority, approximately 20–30%, have some degree of sexual dysfunction, including problems with seizure exacerbation, libido, arousal, and orgasm. Fluctuating hormone levels may contribute to an array of reproductive cycling abnormalities. With regard to sexual dysfunction, there is some evidence of reduced genital blood flow in women with temporal lobe epilepsy. Other studies suggest that psychosocial factors, such as depression, feeling stigmatized, and being anxious about having seizures during sex, may contribute to the higher rates of sexual dysfunction in this patient population. Some antiepileptic drugs may adversely affect normal reproductive cycling and sexual function, particularly drugs that increase serotonergic transmission. Conversely, resective epilepsy surgery has been shown to restore sexual function. Treatments for sexual dysfunction include testosterone replacement, although transdermal testosterone replacement is not yet approved by the Food and Drug Administration for women. Given the possibility that women with epilepsy may experience inadequate vasocongestion during arousal, sildenafil may have a useful role, though it has not proved effective for women in general. This review focuses on potential sexual problems that are faced by women with epilepsy, with the suggestion that proper treatment may alleviate these problems.

Uterine arterial blood flow and the substances of ovarian renin–angiotensin system in women with polycystic ovaries undergoing in vitro fertilization

Objective To find whether plasma and follicular prorenin concentrations have any effect on the uterine arterial blood flow in women with polycystic ovarian syndrome (PCOS) compared to those with normal menstrual cycles (NMC). Study design Controlled prospective clinical study involved 55 women undergoing in vitro fertilization: 24 with PCOS and 31 with NMC. In both groups transvaginal colour Doppler assessment of uterine arterial blood flow was analysed on day 22 of the cycle, on the day of human chorionic gonadotrophin (HCG) administration and 36 h after HCG. Plasma and follicular (in the dominant follicle containing mature oocyte, and in the pooled follicles) prorenin and active renin, and serum estradiol and androstenedione concentrations were measured at these time-points. The Student's t-test and Pearson correlation were used for the statistical analysis. Results The resistance index (RI) in the NMC group decreased from 0.84 ± 0.05 on the day of HCG to 0.78 ± 0.08 36 h after HCG ( P < 0.05); in the PCOS group the RI did not decrease. Follicular prorenin concentrations in the dominant follicle and in the pooled follicles were lower in the PCOS than in the NMC group (20,210 ± 10,831 μU/l, 16,753 ± 8634 μU/l versus 42,637 ± 35,400 μU/l, 33,067 ± 26,200 μU/l; P < 0.05). Conclusions Plasma prorenin concentrations do not affect vascular impedance to the uterine artery, but follicular prorenin do by newly formed low resistant vessels in the follicles.

Ovarian size and blood flow in women with polycystic ovary syndrome and their correlations with endocrine parameters

To determine how common polycystic ovarian morphology may be in women given the clinical diagnosis of polycystic ovary syndrome (PCOS) based on chronic anovulation and hyperandrogenism and whether certain hormonal factors correlate with ovarian morphology and blood flow. Prospective study. Two academic endocrinology centers in Italy. Three hundred twenty-six women with PCOS and 50 age-matched and weight-matched ovulatory women. Ultrasound assessment of ovarian morphology in patients and controls and ovarian blood flow and fasting hormone levels in a subset of 50 patients and matched controls. Ovarian morphological assessments, ovarian blood flow by pulsatility index (PI) and resistance index (RI), and measurements of gonadotropins, estrogen, sex hormone-binding globulin, androgens, inhibin B, glucose, and insulin. Using strict ultrasound criteria, 195 woman (60%) had enlarged ovaries, 135 (35%) had normal ovarian size but characteristic morphology, and 16 (5%) had normal size and morphology. Ovarian blood flow was increased (reduced PI and RI) in PCOS. All hormonal parameters were elevated in PCOS. Ovarian size correlated only with insulin and a measure of insulin resistance. Ovarian blood flow correlated positively with insulin, T, free T, and E2 but not with luteinizing hormone. Inhibin B showed a negative correlation with ovarian blood flow. When a clinical diagnosis of PCOS was made, virtually all women were found to have characteristic ovarian morphology. Insulin correlated with increased ovarian size as well as with increased blood flow. Blood flow also correlated positively with sex steroids but negatively with inhibin B.

Blood Rheology and Risk of Thromboembolism in Adult and Climacteric Women

Increased age is associated with an increased thrombosing tendency, especially deep vein thrombosis and pulmonary embolism. We investigated blood flow in women of various age groups and found that blood flow decreases with advancing age. Because decreased blood flow can lead to platelet and leukocyte activation, it could be related to the pathogenesis of venous thromboembolism with age.

Comparison of ovarian stromal blood flow between fertile women with normal ovaries and infertile women with polycystic ovary syndrome

Conflicting information exists in the literature with respect to ovarian stromal blood flow in women with polycystic ovary syndrome (PCOS). We compared the ovarian stromal blood flow and serum vascular endothelial growth factor (VEGF) concentration between fertile women with normal ovaries and infertile women with PCOS. In the second to fourth day of the menstrual period, they underwent transvaginal scanning with three-dimensional (3D) power Doppler to determine total antral follicle count (AFC), total ovarian volume, total ovarian vascularization index (VI), flow index (VFI) and vascularization flow index (VFI). Serum FSH, LH and VEGF concentrations were also checked. 107 fertile controls and 32 PCOS women were recruited. Fertile controls and PCOS women had similar total ovarian VI/FI/VFI after controlling for age of the woman, although PCOS women had significantly higher total AFC, total ovarian volume and serum LH concentration than fertile controls. Total ovarian VI/FI/VFI were significantly higher in normal weight (BMI < 25 kg/m2) PCOS women than their overweight (> or = 25 kg/m2) counterparts. Fertile controls and PCOS women had similar total ovarian 3D power Doppler flow indices. Normal weight PCOS women had significantly higher total ovarian 3D power Doppler flow indices than their overweight counterparts.

Power Doppler ultrasound assessment of ovarian perifollicular blood flow in women with polycystic ovaries and normal ovaries during in vitro fertilization treatment

To evaluate whether ovarian perifollicular blood flow (PFBF) varies by ultrasound among women with polycystic and normal ovaries undergoing in vitro fertilization (IVF). Prospective observational cohort study of women undergoing IVF treatment. Department of reproductive medicine at a university teaching hospital. Thirty four women with regular spontaneous ovulatory menstrual cycles undergoing IVF divided into two groups according to findings on a baseline transvaginal ultrasound scan: group 1 consisted of 20 women with ultrasound-evident normal ovaries (USNO group), and group 2 consisted of 14 women with ultrasound-evident polycystic ovaries (USPCO group). Serial transvaginal power Doppler ultrasound assessments throughout the follicular phase of ovarian stimulation. Ovarian PFBF and ovarian stromal artery pulsatility index. Women with USPCO had a significantly lower ovarian stromal artery pulsatility index at the time of the first ultrasound assessment before starting the FSH injections compared with USNO women. However, there was no difference in ovarian PFBF between women with USPCO and USNO during the follicular phase of ovarian stimulation for IVF. There is no difference in ovarian follicular vascularity between women with polycystic and normal ovaries during ovarian stimulation at IVF treatment.

The effect of magnesium sulfate on large cerebral artery blood flow in preeclampsia

Objectives. To determine the effect of a 6 gram intravenous bolus of magnesium sulfate on maternal cerebral blood flow in women with preeclampsia.Study Desiqn. Velocity-encoded phase-contrast magnetic resonance imaging studies were performed on twelve preeclamptic women prior to and immediately after infusion of a 6 gram magnesium sulfate loading dose. Cerebral blood flow was determined at the bilateral proximal middle and posterior cerebral arteries. Study participants returned 6 weeks postpartum for a non-pregnant measurement of cerebral blood flow. The Wilcoxon paired-sample test was used with statistical significance defined as p<0.05.Results. There was no significant difference in cerebral vessel diameter nor blood flow for any of the examined arteries between the pre- and post magnesium sulfate therapy states.Conclusions. The absence of a significant difference in cerebral blood flow of the middle and posterior cerebral arteries before and after infusion of a 6 gram loading dose of magnesium sulfate in women with preeclampsia could suggest the absence of vasoconstriction of the large cerebral arteries in preeclampsia and question the role of magnesium sulfate as a vasodilator of these arteries.

Efficacy of enoxaparin for improving pregnancy outcomes and uteroplacental blood flow in women with thrombophilia and recurrent pregnancy loss

Maternal thrombophilia is associated with recurrent pregnancy loss (RPL). Prophylaxis with low-molecular-weight heparin can benefit women with thrombophilia and RPL. There is little information about the effect of such treatment on uteroplacental blood flow. The purpose of this study was to evaluate the efficacy of two doses of enoxaparin for improving pregnancy outcomes and to invesigate the effect on uteroplacental blood flow.

Ovarian stromal blood flow changes after laparoscopic ovarian drilling in women with polycystic ovary syndrome

To evaluate the effects of laparoscopic ovarian drilling on hormonal profile and ovarian blood flow in women with polycystic ovaries. Prospective clinical trial. Sixty women with polycystic ovarian syndrome who failed to ovulate with clomiphene citrate and who subsequently underwent laparoscopic ovarian drilling were studied. Hormonal assay and ovarian blood flow measurement by colour Doppler ultrasonography were carried out before and after ovarian drilling. In the responder group in whom hormonal profiles improved, the Mean±SD pulsatility index and resistance index increased from 1.01±0.38 and 0.52±0.12 before operation to 2.18±0.45 and 0.75±0.15(P<0.001) after operation respectively. Peak cystolic velocity decreased from 14.39±6.7 before operation to 11.24±5.9(P<0.001) after operation. Laparoscopic ovarian cauterization in women with polycystic ovarian syndrome may result in a decrease in ovarian blood flow in parallel with decrease in serum levels of LH and androgen.

A Randomized, Placebo-Controlled, Crossover Study of Ephedrine for SSRI-Induced Female Sexual Dysfunction

The objective of this study was to determine whether ephedrine, an alpha- and beta-adrenergic agonist previously shown to enhance genital blood flow in women, has beneficial effects in reversing antidepressant-induced sexual dysfunction. Nineteen sexually dysfunctional women receiving either fluoxetine, sertraline, or paroxetine participated in an eight-week, double-blind, placebo-controlled, cross-over study of the effects of ephedrine (50 mg) on self-report measures of sexual desire, arousal, orgasm, and sexual satisfaction. Although there were significant improvements relative to baseline in sexual desire and orgasm intensity/pleasure on 50 mg ephedrine 1-hr prior to sexual activity, significant improvements in these measures, as well as in sexual arousal and orgasmic ability also were noted with placebo. These findings highlight the importance of conducting placebo-controlled trials for this condition.

A Nonincisional, Doppler-Guided Transvaginal Approach to Uterine Artery Identification and Control of Uterine Perfusion

Study Objective To determine the location and depth of uterine arteries from the vaginal fornix using a Doppler-guided nonincisional transvaginal approach. Design Observational study (Canadian Task Force classification II-3). Setting Two women's health and fertility centers. Patients One hundred nine healthy premenopausal women (age >18 yrs). Intervention Transvaginal uterine artery identification. Measurements and Main Results After uterine size and position were determined, with a standard bivalve speculum in place, uterine arteries were located bilaterally using the DWL Multi-Dop B+ system with 8-MHz probe (Sipplingen, Germany) in toggle mode. Continuous Doppler mode was used to locate uterine arteries, and pulsed Doppler to estimate depth of the arteries from the vaginal fornix. The average uterine size was less than 8 weeks, with the largest measuring 18 weeks' gestational size. The right uterine artery could be identified between 8 and 11 o'clock positions, and was most commonly found at the 9 o'clock position (average depth 9.30 mm, range 4–17 mm). The left uterine artery could be identified between 1 and 4 o'clock positions and was most commonly found at the 3 o'clock position (average depth 8.88 mm, range 4–15 mm). Conclusion Due to ease of identification of uterine arteries transvaginally, despite differences in parity, uterine size, and position, access to and occlusion of uterine arteries with a Doppler-guided device might offer an alternative to invasive procedures intended to occlude uterine artery blood flow in women with symptomatic uterine leiomyomas.