Ovarian Perfusion Research Articles

Use of Indocyanine Green to Evaluate Ovarian Perfusion After Laparoscopic Detorsion. A Step-By-Step Demonstration Video

Demonstrate the usefulness of using indocyanine green after laparoscopic ovarian detorsion to save the ovary. A step-by-step video demonstration of a surgical technique. Ovarian torsion is one of the most common gynecological emergencies, mainly affecting patients younger than 20 years of age [1], and causes 2% to 7% of acute abdomens [2]. It is not advisable to routinely perform ovariectomy even with a necrotic ovary appearance [1]. Furthermore only in a small percentage of cases (16%) necrosis has been confirmed histologically [2]. Some studies have demonstrated that using indocyanine green to evaluate ovarian perfusion is inexpensive, low risk, and easily reproducible [3-5]. A 17-year-old patient was referred to our hospital for acute abdominal pain. Ultrasound revealed ovarian torsion; therefore, the patient underwent surgical treatment. During laparoscopy, the presence of a right ovarian torsion was confirmed. A lesion compatible with a hemorrhagic corpus luteum of 6 cm was present on the ovary affected. Before ovarian detorsion, indocyanine green was administered intravenously at a 0.5 mg/kg dose. The first aspect noted was the total lack of ovarian vascularization; then ovarian detorsion was performed. At this point, using technology of Rubina (KARL STORZ SE & Co. KG, Tuttlingen, Germany), it was possible to highlight the progressive ovarian revascularization. Ovarian reperfusion occurred starting from the ovarian hilum and ending at the periphery. We proceeded with enucleation of the hemorrhagic corpus luteum by stripping technique, with subsequent ovarian reconstruction with continuous 2-0 monofilament suture. Finally, we fixed the ovary to the stump of the right round ligament. The final view highlights good ovarian vascularization. No complications occurred; the patient was discharged on the first postoperative day. A 6-month follow-up ultrasound confirmed the recovery of the vascularization of ovary. Using indocyanine green represents a valid option to evaluate ovarian perfusion after detorsion. It could help the surgeon decide to save the ovary and thus allow fertility-sparing surgery in more cases.

Luteal tissue characteristics of Morada Nova ewes with hCG application 7.5 days after the end of estrus synchronization protocol in the breeding season

Results with the use of hCG after synchronization protocol are still inconsistent, which may vary according to breed, season, day of application and dose of the drug used. The aim of the present study was to evaluate the functionality of luteal tissue and ovarian perfusion after hCG treatment during early luteal phase. Estrus-synchronized ewes were randomly assigned to receive i.m. injection of 300 IU of hCG (G-hCG; n = 40) or 1 mL of saline (G-Control; n = 32) on Day 7.5 after progesterone withdrawal. Ultrasonographic evaluations of the ovaries and ovarian and iliac arteries were performed on Days 7.5, 10.5, 13.5, and 21.5. The accessory corpus luteum (aCL) formation rate was 52.5% for G-hCG. There was interaction (p > 0.05) for treatment (G-hCG and G-Control), days (7.5, 10.5, 13.5 and 21.5) and PD (Pregnant and Non-pregnant) for the variables of biometric characteristics of the corpus luteum B-Mode and Color Doppler on days 7.5, 10.5, 13.5 and 21.5. There was no difference (p > 0.05) for pregnancy rates and mean fetuses per ewe between the treatment groups. It is concluded that the application of hCG 7.5 days after the hormonal protocol in Morada Nova ewes in a breeding season is efficient in inducing aCL formation and increasing luteal tissue biometry. However, there was no effect on pregnancy rate.

Impact of ovulation inducers on ovarian artery in mares: pulsatility and resistivity indexes

A failure of vascular development in reproductive organs may be the cause of several dysfunctions during the estrous cycle and gestation. Therefore, it is important to evaluate the in vivo influences of ovarian vaso- irrigation on ovulation. The ovarian follicles need an adequate blood supply for oxygen, nutrients, and hormones, besides eliminating CO2 and other metabolites (Bruno et al. Animal Reproduction. 2009; 6, 2:371-379). Transrectal ultrasonography (US) with color, power, and spectral Doppler US has been used to study blood flow and ovarian perfusion in mares (Acosta et al. Biology of Reproduction. 2004b; 71, 2: 502-507). Studies have shown a daily increase in vascularization of the wall of the dominant follicle as it approaches the day of ovulation (Gastal et al. Animal Reproduction Science. 2007; 102, 3-4: 314-321); However, a few hours before ovulation, an abrupt decrease in blood perfusion of the follicular wall has been detected (Ginther et al. Journal of Equine Veterinary Science. 2007a; 27, 1: 20-27). The drugs most used as ovulation inducers in horses are human chorionic gonadotropin (hCG) and analogues of gonadotropin-releasing hormone (GnRH), such as deslorelin (Chavatte & Palmer Equine Veterinary Education. 1998; 10, 26-30). Using different ovulation inducers, this study aimed to evaluate changes in ovarian arteryblood flow after induction of ovulation in mares with follicles ≥ 35mm diameter. Twenty-eight estrous cycles were followed, randomly and equally distributed: GI: control mares without treatment; GII: 1000 IU IV of hCG; GIII: 750µl IV of deslorelin; GIV: 250µg IM of hysterelin. The ovarian artery pulsatility and resistivity indexes (PI and RI) were measured. Thereafter, estrous cycles were followed every 12 hours from time 0 (induction) until ovulation using B-mode US and spectral mode Doppler US of ovarian arteries. Statistical analysis was performed with ANOVA, a p-value of <0.05 was considered significant. No statistical difference was found in PI between groups (p=0.1297) of at the different evaluation times. When the times of analysis were compared separately between the groups, no statistical difference was found between 0h (p= 0.7092), 12h (p= 0.5148), 24h (p=0.2642), and 36h (p=0.582). Similarly, the RI did not differ between the groups analyzed (p= 0.1397), regardless of the time of evaluation, nor between the timepoints analyzed separately between 0h (p= 0.5049), 12h (p= 0.7334), 24h (p=0.3589) and 36h (p=0.1621). It can be concluded that although an increase in vascularization of the wall of the dominant follicle occurred, the PI and RI of the ovarian artery were not influenced by any ovulation inducer of the pre-ovulatory follicles.

The Use of near Infra-Red Radiation Imaging after Injection of Indocyanine Green (NIR-ICG) during Laparoscopic Treatment of Benign Gynecologic Conditions: Towards Minimalized Surgery. A Systematic Review of Literature.

Background and Objectives: To assess the use of near infrared radiation imaging after injection of indocyanine green (NIR–ICG) during laparoscopic treatment of benign gynecologic conditions. Materials and Methods: A systematic review of the literature was performed searching 7 electronic databases from their inception to March 2022 for all studies which assessed the use of NIR–ICG during laparoscopic treatment of benign gynecological conditions. Results: 16 studies (1 randomized within subject clinical trial and 15 observational studies) with 416 women were included. Thirteen studies assessed patients with endometriosis, and 3 studies assessed non-endometriosis patients. In endometriosis patients, NIR–ICG use appeared to be a safe tool for improving the visualization of endometriotic lesions and ureters, the surgical decision-making process with the assessment of ureteral perfusion after conservative surgery and the intraoperative assessment of bowel perfusion during recto-sigmoid endometriosis nodule surgery. In non-endometriosis patients, NIR–ICG use appeared to be a safe tool for evaluating vascular perfusion of the vaginal cuff during total laparoscopic hysterectomy (TLH) and robotic-assisted total laparoscopic hysterectomy (RATLH), and intraoperative assessment of ovarian perfusion in adnexal torsion. Conclusions: NIR–ICG appeared to be a useful tool for enhancing laparoscopic treatment of some benign gynecologic conditions and for moving from minimally invasive surgery to minimalized surgery. In particular, it might improve treatment of endometriosis (with particular regard to deep infiltrating endometriosis), benign diseases requiring TLH and RATLH and adnexal torsion. However, although preliminary findings appear promising, further investigation with well-designed larger studies is needed.

Intraoperative Indocyanine Green Dye Use in Ovarian Torsion: A Feasibility Study

To determine the feasibility of intravenous indocyanine green (ICG)dyeuse inpatients withadnexal torsion to intraoperatively evaluate ovarian perfusion after detorsion. A prospective multicenter single-arm feasibility study. A teaching hospital. A total of 12 nonpregnant patients, 18 to 45 years old with surgically confirmed adnexal torsion. Torsion was surgically confirmed, the involved adnexa were untwisted laparoscopically, and ICG dye was injected intravenously. The absence or presence of ICG perfusion was documented, and the clinical decision for ovarian conservation or removal was determined by the surgeon. The primary outcome was feasibility of using ICG dye including measures such as time to visualized perfusion and operative time. Secondary outcomes included presence or absence of ovarian preservation and postoperative follow-up measures. Intraoperative visualization of ICG perfusion to the detorsed adnexa was achieved in 10 patients (83%) in a median time of 1 minute (0, 2), resulting in entire (n=9) or partial (n=1) ovarian conservation. Perfusion was absent in 2 cases, and postoophorectomy histologic necrosis was confirmed in one case. Median operative time was 74 minutes (48, 94). There were no adverse events related to ICG dye use. Intraoperative ICG dye use in this study was logistically feasible and conservation of the entire or partial ovary was observed in 83% of patients, including one case where preoperative Doppler flow was absent.

Therapeutic Angiogenesis for Ovarian Transplantation through Ultrasound-Targeted Microbubble Destruction

Timely angiogenesis and effective microcirculation perfusion are essential for the survival and functional recovery of transplanted ovaries. Ultrasound-targeted microbubble destruction (UTMD) can lead to angiogenesis and increase flow perfusion by causing transient inflammation. The purpose of this study was to evaluate the effects of UTMD on transplanted ovarian revascularization and survival. In vitro, for the criteria of cell viability and tube formation capability, the optimal exposure parameters were determined to be a microbubble concentration of 1 × 108/mL, mechanical index of 1 and exposure time of 30 s. After ovarian transplantation, 40 female Sprague Dawley rats were divided into four groups: transplantation alone, ultrasound alone, microbubbles alone and ultrasound and microbubbles (UTMD). At 7 d after transplantation, ovarian perfusion was assessed using qualitative and quantitative methods. The effect of angiogenesis was assessed by contrast-enhanced ultrasound, laser Doppler perfusion imaging and histologic analysis. The results, in which ovarian perfusion was highest in the UTMD group, suggest that UTMD can effectively improve ovarian perfusion. Compared with the other three groups, the number of follicles, microvascular density and rate of Ki-67-positive cells increased significantly in the UTMD group, while apoptosis decreased significantly (p < 0.05). The study indicates that UTMD promoted ovarian re-vascularization after ovarian transplantation and maintained follicular reserve.

Variations in the Profiles of Vascular-Related Factors Among Different Sub-Types of Polycystic Ovarian Syndrome in Northern China.

Recently, a growing body of evidence has suggested that abnormal ovarian angiogenesis, secondary to the imbalance between various angiogenic markers, is involved in the pathogenesis of PCOS, and this has led to the use of various interventions (such as Diane-35) to restore the normal ovarian angiogenesis. Therefore, we conducted the current investigation to determine the role of such markers (endothelial growth factor (VEGF), endostatin (ES), and thrombospondin-1 (TSP-1)) in the pathogenesis of PCOS along with the associated changes in ovarian blood flow in patients with PCOS compared to healthy controls, both before and after a course of oral contraception. A total of 381 patients with PCOS and 98 healthy females of childbearing age were recruited from July 2014 to June 2017 at the Reproductive Center of the Second Affiliated Hospital of Harbin Medical University. The serum levels of VEGF, ES, and TSP-1 were determined by enzyme-linked immunosorbent assay, while ovarian perfusion was measured by the pulsatility index (PI) and resistance index (RI) by using transvaginal color Doppler ultrasound. Repeated analyses were carried out after 3 months of Diane-35 treatment. Post-treatment serum levels of luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio of patients with PCOS decreased significantly (P <0.05). The RI values of most PCOS patients increased after treatment (P<0.05), while PI was significantly increased in all patients (P<0.05). However, variable changes in the serum levels of TSP-1, VEGF, and ES after treatment were observed. Serum VEGF levels showed a negative correlation with serum LH/FSH ratio, T concentration, and ES (P <0.05), while ES levels were negatively correlated with serum T concentrations only (P<0.05). The markers of angiogenesis (VEGF, ES, and TSP-1) were expressed differently among PCOS patients, who also responded differently to the same course of Diane-35 treatment. This field still warrants further investigation to reach a more definitive conclusion.

Clinical observation on herb-partitioned spreading moxibustion at Baliao points plus climen for diminished ovarian reserve

To observe the clinical efficacy of herb-partitioned spreading moxibustion at Baliao points plus climen for diminished ovarian reserve (DOR). A total of 60 patients with DOR were randomized into a spreading moxibustion group and a Western medicine group by the random number table method, with 30 cases in each group. The Western medicine group was treated with climen, starting from the 5th day of the menstrual cycle for 21 d. The spreading moxibustion group was treated with herb-partitioned spreading moxibustion at Baliao points on the basis of the medication in the Western medicine group, 1 h per time, once a week. The treatment was performed for 1 month as one treatment course in both groups, for 3 courses in total. The serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) in the patients were measured before and after treatment. The peak systolic velocity (PSV) and resistance index (RI) were also detected. The traditional Chinese medicine (TCM) symptom score was evaluated. The clinical efficacy was evaluated after treatment. The total effective rate in the spreading moxibustion group was 93.3%, which was significantly higher than 80.0% in the Western medicine group, and the difference between the groups was statistically significant (P<0.05). After treatment, the TCM symptom scores, the serum FSH levels, FSH/LH ratios and RI in both groups decreased, and the intra-group differences were all statistically significant (all P<0.05). The serum E2 level and PSV increased compared with those in the same group before treatment, and the intra-group differences were statistically significant (all P<0.05). After treatment, the TCM symptom score, the serum FSH level, FSH/LH ratio and RI in the spreading moxibustion group were lower than those in the Western medicine group, while the serum E2 level and PSV were higher than those in the Western medicine group, and the differences between the groups were statistically significant (all P<0.05). Herb-partitioned spreading moxibustion at Baliao points plus climen can produce valid therapeutic efficacy for DOR. It can improve the clinical symptoms, regulate serum hormone levels and increase ovarian blood perfusion, thus improving ovarian reserve function, producing more significant efficacy than climen alone.

Evaluation of Ovarian Perfusion With Indocyanine Green Dye (ICG) in Patients With Suspected Adnexal Torsion [OP02-4B

INTRODUCTION: The aim of this study is to assess the safety and feasibility of Indocyanine Green (ICG) dye in patients with adnexal torsion. Our hypothesis is that the use of ICG dye will aid in the surgical determination of tissue viability, ultimately preventing the resection of salvageable ovaries. METHODS: An IRB approved pilot study is currently enrolling patients 18-45 years old with suspected adnexal torsion in a multicentered tertiary care hospital setting. During laparoscopy, the involved adnexa is untwisted and ICG dye is injected intravenously. The untwisted ovary is then observed. Adnexal tissue demonstrating perfusion is preserved and patients are followed postoperatively with anti-Mullerian hormone level and ultrasound. Non-perfused tissue is resected and histologically evaluated for necrosis. RESULTS: Eleven patients with suspected adnexal torsion were enrolled, of which eight had surgically confirmed torsion. Six women demonstrated perfusion with the use of ICG dye even though three of these patients had minimal or no flow on preoperative ultrasound. The remaining 2/8 patients with confirmed torsion failed to demonstrate perfusion with the ICG dye and oophorectomies were performed. One of these patients had confirmed histologic necrosis. There have been no adverse events. CONCLUSION: The use of intravenous ICG dye appears to be a safe and valuable adjunct in the surgical management of adnexal torsion. This may be particularly helpful in patients with diminished adnexal perfusion on preoperative ultrasound. Further research is recommended to determine the generalized role of ICG dye in patients with adnexal torsion.

25: Indocyanine green dye for intraoperative assessment of ovarian perfusion: A feasibility study

25: Indocyanine green dye for intraoperative assessment of ovarian perfusion: A feasibility study

ICG to Assess Ovarian Perfusion

ICG to Assess Ovarian Perfusion

Feasibility of transabdominal Doppler ultrasonography for studying ovarian blood flow characteristics in cycling gilts.

The aim of this study was to assess ovarian blood flow characteristics by applying transabdominal color Doppler ultrasonography during the course of the estrous cycle in gilts. Estrus and ovulation were synchronized in 15 pubertal gilts. During their consecutive spontaneous estrous cycle the gilts were sonographically scanned daily and ovarian blood flow was determined by imaging perfused areas of the ovarian hilus and the ovarian tissue. Recorded video clips were then analyzed for the parameters perfused area (Amix), blood flow velocity (vmix) as well as resistance (RIvmix) and pulsatility index (PIvmix) using the software PixelFlux®. All blood flow parameters showed an estrous cycle dependent course, with Amix and vmix being highest in diestrus, followed by proestrus, while RIvmix and PIvmix patterns were inversely proportional. Transabdominal color Doppler ultrasonography proved feasible to study ovarian perfusion characteristics in pubertal gilts. The ovarian blood flow was dependent on the stage of estrous cycle and highest in diestrus. The results of this study encourage the use of color Doppler ultrasonography to also investigate reasons of ovary-caused infertility including corpus luteum insufficiency or seasonal effects on ovary function.

Fertility Preservation Using GnRH Agonists: Rationale, Possible Mechanisms, and Explanation of Controversy.

The only clinically accepted method of fertility preservation in young women facing gonadotoxic chemo- and/or radiotherapy for malignant or autoimmune diseases is cryopreservation of embryos or unfertilized ova, whereas cryopreservation of ovarian tissue for future reimplantation, or in vitro maturation of follicles, and the use of gonadotropin-releasing hormone agonists (GnRHa) are still considered investigational, by several authorities. Whereas previous publications have raised the fear of GnRHa’s possible detrimental effects in patients with hormone receptor-positive breast cancers, recent randomized controlled trials (RCTs) have shown that it either improves or does not affect disease-free survival (DFS) in such patients. This review summarizes the pros and cons of GnRHa co-treatment for fertility preservation, suggesting 5 theoretical mechanisms for GnRHa action: (1) simulating the prepubertal hypogonadotropic milieu, (2) direct effect on GnRH receptors, (3) decreased ovarian perfusion, (4) upregulation of an ovarian-protecting molecule such as sphingosine-1-phosphate, and (5) protecting a possible germinative stem cell. We try to explain the reasons for the discrepancy between most publications that support the use of GnRHa for fertility preservation and the minority of publications that did not support its efficiency.

A new strategy and system for ex vivo ovary perfusion and cryopreservation

A new strategy and system for ex vivo ovary perfusion and cryopreservation

A new strategy and system for the ex vivo ovary perfusion and cryopreservation: An innovation

Children and young adults, who suffer from cancer, receive gonadotoxic therapy, which destroys their fertile abilities after survival. Ovarian cryopreservation and transplantation provide the promising solution to this problem, where the ovary can be removed before the gonadotoxic therapy and reimplanted after patient's survival, where the ovary is to be cryopreserved during the period of the therapy. However, cryopreservation of the whole ovary is still facing great obstacles, namely the ischemic reperfusion injury and the defective cryopreservation related to the defective ability to universally deliver the cryopreservation/warming solutions through the ovarian vascular bed. Meanwhile, the currently applied technique of ovarian tissue cryopreservation provides limited follicular recovery because many follicles are lost until the development of revascularization post-transplantation. To solve the problems, an innovative system has been developed to insure immediate and universal delivery of the cryopreservation/warming solutions to the graft, in addition to keeping the graft under continuous perfusion before and after cryopreservation, minimizing any chance for microthrombi formation or ischemia-reperfusion. This innovative system can be applied in the following surgical and clinical interventions: 1) Allogeneic ovarian transplantation; 2) Preservation of fertility after systemic chemotherapy or bone marrow transplantation in young females, where the ovaries could be removed before the therapy and exposed to the adequate cryopreservation provided by the system till re-implantation after the patient's survival; 3) The system is also suitable for the corresponding applications on the testicles.

A New Strategy and System for the Ex Vivo Ovary Perfusion and Cryopreservation

Childern and young adults, who suffer from cancer, receive gonadotoxic therapy, which destroys their fertile abilities after survival. Ovarian cryopreservation and transplantation provides the promising solution to this problem, where the ovary can be removed before the gonadotoxic therapy and reimplanted after patient's survival, where the ovary is to be cryopreserved during the period of the therapy. However, cryopreservation of the whole ovary is still facing great obstacles, namely the ischemic reperfusion injury and the defective cryopreservation related to the defective ability to universally deliver the cryopreservation/warming solutions through the ovarian vascular bed. Meanwhile, the currently applied technique of ovarian tissue cryopreservation provides limited follicular recovery because many follicles are lost until the development of revascularization post-transplantation. To solve these problems, an innovative system has been developed to insure immediate and universal delivery of the cryopreservation/warming solutions to the graft, in addition to keeping the graft under continuous perfusion before and after cryopreservation, minimizing any chance for microthrombi fomation or ischemia- reperfusion. This innovative system can be applied in the following surgical and clinical interventions: 1. Allogeneic ovarian transplantation 2. Preservation of fertility after systemic chemotherapy or bone marrow transplantation in young females, where the ovaries could be removed before the therapy and exposed to the adequate cryopreservation provided by the system till re-implantation after the patient's survival. 3. The system is also suitable for corresponding applications on the testicles.

A New Strategy and System for the Ex Vivo Ovary Perfusion and Cryopreservation

Background: Cardiovascular disease is a major cause of morbidity and mortality after kidney transplantation. Endothelial dysfunction was shown to constitute an independent predictor of cardiovascular events. This study aimed at detecting endothelial dysfunction in pediatric renal transplant recipients. Methods: This was a prospective cohort study of 36 pediatric renal transplant recipients during their first posttransplantation year (transplantation group), 30 patients with end stage renal disease (ESRD) on regular hemodialysis (HD) (dialysis group) and 30 normal subjects (control group). Doppler ultrasound was performed for assessment carotid artery intima-media thickness (IMT) and brachial artery flow-mediated dilatation (FMD). Results: Carotid artery IMT measurements in the transplantation group (mean ± SD = 0.43 ± 0.08 mm) were significantly (p=0.001) lower than the dialysis group (0.5 ± 0.1mm) and insignificantly higher than the control group (0.41 ± 0.07mm). FMD was significantly impaired in the dialysis group. The median (IQR) FMD of the transplantation group, 8.7% (2.5-20.4), tended to be higher than that of the dialysis group, 4.4% (2.6-10.8) and lower than that of normal controls, 14% (8.5-19.7); p=0.055 and 0.12 respectively. Conclusion: Pediatric renal transplant recipients tend to show evidence of endothelial dysfunction at an apparently lesser extent than those on regular hemodialysis.

Ligating Internal Iliac Artery: Success beyond Hesitation.

To study the outcomes, benefits and complications of internal iliac artery ligation in both obstetric and gynecological cases. To study the outcomes, effectiveness and complications of internal iliac artery ligation (IIAL). This is an analytical longitudinal study done among women who have undergone internal iliac artery ligation in Dr. BRAMH a tertiary referral center from July 2013 to June 2015. Follow-up was done through color Doppler analysis of pelvic arteries before discharge, after 6weeks and after 6months. The efficacy of IIAL was 96.87%. The mean shock index was 0.94±0.26. Sixty-four women underwent IIAL out of which placenta previa (21.8%) was the major indication. There were four maternal deaths. There were no intraoperative or ischemic complications. The greater the time interval between onset of hemorrhage and IIAL, the graver the outcome. For all women in whom uterus could be salvaged, resumption of menstrual cycles was seen within 6months of IIAL. There was a significant decrease in the RI and PI of uterine arteries. In the ovarian arteries, there was a significant increase in RI and no significant change in PI initially. Flow in distal part of ligated internal iliac arteries could be detected in 54 (90%) women out of 60 after 6months of ligation of internal iliac arteries. IIAL is an effective life-saving method to control obstetric and gynecological hemorrhage, and a hysterectomy can often be avoided. Early resort to IIAL is vital for improving the patient outcome. Uterine perfusion is well maintained, while there may be a decrease in ovarian perfusion. Resumption of menstrual cycles and presence of distal flow in internal iliac artery within 6months suggest the preservation of future fertility; in order to better understand the impact of IIAL on ovarian functions and future fertility, larger studies with longer follow-up periods need to be conducted.

The effect of isosorbide dinitrate on uterine and ovarian blood flow in cycling and early pregnant mares: A pilot study

Poor uterine perfusion has been proposed as a cause of infertility in mares. The objective of this study was to investigate the effect of isosorbide dinitrate (ISDN), a nitric oxide donor, on uterine and ovarian blood flow resistance during diestrus and early pregnancy in mares. Six Trotter mares, aged 7 to 14 years, were examined daily during the first 11 days of three diestrous periods, and five of those mares were also examined during the first 11 days of two pregnancies. Six mares randomly received a placebo, a low dose (30 mg, ISDN30), or a high dose of ISDN (60 mg, ISDN60) through three nonconsecutive cycles. The treatments were administered orally, every 12 hours from Day 1 to 11 of the cycle (Day 0 = ovulation). Five of the 6 mares received a placebo or 60 mg of ISDN orally every 12 hours from Day 1 to 11 of pregnancy. The mares were short cycled on Day 12 of each trial. Transrectal color Doppler was used to determine blood flow resistance semiquantitatively and expressed as pulsatility index. Mean pulsatility index of both uterine arteries combined and of the dominant (ipsilateral to the CL) ovarian artery was lower (treatment effects: P ≤ 0.01; time effects: P ≤ 0.002) in mares receiving 30 mg or 60 mg of ISDN compared with placebo-treated mares. Blood flow resistance in the dominant ovarian artery was lower in ISDN-treated pregnant mares than in placebo-treated pregnant and cycling mares (treatment effect: P = 0.04; time effect: P = 0.003). Isosorbide dinitrate increases uterine and ovarian perfusion in cycling mares and ovarian perfusion in early pregnant mares. Further studies are needed to investigate these effects in relation to fertility of the mare.

A comparative analysis of arterial blood flow in unexplained infertility, tubal infertility and fertile groups

We aimed to compare ovarian (O), uterine (U) and spiral (S) artery (A) resistance of patients diagnosed as fertile, unexplained infertility (UI) and tubal factor infertility (TFI) in the peri-implantation period and independent from the impact of the treatment. UI (n = 70), TFI (n = 75) and fertile (n = 72) patients’ ovarian, uterine and spiral artery pulsatility index (PI), resistance index (RI) and the endometrial thickness, serum estradiol and progesterone levels were compared. The specificity and sensitivity values were calculated according to determined cutoff values. Both TFI and control groups’ UA PI values were significantly lower than the UI group’s PI values. The highest UA RI values were found in UI group and the lowest values were in the control group. UI and TFI groups’ OA PI/RI values were significantly higher than the control group. Both the control and TFI groups’ SA PI/RI values were significantly lower than UI group’s PI/RI values. UI patients’ uterine and spiral arteries PI values >1.86 and >0.85, RI values >0.80 and >0.53 can be used as a valuable test showing reduced uterine perfusion. Ovarian artery PI values >0.96 and RI values >0.58 can be used as tests showing decreased ovarian perfusion in patients with TFI. In these patients, embryo cryopreservation can be considered.