Perifollicular Blood Flow Research Articles

A Comparative Analysis of Follicular Diameter Assessment Versus Doppler Ultrasound in Predicting Ovulation Timing for the Infertility Treatment: Insights From a Prospective Study.

Background Infertility remains a significant challenge affecting millions of couples worldwide, with ovulation abnormalities being a common underlying cause. Pharmacological methods, such as clomiphene citrate, are often used to stimulate ovulation. However, the optimal timing for sexual intercourse during ovulation induction remains contentious. Objectives This study aimed to compare the efficacy of transvaginal ultrasonography (TVS) for measuring follicle size with Doppler ultrasound for assessing changes in blood flow to predict the timing of ovulation. Methods We conducted a comparative analysis involving 64 women undergoing infertility therapy. Participants were evaluated using both TVS to measure follicle diameter and Doppler ultrasound to assess perifollicular blood flow dynamics. The primary outcomes measured included ovulation rates, resistive index (RI) values, peak systolic velocity (PSV) values, and conception rates. Results The analysis showed comparable age distributions between the TVS and Doppler groups. There was no significant correlation between follicle diameter and ovulation when assessed by TVS. However, Doppler ultrasound revealed a substantial association between perifollicular blood flow dynamics and ovulation. Higher ovulation rates were linked to lower RI values and higher PSV values, indicating their potential as predictors of ovulation. Additionally, higher conception rates were positively correlated with increased vascularity in Zone 4 of the endometrium. Conclusion Doppler ultrasonography indices, particularly RI and PSV values, provide critical insights into perifollicular blood flow dynamics and endometrial vascularity, which can enhance the effectiveness of fertility treatments. While these findings highlight the potential of Doppler ultrasound in predicting ovulation and improving treatment outcomes, further research is required to understand the underlying mechanisms and validate these results for personalised treatment strategies.

ОЦЕНКА ОВАРИАЛЬНОГО РЕЗЕРВА ПАЦИЕНТОК С ХРОНИЧЕСКИМ САЛЬПИНГООФОРИТОМ

An important problem in reproductology is inflammatory diseases of the pelvic organs. About 60% of patients with chronic salpingoophoritis are of reproductive age, and 65-77% of cases of acute processes turn into chronic. The analysis of the scientific literature on the effect of chronic salpingoophoritis on the reproductive function of women is carried out. The diagnostic significance of the ultrasound method in assessing the state of the ovarian reserve has been studied. The analysis of the dependence of the concentration of anti-Muller hormone and the indicators of the ovarian reserve was carried out. Evaluation of the ovarian reserve should be carried out using high-frequency transvaginal sensors. These methods allow us to study the architectonics of the intra-organ bloodstream of the ovaries. Modern ultrasound machines allow you to study in detail all the indicators of the ovarian reserve and remove Doppler parameters. Dopplerography can be considered effective for assessing blood flow in the ovaries. The PD energy doppler makes it possible to evaluate intra- and perifollicular blood flow in small diameter vessels. Extensive visualization capabilities are important, capable of creating a planar and 3D image of the ovary under study. An integrated approach is needed to assess the ovarian reserve. In comparison with ultrasound examination, the level of anti-muller hormone more fully shows the activity of immature follicles ranging in size from 0.2 to 4 mm, which are visible during ultrasound examination are poorly visible.

The Effect Of Aspirin and Sildenafil on Endometrial Thickness, Oocyte Characteristic, Embryo quality and Pregnancy test in Iraqi Infertile Women Undergoing Intracytoplasmic Sperm Injection

Infertile couples undergoing Assisted Reproductive techniques are really receptive to any intervention intended to enhancement their fertility. Successful implantation of an embryo requires a receptive endometrium, a good quality embryo, and embryo endometrial synchronization in all species. Pharmacological agents such as aspirin and sildenafil have been included in previous clinical trials to improve endometrial vascularity and perifollicular blood flow but the results were inconsistent. To evaluate the effect of oral low dose aspirin or vaginal sildenafil citrate on endometrial thickness, retrieved oocyte, degree of maturation, embryo quality and pregnancy test. This comparative prospective study was conducted on the 60 infertile women who participated in intracytoplasmic sperm injection (ICSI) cycles at the infertility clinic associated with the "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al- Nahrain University / Baghdad/ Iraq." December 2020 to June 2022. In the present study the count of total oocytes retrieved was significantly higher in aspirin treated group in comparison to sildenafil treated group 12.5 ±5.3 versus 9.37 ±5.5 respectively. No significant variation in mean endometrial thickness among study groups. Regarding biochemical pregnancy test, positive results were obtained in 12 (40.0 %), 10 (33.3 %) in aspirin treated group, sildenafil treated group respectively and the difference was not significant. Aspirin treatment resulted in higher number of total retrieved oocytes, aspirin and sildenafil did not improve endometrial thickness, but they resulted in improvement of sub endometrial vascularity; however, biochemical pregnancy test was not affected by either pharmacological agent

Effectiveness of Low Dose Aspirin or Vaginal Sildenafil on Perifollicular Blood Flow Using Doppler ultrasound and EG-VEGF and their Impacts on ICSI Cycle Outcome

Effectiveness of Low Dose Aspirin or Vaginal Sildenafil on Perifollicular Blood Flow Using Doppler ultrasound and EG-VEGF and their Impacts on ICSI Cycle Outcome

Comparison Between Preovulatory Follicular Pulsed Doppler Indices Under the Effect of Mild Ovarian Stimulation by Clomiphene Citrate vs Letrozole

It was observed that embryos from oocytes resulting from well-vascularized follicles had a higher implantation rate than those from oocytes developed in poorly vascularized follicles. Neovascularization was recognized as primary in terms of ovulatory follicles growth and selection. Vascular endothelial growth factor serum level has a positive correlation with perifollicular blood flow. The 2D Color and Pulsed Doppler ultrasounds that allow visual observation of the flux of the blood in a limited part of the wall of the preovulatory follicles can be easily measured. To study the preovulatory follicle's blood flow parameters in infertile women undergoing different ovulation induction protocols. 50 infertile female patients who had undergone Intrauterine Insemination (IUI) procedures were classified into two groups which were letrozole or clomiphene citrate groups as induction protocol. Another ultrasound was performed on cycle day 11, 12, or 13 to evaluate growth follicles, also a Doppler study was done to measure perifollicular blood flow and endometrial thickness at the same time blood sample to measure vascular endothelial growth factor were taken. Human chorionic gonadotropin was injected and then after 36-40 hrs. IUI Procedure is done and follows up with the patient to do a pregnancy test after 14 days. The number of dominant follicles, endometrial thickness at HCG trigger, Perifollicular doppler blood flow vascular endothelial growth factor level, pregnancy rates were all measured in both groups. There were significant differences in Perifollicular RI (p<0.001) but there were no significant differences in Perifollicular PI (p=0.476). Regarding pregnancy rate, the letrozole group has a higher although not significant pregnancy rate (32%), if compared with those using CC (20%).

Peri-follicular blood flow in the follicle from which ovulation occurs in cows

The hypothesis of the study was that the vascularity of ovulatory follicles (OF) determines the ovulatory status. The peri-follicular blood flow characteristics of OF were sequentially recorded using Color Doppler Imaging ultrasonography from the onset of induced estrus (Day 0) to ovulation at 12 h intervals. The OFs were categorized into two groups based on the timing of ovulation (i) Normal ovulation (OFN) - When ovulation occurred within 36 h after the onset of estrus (n = 18) and (ii) Delayed ovulation (OFD) - When ovulation occurred after 36 h (n = 15). The blood flow velocity, Doppler pulse duration (DPD) and Pulsatility index (PI) of the OF were recorded during each examination. The OF was well vascularized with a detectable blood flow signals, while the subordinate or atretic follicles were devoid of detectable blood flow. On Day 0, the DPD (874.33 ± 56.99 ms) and PI (0.62 ± 0.01) values were less in the OFN when compared to OFD (1140.56 ± 27.54 ms and 1.28 ± 0.15 respectively) group. In the OFD group, ovulation occurred between 36 and 60 h after onset of estrus when the DPD value reduced to 878.17 ms. Based on ROC analysis, it was evident that the DPD value of < 929 ms is a necessary factor for induction of ovulation. The decreased DPD and PI values of the OF on the day of estrus are positive indicators of a normal ovulation process.

Follicular fluid vascular endothelial growth factor is associated with type of infertility and interferon alpha correlates with endometrial thickness in natural cycle in vitro fertilization

The aim of this study was to analyse the presence of vascular endothelial growth factor (VEGF) and interferon alpha (IFN-α) in the follicular fluid (FF) and their possible influence, as pro-angiogenic or anti-angiogenic factors, on in vitro fertilization outcome. The concentrations of VEGF and IFN-α were correlated with oocyte and embryo quality, concentrations of hormones in the serum, perifollicular blood flow and endometrial thickness. VEGF was detected in all FF samples (median 706.6 pg/ml, range 182.9–6638 pg/ml). IFN-α was detected in 60% of the samples (median 6.5 pg/ml, range 0–79.4 pg/ml), while in 40% of the samples its levels were below the test detection limit. VEGF and IFN-α concentrations did not correlate with the cause of infertility, concentrations of FSH, LH, E2 and prolactin, oocyte or embryo quality. Significantly higher concentrations of VEGF have been found in women with primary compared with secondary infertility (p = 0.011, Mann Whitney test). The concentrations of VEGF and IFN-α did not correlate with the resistance index (RI) on days of hCG administration, follicular aspiration and embryo transfer. However, the concentrations of IFN-α correlated with endometrial thickness on the day of embryo transfer (Spearman correlation coefficient ρ = 0.4107; P < 0.05) but not on days of hCG administration and follicular aspiration. The mechanism of VEGF association with the previous ability of having a child needs to be clarified in future studies. The results of this study indicate a possible role of IFN-α in pathways of endometrial remodelling.

Perifollicular blood flow and its relationship with endometrial vascularity, follicular fluid EG-VEGF, IGF-1, and inhibin-a levels and IVF outcomes.

The aim of this study is to investigate the association of perifollicular blood flow (PFBF) with follicular fluid EG-VEGF, inhibin-a, and insulin-like growth factor-1 (IGF-1) concentrations, endometrial vascularity, and IVF outcomes. Forty women with tubal factor infertility were included in a prospective cohort study. Each woman underwent IVF/ICSI procedure. Individual follicles of ≥16mm (n = 156) were evaluated by power Doppler analysis and categorized as well-vascularized follicles (WVFs) or poorly vascularized follicles (PVFs). WVFs referred to those with perifollicular vascularity of 51-100%. Each follicular fluid (FF) was individually aspirated and FF/serum EG-VEGF, inhibin-a, and FF IGF-1 levels were evaluated. Zones III-IV endometrial vascularity was classified as a well-vascularized endometrium (WVE). The presence of a WVE and mature oocytes, in addition to the embryo quality and clinical pregnancy rate (CPR), were recorded for each follicle. The main outcome measures were FF serum EG-VEGF, inhibin-a, IGF-1 levels, and WVE and IVF outcome per PFBF. For WVFs, the level of FF EG-VEGF (p = 0.008), oocyte quality (p = 0.001), embryo quality (p = 0.002), a WVE (p = 0.001), and CPR (p = 0.04) increased significantly. The pregnant group was characterized by increased numbers of WVFs (p = 0.044), a WVE (p = 0.022), and increased levels of FF IGF-1 (p = 0.001) and serum EG-VEGF (p = 0.03). FF IGF-1 >50ng/mL (AUC 0.72) had 75% sensitivity and 64% specificity for predicting CPR. WVFs yield high-quality oocytes and embryos, a WVE, increased FF EG-VEGF levels, and increased CPRs.

The significance of monitoring folliculogenesis

This manuscript describes various uses of ultrasound imaging in assisted reproductive technologies as the principal noninvasive technique for evaluation of ovarian function and the process of follicular growth. Serial real-time pelvic ultrasonography has been described as a rapid, reliable method for monitoring follicular growth, rupture, and regression. The evaluation of preovulatory follicles by ultrasounds relies mainly on the study of the follicle diameter, but also on the follicle growth pattern, the follicular wall thickness, the perifollicular vascularity and the perifollicular blood flow. Predicting fertility potential has become important as women seek to use costly assisted reproductive technologies. The term ovarian reserve has been used to describe the capacity of ovaries to respond to stimulation with gonadotropins and therefore predict fertility potential. Ultrasounds can evaluate the ovarian reserve by the study of the antral follicle count and the study of the ovarian volume. Ultrasounds monitoring is important in assisted reproductive techniques. During controlled ovarian stimulation (COS), ultrasonographic evaluation of follicle growth and number will influence gonadotropin dose in the next days or the cancellation of the cycle if no response is documented. Monitoring of follicle growth and its vascularization at the end of COS could certainly increase the quality of the retrieved oocytes considerably. Moreover, the better monitoring of controlled ovarian stimulation in vitro fertilization-intracytoplasmic sperm injection permits a final good outcome.

Radiation-induced Alopecia Treated with Botulinum Toxin Type A Injection.

1 Moo Yeol Hyun, MD Beom Joon Kim, MD, PhD Department of Dermatology Chung-Ang University College of Medicine Seoul, Korea Changjin Lee, MD, PhD Jae Wook Kim, MD, PhD Hugel, Inc. Gangwon-do, Korea Sir: B toxin type A (BTXA) has been in use for more than 20 years in the treatment of various neurological conditions and aesthetic treatments.1,2 BTXA is also occasionally used to treat alopecia; however, the efficacy of BTXA in alopecia remains unclear. A 65-year-old woman presented with a history of diffuse hair loss in the frontoparietal scalp after carniosurgery and radiotherapy for a meningioma 1 year before her visit. Physical examination revealed diffuse hair loss and a linear depression on the frontoparietal scalp caused by surgery (Fig. 1). Because she refused our suggestion for biopsy to evaluate the degree of fibrosis, we diagnosed her condition as radiation-induced alopecia based on clinical evidences. We initially treated her with an intralesional injection of triamcinolone acetonide (5 mg/ml) monthly and with a 308-nm excimer laser (Xtrac laser, Photomedex, Montgomeryville, PA.) every other week for 1 year. However, the patient’s response to these treatments was limited. Thus, we decided to combine the above treatments with injection of BTXA (Botulax; Hugel Pharma, Seoul, Korea). To this end, we injected 150 U of Botulax (5 U per 0.1 ml saline) into the muscles surrounding the patient’s scalp, including the frontalis, temporalis, periauricular, and occipitalis muscles, in doses divided equally over 30 injection sites every 3 months for 12 months. After 3 months, sparse vellus hairs were observed, and after 12 months, hair density and thickness were improved, and she had some hair growth on the frontal scalp. The scalp was also slightly softer and more sanguine in appearance compared with the scalp before botulinum toxin injections were initiated (Fig. 2). In our case, BTXA induced idiopathic hair growth, although the mechanism by which this took place remains unclear. We speculated that BTXA injections facilitated tension relief of muscles surrounding the scalp and increasing perifollicular blood flow decreased by radiation damage.3 A pilot study by Freund and Schwartz4 reported treatment of male pattern baldness with botulinum toxin. They asserted that BTXA “loosens” the scalp, which in turn reduces pressure on the perforating vasculature to allow for increased blood flow and oxygen concentration. Likewise, in Cutrer and Pittelkow’s5 case

Effects of combining low‑dose aspirin with a Chinese patent medicine on follicular blood flow and pregnancy outcome.

The aim of the present study was to investigate the clinical value of low‑dose aspirin in combination with Tiao Jing Cu Yun pills in patients with polycystic ovary syndrome (PCOS) by measuring follicular peripheral blood flow parameters and the clinical efficacy. The study involved 78infertile females with PCOS who were randomly divided into experimental (n=38) and control (n=40) groups. The subjects in the experimental group were treated with letrozole in combination with aspirin and Tiao Jing Cu Yun pills, and the control group was treated with letrozole alone. Transvaginal color Doppler ultrasonography was used to measure the endometrial thickness, pulsatility index (PI), resistance index (RI), peak systolic velocity and end diastolic velocity (EDV) of the follicular peripheral artery on the day of human chorionic gonadotropin administration. The patients who failed to become pregnant in the control group were reintegrated into the experimental group in the subsequent cycle and the clinical effect was observed. In the experimental group, subject perifollicular blood flow was more plentiful, and the PI and RI of the perifollicular blood flow were significantly reduced, while the EDV of the perifollicular blood flow and the rate of clinical pregnancy were markedly elevated compared with the subjects in the control group. Low‑dose aspirin combined with Tiao Jing Cu Yun pills effectively improved perifollicular artery blood flow, and enhanced the oocyte quality and rate of clinical pregnancy.

Role of perifollicular Doppler blood flow in predicting cycle response in infertile women with genital tuberculosis undergoing in vitro fertilization/intracytoplasmic sperm injection.

OBJECTIVE:This study was evaluated the role of perifollicular Doppler blood flow in predicting cycle response in women with and without genital tuberculosis (TB) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles.MATERIALS AND METHODS:This prospective observational study was performed on 254 women undergoing IVF for tubal factor infertility in the assisted reproductive unit. Perifollicular Doppler blood flows were assessed in dominant follicles >16 mm before oocyte recovery in patients with and without genital TB.RESULTS:A positive correlation was found between estradiol on the day of human chorionic gonadotropin (r = 0.15, P = 0.05), number of oocytes retrieved (r = 0.25, P = 0.001), MII (r = 0.24, P = 0.001), day 1 2PN (r = 0.16, P = 0.04), number of embryos (r = 0.16, P = 0.04) and blood flow in patients without genital TB. A trend of having poor ovarian blood flow was observed in patients with genital TB when compared with those without the disease (P > 0.001).CONCLUSION:In our study, the perifollicular blood flow (PFBF) provided a favorable prediction on the quantity of oocytes retrieved, MII, day 1 2PN and number of embryos but did not show any significant statistical difference in other outcome variables including fertilization or cleavage rate in women with or without genital TB undergoing IVF/ICSI cycles. Hence PFBF has the potential to be used as a simple and non-invasive surrogate marker of capillary blood flow around recruitable follicles to predict response to ovarian stimulation and cycle outcome.

Comparison of the efficacy of letrozole and low-dose gonadotropin combination with clomiphene and low-dose gonadotropin combination as a controlled ovarian stimulation regime prior to intrauterine insemination in patients with unexplained infertility

Objective: To evaluate and compare the effects of letrozole and low-dose gonadotropin combination with clomiphene citrate (CC) and low-dose gonadotropin combination prior to intrauterine insemination (IUI) in patients with unexplained infertility. Design: Prospective, randomized, clinical study. Setting: Academic tertiary institute. Patient(s): A total of 94 patients in the age group of 21-37 years with unexplained infertility were randomized using computer-generated random number table to receive follicle-stimulating hormone (FSH) injection and human menopausal gonadotropin (hMG) injection, along with either letrozole or CC. Intervention(s): All the patients received 150 IU of purified urinary FSH on day 2 of the cycle and from day 3 to day 7 of the cycle 5.0 mg/d of letrozole or 100 mg/d of CC were administered; this was followed by administration of 150 IU of hMG on day 9. Ovulation was triggered with human chorionic gonadotropin (hCG) injection (5,000 IU) when the dominant follicle(s) reached 18 mm in diameter. A single IUI was performed 36 h later. The luteal phase was supplemented with micronized progesterone vaginally. Main Outcome Measure(s): Pregnancy rates and the incidence of multiple pregnancies were our primary outcome. The secondary outcome included the number of dominant follicles, grade of perifollicular blood flow, endometrial thickness, endometrial blood flow pattern, side effects, and complications. Result(s): There were no differences in demographic characteristics between the two groups. Pregnancy occurred in four out of 47 patients (120 cycles) in the letrozole group (pregnancy rate: 8.5% per patient and 3.3% per cycle) and eight out of 47 patients (121 cycles) (pregnancy rate: 17% per patient and 6.6% per cycle) in the CC group; the differences were not statistically significant. None of the regimes resulted in a multiple gestation gestation. The number of follicles per cycle was significantly higher in the CC + gonadotropin group as compared to the letrozole + gonadotropin group (1.77 ± 0.99 vs. 1.39 ± 0.617, P < 0.001). There was no statistically significant difference in perifollicular blood flow, endometrial thickness, and endometrial blood flow pattern between the two groups. No side effects were observed in either group. There was one case of ectopic gestation in the CC group. Conclusion(s): The use of lower dose of gonadotropins and oral agents together resulted in decreased medication costs, lesser monitoring [ultrasound (USG) visits], and good primary and secondary outcomes. However, more randomized controlled trials are needed to prove the efficacy of one regime over the other.

Assessment of endometrial receptivity using Doppler ultrasonography in infertile women undergoing intrauterine insemination

Objective: The aim of this study was assessment of subendometrial blood flow with Doppler ultrasonography as an indicator of endometrial receptivity in stimulated cycles for intrauterine insemination (IUI).Patients and methods: This prospective study enrolled 90 women scheduled for IUI after ovarian stimulation randomly assigned to one of the three equal groups; group (C) received Clomiphene citrate, group (H) received HMG and group (CH) received Clomiphene citrate in addition to HMG. All participants had ultrasound folliculometry starting on day 9, followed by transvaginal Doppler study of the subendometrial blood flow and perifollicular blood flow on the day of detecting at least one follicle >18 mm. Resistivity index (RI) and pulsatility index (PI) of subendometrial and perifollicular flow were measured. Endometrial thickness was measured on day of hCG injection.Results: Group (H) showed significantly higher frequency of subendometrial flow (80%) compared to the other two groups (p = 0.009). In cases of positive subendometrial flow, the RI and PI were significantly lower in group (H) compared to the other two groups (p = 0.007 and 0.012, respectively). Endometrial thickness was significantly lower in group (C) compared to group (H) (p < 0.001) and group (CH) (p < 0.001). Successful intrauterine implantation was documented in a total of 16 women (17.8%); the highest frequency was in group (H) (23.3%) and the lowest in group (C), however, the difference between the three groups was not significant (p = 0.372). Subendometrial indices and perifollicular RI were significantly lower in cases of successful implantation, while endometrium was significantly thicker in these cases (p < 0.001).Conclusion: The presence of subendometrial flow is associated with successful IUI in women under stimulated cycles undergoing IUI. HMG seems a superior option for induction of ovulation regarding success of implantation.

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

Ovarian angiogenesis and subsequent intrafollicular O2 content is a critical point in determining oocyte competence and IVF outcome.We wanted to evaluate the differences in ovarian perifollicular blood flow (PFBF) in normal and PCOS ovaries during IVF by using three-dimensional power Doppler (3D pD). 80 unexplained infertile women and 74 women with US evidence of PCOS were enrolled.Controlled ovarian hyperstimulation was induced by long or short protocol + rFSH(alpha-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.Ovulation was induced by hCG administration. 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 α-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.

Does Peri-follicular Blood Flow On The Day Of Ovum Pick-up Predict The Likelihood Of Retrieving An Oocyte?

Objective: To determine whether peri-follicular blood flow predicts pick up of an oocyte at egg retrieval. Patients and Methods: A prospective cohort study was made on fortyseven women undergoing in vitro fertilization treatments in a university hospital. Peri-follicular blood flow was analyzed on the day of egg retrieval. Two groups were formed regarding the presence or absence of oocyte during retrieval. Oocyte grades in different peri-follicular blood flow groups were compared. Results: There was no significant difference between the groups regarding the perivascular blood flow per follicle. The oocyte grade did not differ between follicles with different peri-follicular vascularity. Conclusions: It appears that high peri-follicular vascularity on the day of egg retrieval does not predict the likelihood of obtaining an oocyte. High peri-follicular vascularity does not confirm good egg quality even if an egg could be collected.(Marmara Medical Journal 2012;25:118-22)

Nitric oxide concentrations, estradiol-17β progesterone ratio in follicular fluid, and COC quality with respect to perifollicular blood flow in cows

The objectives were to investigate relationships among concentrations of nitric oxide (NO), estradiol 17 beta (E2), and progesterone (P4) in follicular fluids (FF), and quality of cumulus oocyte complexes (COCs) with respect to perifollicular blood flow (FBF). In Experiment I, follicles (138) were classified according to the presence or absence of FBF (assessed with transvaginal Doppler ultrasonography) and diameter of follicles (small, 2–4mm; medium, 5–8mm; and large, ≥9mm). Concentrations of NO in FF did not differ significantly among these size categories. However, NO concentrations in FF with FBF (54.4±7.4μmol/l) were higher (P<0.05) than in those without FBF (36.6±4.1μmol/l). There was a positive correlation (r=0.30, P<0.05) between NO concentrations and the E2:P4 in FF. Rate of E2 active (E2:P4≥1) follicles were numerically 1.2 (0.8–1.8) times higher in follicles with FBF (38.1%) compared to those without FBF (25.0%). Moreover, rates of E2 active follicles were 6.1 (0.7–55.2) and 1.3 (0.1–17.3) times higher (P<0.06) in large (43.3%) and medium (14.3%) compared to small follicles (11.1%), respectively. In Experiment II, quality of COCs from 2 to 8mm follicles, obtained by transvaginal ovum pick up (OPU), was investigated with respect to FBF. Odds ratio to obtain higher quality COCs from follicles with FBF (47.1%) was 3.3 (1.1–9.6) fold higher (P<0.05) compared to those from follicles without FBF (14.6%). In conclusion, E2:P4, and NO concentrations in FF, as well as FBF, could be used to determine the functionality of ovarian follicles in cows. Moreover, determination of FBF could be useful to predict quality of COCs in cattle.

Echographic Evidence of Follicle Development and Maturation

ABSTRACT Monitoring of individual follicles during the menstrual cycle demonstrates in a non-invasive way the changes in their number and position during the early and the late follicular phase and the luteal phase. The differences in relations between the follicles near the dominant follicle can be demonstrated with the same technique using 3D reconstruction of the ovary. Recognition of the follicle growth pattern has a prognostic value for the outcome of assisted reproduction methods. Follicular diameter and changes in growth patterns are more important than follicular wall thickness as parameters having an impact on clinical success. An increased perifollicular blood flow can be measured in the perifollicular period using color and pulsed Doppler. Automated estimation of blood volume around the ovarian follicles brought a new concept to this area. Results confirm the observation that vascularity around the follicle is intense in the periovulatory period. From our results we can hypothesize that those follicles containing oocytes able to produce pregnancy have a prominent and more uniform perifollicular vascular network .

42 THE EVIDENCE-BASED MANAGEMENT OF REPEATED IMPLANTATION FAILURE IN ART

predictors include the measurement of body mass index (BMI), genetic predisposition, serum vascular endothelial growth factor (VEGF), von Willebrand factor and perifollicular blood flow. On the other hand, randomized controlled trials (RCTs) have shown that primary prevention (before starting HMG/FSH) can be achieved by giving FSH rather than HMG (without GnRHa), using the step-up rather than the conventional protocol, giving GnRH antagonists rather than agonists (but with a lower LBR), performing IVM rather than IVF and using the sequential rather than the step down protocol. They have also shown that the alternate day protocol is comparable to the conventional protocol and that the sequential protocol is comparable to the step-up protocol, while the superiority of either the step-up compared to step down protocol needs further evaluation. RCTs have also shown that secondary prevention can be achieved by triggering ovulation with GnRH agonists, metformin administration, intravenous albumin, hydroxyethyl starch, cabergoline (for early OHSS) and laparoscopic ovarian electrocautery. They have also shown that the following approaches are equivocal in preventing OHSS: coasting versus unilateral oocyte aspiration and GnRH antagonists versus coasting, while the following approaches await further evaluation: cancellation of the cycle, coasting, diminishing the dose of HCG, embryo freezing and triggering with GnRHa + embryo freezing.

43 IMSI IN NATURAL CYCLE. PRE CONGRESS COURSE: MILD STIMULATION

predictors include the measurement of body mass index (BMI), genetic predisposition, serum vascular endothelial growth factor (VEGF), von Willebrand factor and perifollicular blood flow. On the other hand, randomized controlled trials (RCTs) have shown that primary prevention (before starting HMG/FSH) can be achieved by giving FSH rather than HMG (without GnRHa), using the step-up rather than the conventional protocol, giving GnRH antagonists rather than agonists (but with a lower LBR), performing IVM rather than IVF and using the sequential rather than the step down protocol. They have also shown that the alternate day protocol is comparable to the conventional protocol and that the sequential protocol is comparable to the step-up protocol, while the superiority of either the step-up compared to step down protocol needs further evaluation. RCTs have also shown that secondary prevention can be achieved by triggering ovulation with GnRH agonists, metformin administration, intravenous albumin, hydroxyethyl starch, cabergoline (for early OHSS) and laparoscopic ovarian electrocautery. They have also shown that the following approaches are equivocal in preventing OHSS: coasting versus unilateral oocyte aspiration and GnRH antagonists versus coasting, while the following approaches await further evaluation: cancellation of the cycle, coasting, diminishing the dose of HCG, embryo freezing and triggering with GnRHa + embryo freezing.