Stromal Artery Research Articles

Intra-ovarian Doppler artery indices values in cases with polycystic ovarian syndrome: a case control study

Background and objective: polycystic ovarian syndrome (PCOS) is the most common female endocrine disorder during their reproductive age which results in hyperandrogenism and anovulation or oligo-ovulation. Significant changes occur in ovarian vascularization at the level of the intra ovarian arteries in PCOS patients. The objective is to assess Doppler hemodynamic changes in ovarian stromal arteries in follicular phase of the cycle in both ovaries in women with PCOS compared to normal ovulatory fertile women (control) using transvaginal Color Doppler technique, by calculating intra ovarian Doppler artery indices values: Resistive index (RI) and pulsatility index (PI) of both ovaries. Methods: Two hundred women were included in the study. One hundred patients were diagnosed as PCOS (cases) according to Rotterdam’s criteria and another one hundred were normal fertile women (controls). Transvaginal color Doppler technique is used in examining the recruited cases and controls, Doppler indices values of intraovarian stromal arteries were measured. Results: in the current study, the RI and PI of the ovarian stromal artery were lower in women with PCOS (cases) compared to controls. These hemodynamic changes are a predictor for the diagnosis of PCOS. Conclusion: Doppler ultrasonography was a successful tool in assessing the hemodynamic changes in PCOS women.

Association of the key immunological and hemodynamic determinants with cervix ripening in pregnant women.

Aim: To investigate a correlation between cervical ripening, the immunological features and the hemodynamic characteristics of the cervix during the preparation for vaginal labor. Materials and Methods: We examined 75 pregnant women at different gestational age. General clinical and immunological studies were conducted in order to check serum concentration of cytokines IL-6, IL-1β, and TNF-α. Ultrasound and Doppler study were used to determine resistance index and systolic-diastolic ratio of blood flow in the common uterine artery as well as the descending and ascending parts and cervical stromal arteries. Results: Pregnant women with high cervical ripening score had high concentrations of the major proinflammatory cytokines (IL-1β, IL-6, and TNF-α). Analysis of the of the cervical blood flow indicators of the studied groups showed significant differences in the indices of vascular resistance in the vessels that feed the cervix. Our data showed a significant correlation between the cervix ripening and both the serum levels of the studied cytokines and the level of peripheral vascular resistance indices in the common uterine arteries of the cervix, and the blood flow indices in the cervical stromal vessels. Conclusions: Our study shows that the process of preparing the woman's body for labor is associated with immunological adjustment and increased hemodynamics of the cervix. We report that cervical ripening is associated with the immunological components and hemodynamic parameters of the cervix at late-stage pregnancy. Measuring cervix ripening and the accompanied changes in cytokine levels and hemodynamic parameters will form a more accurate assessment of birth preparedness and labor complications.

Ovarian Reserve and Pelvic Ultrasound Assessment in Familial Mediterranean Fever.

IntroductionFamilial Mediterranean fever (FMF) is an inflammatory rheumatic disease that affects people in their reproductive period. The aim of this study was to investigate the number of gravida, ovarian reserve, and ovarian doppler characteristics in FMF patients.MethodsThe study design is cross-sectional. Between November 1, 2018, and October 31, 2019, 40 FMF patients, and 40 age-matched volunteers were included in the study. Early follicular phase follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2), progesterone, and anti-Mullerian hormone (AMH) levels, as well as ovarian volume, antral follicle count (AFC), ovarian stromal artery doppler findings, and pelvic pathologies, were evaluated.ResultsThe number of gravida, and the AFC was significantly higher in the control group (16.00 ± 5.22) compared to the patients with FMF (13.00 ± 4.09) (p = 0.026). LH values were significantly higher in the FMF group. Thirteen patients (32.5%) received anakinra and colchicine, and 27 patients (67.5%) received only colchicine. There was no significant difference between the patients receiving anakinra, and the patients receiving colchicine in terms of AMH, FSH, AFC, and E2 values.ConclusionFMF patients were found to have low gravida and AFC, and a significant portion was observed to have pelvic fluid and hydrosalpinx. In conclusion, the presence of pelvic fluid, hydrosalpinx, and low AFC persist in FMF patients despite colchicine and/or anti-interleukin-1 treatments. The low gravida may be related to these pathologies detected in patients with FMF.

Application of ultrasound markers measured at different time points of COH cycle in the prediction of ovarian response for individualised ovulation induction

The purpose of this study was to evaluate the predictive value of ultrasound markers measured at different time points of the controlled ovarian hyperstimulation (COH) cycle on ovarian response and outcome indicators in the IVF-ET cycle. According to the oestrogen level and the number of retrieved oocytes, patients who planned for COH treatment were separated into low-response group, normal and high-response group. The ovarian stromal artery flow parameters on the day of pituitary down-regulation, day 1, day 7, day 10, and the day of hCG injection were collected prospectively. We also have collected the data of cumulus oophorus count on the day of hCG injection by transvaginal sonography. Compared with the low-response group, on the first day of the COH cycle PI, RI, and S/D were lower in the high-response group than they were in the low-response group (p < .05). PSV and EDV were significantly higher in the high-response group than they were in the low-response group (p < .01), and the PSV on the first day of the COH cycle have statistical significance in predicting the number of high-quality embryos. The number of cumulus oophorus on the day of hCG injection has statistical significance in predicting the number of oocytes retrieved and fertilised oocytes. We conclude that the ovarian stromal artery flow parameters on the first day of the COH cycle and cumulus oophorus count on hCG injection day can serve as efficient indicators for an early assessment of ovarian response and individualised ovulation induction. IMPACT STATEMENT What is already known on this subject? AMH, AFC, and the age of the patient are well-known effective parameters for the evaluation of ovarian response, but these are insufficient and full of individual differences. Some researchers have investigated the value of colour Doppler ultrasound and cumulus oophorus in assessing ovarian response, but no definitive conclusion has been reached. What do the results of this study add? The hemodynamic parameters of ovarian stromal artery on the first day of the COH cycle and the number of cumulus oophorus on the day of hCG injection detected by Transvaginal Colour Doppler Sonography (TV-CDS) could be used to predict the ovarian response. What are the implications of these findings for clinical practice and/or further research? Ovarian stromal artery flow parameters and cumulus oophorus detected by TV-CDS can potentially be offered as a complementary parameter for ovarian reserve.

Predictors of patient responses to ovulation induction with clomiphene citrate in patients with polycystic ovary syndrome experiencing infertility.

To identify predictors of clomiphene citrate-induced ovulation in patients with polycystic ovary syndrome (PCOS). A prospective observational study of patients 18-40 years of age with PCOS experiencing infertility was conducted at Menoufia University Hospital between January 2011 and January 2013. A range of potential predictors of ovulation were recorded before patients received a 50-mg dose of clomiphene citrate. Following ovulation or no response to increasing clomiphene-citrate doses, correlations between predictors and treatment responses were analyzed. In total, 150 patients with PCOS experiencing infertility were enrolled. Following treatment, 110 (73.3%) patients ovulated. Highly significant differences were observed between treatment responders and non-responders in baseline amenorrhea, body mass index (BMI), waist circumference, total testosterone, anti-Müllerian hormone, fasting insulin, homeostatic model assessment of insulin resistance, and visceral fat area (P<0.001). Significant differences in mean ovarian volume (P<0.009) and ovarian stromal artery pulsatility index (P<0.003) were also observed. Total testosterone was the best individual predictor of clomiphene citrate treatment response. The area under the receiver operating characteristic curve in a multivariate prediction model was 0.98. A combination of patient amenorrhea, BMI, total testosterone, anti-Müllerian hormone, ovarian volume, ovarian stromal artery pulsatility index, and visceral fat area could be used to predict clomiphene-citrate treatment response in patients with PCOS experiencing infertility. ClinicalTrials.gov: NCT02269306.

A Comparison of Color Doppler Sonography Findings in Polycystic Ovarian Syndrome Patients and Healthy Women

BACKGROUND AND OBJECTIVE: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. The assessment of uterine and ovarian artery resistance indices (RI) can provide additional information on pathophysiology of the syndrome, and can be applied as a diagnosis criterion in suspected cases of PCOS. This study aims to compare the parameters of uterine artery blood flow and ovarian stromal artery in PCOS patients and healthy women. METHODS: This cross-sectional study was performed on 20 women with PCOS (PCOS group) and 20 healthy women (control group). In the initial evaluations, age, body mass index, levels of follicle stimulating and luteinizing hormones, as well as severity of hirsutism and acne were recorded. Then, ovarian volume, uterine and ovarian artery RI and the rate of vascularization of ovarian stromal arteries were measured and compared with each other using Gray-scale and color Doppler sonography (CDS). FINDINGS: Uterine artery RI on both sides in the PCOS patients (0.94) was significantly higher than the healthy women (0.86) (p<0.001). Ovarian artery RI on both sides in the PCOS group (0.65) was lower than the control group (0.71) (p<0.001). The rate of vascularization of ovarian stromal arteries was higher in the PCOS patients (45%), as compared to the healthy women (0%) (p<0.001). CONCLUSION: According to the CDS findings, ovarian stromal and uterine blood flow parameters were significantly different in the PCOS and control groups.

Comprasion of ovarian stromal blood flow measured by color Doppler ultrasonography in polycystic ovary syndrome patients and healthy women with ultrasonographic evidence of polycystic

Objective: To compare ovarian stromal artery blood flows measured by Doppler ultrasonography of polycystic ovary syndrome (PCOS) patients and healthy women with polycystic ovarian image in ultrasonography.Methods: Forty-two patients diagnosed with PCOS according to the criteria of 2003 Rotterdam Concencus Conferance on PCOS and 38 healthy volunteers with polycystic ovarian image in ultrasonography were included in the study. Ovarian volumes and ovarian stromal artery blood flows were measured by 3-dimensional (3-D) ultrasonography and Doppler ultrasonography in all patients.Results: In patients with PCOS, ovarian stromal artery pulsatility index (PI) and resistivity index (RI) were found significantly different from healthy women with polycystic ovarian image in ultrasonography (p < 0.05). 3-D ovarian volumes were found significantly higher in patients with PCOS (p < 0.05), and a negative correlation was also obtained between ovarian volumes and ovarian stromal artery resistivity indices.Conclusion: Ovarian stromal artery Doppler examination could have an importance to explain the pathophysiology of PCOS, but there are few publications in the literature about PCOS and the details of ovarian stromal artery Doppler parameters in patients with polycystic ovarian image only. We conclude that Doppler ultrasonography findings of PCOS patients might be helpful in understanding the clinical follow-up and etiology of the disease.

Ovarian Features after 2 Weeks, 3 Weeks and 4 Weeks Transdermal Testosterone Gel Treatment and Their Associated Effect on IVF Outcomes in Poor Responders.

This study was performed to investigate the effect of of transdermal testosterone gel (TTG) on controlled ovarian stimulation (COS) and IVF outcomes and ovarian morphology according to pretreatment duration in poor responders. A total of 120 women were recruited for this pilot study. They were randomized into control, 2 weeks, 3 weeks or 4 weeks TTG treatment groups. For three TTG treatment groups, 12.5 mg TTG was applied daily for 2 weeks, 3 weeks or 4 weeks in preceding period of study stimulation cycle. After 3 weeks of TTG pretreatment, significant increase of antral follicle count (AFC) and significant decreases of mean follicular diameter (MFD) and resistance index (RI) value of ovarian stromal artery were observed (p=0.026, p<0.001, p<0.01, respectively). The total dose of rhFSH administered for COS significantly decreased after 3 and 4 weeks TTG treatment both compared with control group (p<0.001, p<0.001). The numbers of oocytes retrieved and mature oocytes were significanty higher in 3 and 4 weeks TTG treatment groups than control group (p<0.001, p<0.001 in the number of oocytes retrieved; p<0.001, p<0.001 in the number of mature oocytes). The clinical pregnancy rate and live birth rate were increased only in 4 weeks TTG treatment group compared with control group (p=0.030 and p=0.042, respectively). These data demonstrated that TTG pretreatment for 3 to 4 weeks increases AFC and ovarian stromal blood flow, thereby potentially improving the ovarian response to COS and IVF outcome in poor responders undergoing IVF/ICSI.

Comprasion of Ovarian Stromal and Uterin Artery Blood Flow Measured by Color Doppler Ultrasonography in Polycystic Ovary Syndrome Patients and Patients With Ultrasonographic Evidence of Polycystic

Background: In this study, the difference between ovarian stromal and uterine artery blood flow measured with color Doppler ultrasound between polycystic ovary syndrome (PCOS) patients and patients with ultrasonographic evidence of polycystic were evaluated. Methods: Serum hormone levels and ultrasonographic and color Doppler analysis were evaluated for 20 patients with PCOS and 20 healthy women with ultrasonographic evidence of polycystic. Results: There were significant difference between uterine artery pulsatility index (PI), uterine artery resistance index (RI), ovarian stromal artery PI and ovarian stromal artery RI measurements of PCOS and healthy women with ultrasonographic evidence of polycystic groups (P values respectively; P < 0.01, P < 0.05, P < 0.01, P < 0.01). In PCOS group ovarian stromal artery RI values were inversely correlated with androstenedione levels (r = -0.536; P < 0.05). Also in PCOS group uterine artery PI values were positively correlated with androstenedione levels (r = 0.536; P < 0.05). Conclusion: ​ In patients with PCOS uterine artery PI and RI values are higher than women with ultrasonographic evidence of polycystic while ovarian artery PI and RI values ​​ were lower. Ovarian stromal artery RI value is inversely proportional to the serum androstenedione level while exchange value of uterine artery PI varies in direct proportion to the serum androstenedione level for PCOS patients. doi: http://dx.doi.org/10.4021/jcgo85w

Comprasion of Ovarian Stromal and Uterin Artery Blood Flow Measured by Color Doppler Ultrasonography in Polycystic Ovary Syndrome Patients and Patients With Ultrasonographic Evidence of Polycystic

Comprasion of Ovarian Stromal and Uterin Artery Blood Flow Measured by Color Doppler Ultrasonography in Polycystic Ovary Syndrome Patients and Patients With Ultrasonographic Evidence of Polycystic

PCOS and Urethrovaginal Space: 3-D Volumetric and Vascular Analysis

The vaginal orgasm seems to be evocated by the stimulation of the G-spot: a highly sensitive area on the anterior wall of the human vagina. However, the existence of such a spot is controversial. To evaluate, by the use of three-dimensional (3-D) ultrasonography, the anatomic structures of the urethrovaginal space both in polycystic ovarian syndrome (PCOS) patients and eumenorrheic non-hirsute controls. Twenty-three (Group I) PCOS patients and 25 eumenorrheic young women (Group II) were submitted to two-dimensional (2-D) and 3-D ultrasonography and color Doppler analysis of the urethrovaginal space and of the clitoris. 2-D ultrasonographic evaluation of the ovaries and of the urethrovaginal space; color Doppler evaluation of the ovarian stromal arteries, urethrovaginal main feeding artery, and dorsal clitoral arteries; 3-D volume calculation of the urethrovaginal space, and 3-D power Doppler analysis of the vascularization index; flow index; and vascularization flow index; hormonal evaluation. The vaginal orgasm was present in 13/23 (56%) patients in PCOS Group and in 13/25 (52%) in the controls. The 3-D reconstruction of the urethrovaginal space demonstrated a gland-like aspect with small feeding vessels: "female prostate." The 3-D mean volume of the "female prostate" was significantly higher in Group I (0.48 ± 0.21 mL) than in Group II (0.39 ± 0.19 mL; P = 0.044). The Virtual Organ Computer-aided AnaLys (VOCAL) built mean volume of the "female prostate" was positively correlated with the time since intercourse (r = 0.486; P = 0.032), with the total length of the urethrovaginal space (r = 0.616; P = 0.025) and with the testosterone (r = 0.424; P = 0.048) circulating values. The presence of the G-spot and its role in vaginal orgasm remains controversial. In Italians, and normal weight PCOS patients the hyperandrogenism seems to result in ovarian stromal and "female prostate" hyperplasia.

Doppler analysis of uterine perfusion and ovarian stromal blood flow in polycystic ovary syndrome

Objective To investigate blood flow velocity in the ovarian stromal artery and uterine artery in women with polycystic ovary syndrome (PCOS) and to correlate these velocities with clinical and biochemical parameters. Methods A prospective study was carried out in 55 patients with PCOS and 42 age-matched women who did not have PCOS. Clinical, biochemical, and hormonal characteristics, and utero–ovarian Doppler ultrasound blood flow parameters were determined, and correlations between the parameters were evaluated. Results Ovarian stromal blood flow was higher ( P < 0.01) and uterine perfusion was lower ( P < 0.01) in women with PCOS compared with women who did not have PCOS. Ovarian stromal artery pulsatility index (PI) was inversely correlated with levels of dehydroepiandrosterone sulfate (DHEAS) and insulin-like growth factor-1, and with the luteinizing hormone/follicle-stimulating hormone ratio. There was a positive correlation between uterine artery PI and DHEAS level. Conclusion Doppler analysis of the uterine and intraovarian arteries may provide additional information about the etiopathogenesis of PCOS and partly explain the clinical implications of the condition.

Assesment of ovarian stromal artery Doppler characteristics and serum hormone levels in patients with Behçet's Disease

The aim of the study was to examine serum hormone levels, ovarian volume, stromal artery Doppler parameters of patients with Behçet disease (BD) to assess whether there are vascular changes in the gonads of these patients. Twenty patients with BD and 31 healthy controls aged between 18-45 years were examined in the early follicular phase of the menstrual cycle (day 2-3) with transvaginal ultrasound to evaluate ovarian volume and ovarian stromal artery Doppler parameters. On the same day, blood was drawn for determining serum hormone levels. Patients with BD and the controls were comparable with regard to age and body mass index at study inclusion. Although comparison of the ovarian stromal artery Doppler velocimetric parameters did not show significant differences, resistivity, pulsatility indexes and systolic/diastolic ratio were higher, while peak systolic and end diastolic velocities were lower, in BD patients compared to controls. The mean ovarian volume of patients with BD was smaller than the controls but this difference did not reach statistical significance. There were no statistically significant differences between serum hormone levels of either group. We did not find any correlations between hormone levels and mean ovarian stromal artery Doppler parameters of patients with BD. Ovarian stromal artery Doppler parameters of patients with BD did not show any significant differences compared to healthy controls. Therefore, we conclude that ovarian stromal artery is not involved in patients with BD as assessed by transvaginal Doppler ultrasound and serum hormone levels do not differ from the levels of healthy controls.

The impact of immunomodulating drugs on ovarian reserve in multiple sclerosis patients

OBJECTIVE: To determine the impact of immunomodulating drugs on ovarian reserve in patients with multiple sclerosis (MS). DESIGN: Prospective controlled clinical study. MATERIALS AND METHODS: Thirteen normally menstruating MS patients using immunomodulating drugs and 15 age-matched healthy controls were included in the study. Subjects were examined on cycle day 2-5 of a menstrual cycle with transvaginal ultrasound to evaluate ovarian volume, antral follicle count (AFC) and ovarian stromal artery flow by Doppler. On the same day, blood was drawn for determining follicle stimulating hormone (FSH) and estradiol (E2) levels. RESULTS: MS patients and controls were comparable with regard to body mass index and age at study inclusion. FSH and E2 levels and ovarian volumes did not show any significant differences between the two groups, but mean number of total antral follicles (2-10 mm) was significantly lower in MS patients than in controls (7.7±4.04 vs 11.4±4.5) (table-1).Table 1Results of ovarian reserve tests in MS patients using immunomodulating therapiesMS patients (n=13)Control (n=15)p valueAge±SD34.62±5.1732.27±5.87NSBMI25.59±3.9324.04±4.09NSFSH (mIU/mL)8.60±3.507.72±1.69NSE2 (pg/mL)54.14±35.741.67±23.02NSTotal AFC (2-10 mm)7.73±4.0411.40±4.50.03Ovarian volume (cm3)6.67±3.136.98±1.97NSRI.49±.10.43±.08NSPI.85±.23.73±.19NSS/D2.14±.561.85±.35NSPSV10.43±3.4414.423±3.37.01∗BMI: Body mass index. FSH: Follicle stimulating hormone. E2: Estradiol. AFC: Antral follicle count.RI: Resistance index. PI: Pulsatility index. S/D: Systolic/diastolic ratio. PSV: Peak systolic velocity. Open table in a new tab BMI: Body mass index. FSH: Follicle stimulating hormone. E2: Estradiol. AFC: Antral follicle count.RI: Resistance index. PI: Pulsatility index. S/D: Systolic/diastolic ratio. PSV: Peak systolic velocity. The mean ovarian stromal artery resistance index, pulsatility index and systolic/diastolic ratio of MS patients were higher than of the control group, but the difference did not reach statistical significance. The only statistically significant difference in Doppler indices was lower mean peak systolic velocity (PSV) in MS patients. CONCLUSIONS: We found a significant decrease in mean AFC and PSV of ovarian stromal arteries in patients with MS using immunomodulating drugs. These findings support that MS patients using immunomodulating drugs may have a diminished ovarian reserve and fertility. The diminishment maybe related to altered ovarian blood flow but further research will be needed to prove this hypothesis. In the mean time, patients undergoing treatment with immunomodulators should be informed about the possible gonadotoxic effects of these therapies.

Intraluteal regulation of prostaglandin F2α-induced prostaglandin biosynthesis in pseudopregnant rabbits

The objective of the present study was to investigate in rabbit corpora lutea (CL), at both the cellular and molecular level, intraluteal cyclooxygenase (COX)-1, COX-2 and prostaglandin (PG) E2-9-ketoreductase (PGE2-9-K) enzymatic activities as well as in vitro PGE2 and PGF2alpha synthesis following PGF2alpha treatment at either early- (day-4) or mid-luteal (day-9) stage of pseudopregnancy. By immunohistochemistry, positive staining for COX-2 was localized in luteal and endothelial cells of stromal arteries at both the stages. In CL of both stages, basal COX-2 mRNA levels were poorly expressed, but rose (P < 0.01) 4- to 10-fold 1.5-6 h after treatment and then gradually decreased within 24 h. Compared to mid-stage, day-4 CL had lower (P < 0.01) COX-2 and PGE2-9-K basal activities, and PGF2alpha synthesis rate, but higher (P < 0.01) PGE2 production. Independent of luteal stage, PGF2alpha treatment did not affect COX-1 activity. In day-4 CL, PGF2alpha induced an increase (P < 0.01) in both COX-2 activity and PGF2alpha synthesis, whereas that of PGE2 remained unchanged. In day-9 CL, PGF2alpha up-regulated (P < 0.01) both COX-2 and PGE-9-K activities, and PGF2alpha production, but decreased (P < 0.01) PGE2 synthesis. All changes in gene expression and enzymatic activities occurred within 1.5 h after PGF2alpha challenge and were more marked in day-9 CL. Our data suggest that PGF2alpha directs intraluteal PG biosynthesis in mature CL, by affecting the CL biosynthetic machinery to increase the PGF2alpha synthesis in an auto-amplifying manner, with the activation of COX-2 and PGE-9-K; this may partly explain their differentially, age-dependent, luteolytic capacity to exogenous PGF2alpha in rabbits.

Comparison of clinical outcomes and spectral Doppler indices of uterine and ovarian stromal arteries in women undergoing myomectomy with or without hypogastric arterial ligation

To compare clinical outcomes and hemodynamic alterations of uterine and ovarian stromal arteries between patients with symptomatic myomas undergoing myomectomy preceded by arterial ligation and those undergoing myomectomy alone. In this prospective, non-randomized comparative study, myomectomy was performed on 69 women with symptomatic myomas. Myomectomy alone was performed in 31 patients (Group I) and myomectomy with concomitant bilateral hypogastric arterial ligation was performed in 38 patients (Group II). In both groups, surgical results and clinical outcomes were evaluated by peripheral hemoglobin levels, a pictorial blood-loss assessment chart, and visual analog scales. Spectral Doppler indices of uterine and ovarian stromal arteries, including peak systolic velocity, end-diastolic velocity, pulsatility index and resistance index were performed preoperatively, and 1 day and 1 or more months postoperatively. Twenty-two patients in Group I and 31 patients in Group II received regular follow-up examinations for a mean follow-up period of 10.1 months. Menstrual flow, dysmenorrhea and hemoglobin levels improved significantly after surgery in both groups. Blood loss during surgery was less in Group II than it was in Group I (P=0.02). Doppler indices of uterine and ovarian stromal arteries from preoperation to mean follow-up point were not significantly different between the groups, except for a significantly lower uterine artery pulsatility index in Group II (P=0.01). Myomectomy with hypogastric arterial ligation for symptomatic myomas is as efficient as is myomectomy alone and reduces blood loss during surgery. Serial Doppler studies showed that hypogastric ligation does not block uterine and ovarian perfusion, and even reduces the impedance of the uterine arteries. The long-term recurrence rate after myomectomy with hypogastric arterial ligation remains to be determined.

Hormonal and ovarian stromal blood supply changes after laparoscopic tubal sterilization: a prospective controlled study

Objectives The purpose of this study is to determine if the effects of tubal sterilization (TS) by laparoscopy have any risk of a subsequent significant decrease in ovarian reserve and vascular support within the ovary by means of stromal artery Doppler study, and to compare the results with matched paired controls. Design Between February 2002 and January 2005, 148 healthy volunteers were enrolled sequentially, 74 undergoing laparoscopic TS (study group) and 74 age-, parity-, body mass index-matched women were recruited as a control group. The main outcome measurements were blood levels of follicle-stimulating hormone (FSH), luteinizing hormone and E 2, ovarian volume, number of antral follicles and Doppler study of ovarian stromal artery pulsatile index (PI) and maximum velocity ( V max) on the third day of the cycle immediately before, and 1 and 12 months after the surgical intervention. Results There were significant elevations in both serum FSH levels and PI values observed 1 month after TS, compared to the preoperative levels (p<.05), and also when compared to controls. However, there were no significant elevations at 12 months postoperation in both study and control groups. The other outcome measurements did not show any significant differences between the two groups. Conclusions Tubal sterilization by laparoscopic electrocoagulation does not cause any decrease in ovarian reserve or ovarian stromal blood supply, except an early postoperative increase in FSH and PI.

Ovarian reserve and ovarian stromal blood supply after tubal ligation by the Pomeroy technique: Comparison with controls

Objective. To determine if women who undergo tubal sterilization by the Pomeroy technique have any risk of a subsequent significant decrease in ovarian reserve and vascular support inside the ovary, by means of stromal artery Doppler ultrasonography.Methods. Between March 2000 and September 2004, 108 healthy volunteers underwent mini-laparatomic tubal ligation using the modified Pomeroy technique (study group). As a control group, 102 age-matched women were recruited. The main outcome measurements were blood levels of follicle-stimulating hormone (FSH), luteinizing hormone and estradiol, ovarian volume, number of antral follicles and Doppler indices of the ovarian stromal arteries on the third day of the cycle immediately before, 1 month and 12 months after the surgical intervention.Results. In the study group and control group, results of the main outcome measurements immediately before, 1 month and 12 months after the surgical intervention did not show any significant difference except one. There was a significant elevation of FSH levels after 1 and 12 months, which was statistically significant (p < 0.05) in the study group.Conclusion. The 12-month follow-up of patients suggests that there is neither a decrease in ovarian reserve nor an adverse effect on the blood supply of ovarian stroma after tubal sterilization by the modified Pomeroy technique. A significant elevation of FSH levels was observed at 1 and 12 months after the operation.

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.

Effect of tubal ligation on ovarian reserve and the ovarian stromal blood supply.

Our aim was to evaluate possible adverse effects of tubal ligation on ovarian reserve and ovarian stromal vascular support. Ninety-one women who underwent tubal ligation, using a modified Pomeroy technique, were studied. The main outcome measurements were serum follicle stimulating hormone, luteinising hormone and oestradiol levels, ovarian volume, number of antral follicles and Doppler study of ovarian stromal artery on the third day of the menstrual cycle immediately before, 1 month and 12 months after the surgical intervention. Statistically significant elevation of follicle stimulating hormone levels was observed at 1 and 12 months after tubal ligation (P < 0.05). Doppler flow studies of the ovarian stromal arteries showed that there were no significant differences before and after tubal ligation.