Uterine Arteries In Women Research Articles

Changes in the concentration of endothelin-1 and the state of blood flow in the uterine arteries of women in the third trimester of gestation with exacerbation of cytomegalovirus infection in the second trimester of pregnancy

Aim. To assess the change in the concentration of endothelin-1 (ET-1) and the state of uteroplacental blood flow in women in the third trimester of gestation with exacerbation of cytomegalovirus infection (CMVI) in the second trimester of pregnancy.Materials and methods. A comprehensive examination of 120 women with pregnancies uncomplicated and complicated by exacerbation of CMVI in the second trimester of gestation was carried out. The first group consisted of 30 women with a seronegative CMVI normal pregnancy, the second group – 30 patients with a latent course of CMVI and the development of chronic compensated placental insufficiency (CCPI), the third – 30 women with exacerbation of CMVI and CCPI, and the fourth – 30 patients with exacerbation of CMVI and chronic subcompensated placental insufficiency (CSPI).Results. With the development of CCPI at 30-34 weeks of gestation in women of the second group, compared with the first, the concentration of ET-1 in blood serum increased to 1.16±0.09 fmol/L (in the control – 0.86±0.08 fmol/L, p<0,05). There was an increase in the systolic-diastolic ratio (SDR) in the right uterine artery (RUA) by 1.40 times (p=0.000001) and in the left uterine artery (LUA) by 1.46 times (p=0.000001), which illustrated the important role of endothelial activation in increasing resistance in the uterine artery basin. In the third group, in comparison with the first and second ones, an increase in the concentration of ET-1 was recorded to 1.57±0.13 fmol/L (p<0.001 and p<0.05, respectively), reflecting a more pronounced activation of the endothelium. In women of the third group, in comparison with the first and second groups, there was an increase in SDR in the RUA by 1.43 times (p=0.000001) and 1.01 times (p=0.046), respectively. Comparison of blood flow in the LUA in women in the third group in comparison with that in the first and second groups showed an increase in SDR by 1.47 times (p=0.000001) and 1.01 times (p=0.0462), respectively. At the same time, a strong positive correlation was recorded between the SDR in the RUA and the level of ET-1 (r=076; p<0.001), which is a marker of an endothelium-dependent increase in vascular resistance. In women of the fourth group, the level of ET-1 was 2.15±0.17 fmol/L, which is significantly higher compared with group 1 (5.08 times, p=0.000001), with the second group (4.08 times, p=0.000001) and in comparison with the third group (1.23 times, p=0.0029). SDR in RUA in the fourth group compared to the first one increased by 1.62 times (p=0.000001), and compared to the second – by 1.15 times (p=0.00002). At the same time, in patients of the fourth group in comparison with the third group, SDR in RUA increased by 1.13 times (p=0.024). In the fourth group, in contrast to the first one, there was an increase in SDR in LUA by 1.58 times (p=0.000001), and in comparison, with the second group, SDR in LUA was 1.07 times higher (p=0.00021). Patients of the fourth group, in comparison with the third one, had higher SDR indices in the LUA (1.06 times, p=0.0207). There was a stronger relationship between the SDR value in RUA and the concentration of ET-1 (r=0.86; p<0.001) and a weak correlation between SDR in LUA and ET-1 (r=0.47; p<0.01), which reflects the influence of endothelial dysfunction in response to an increase in the tone of the uterine arteries.Conclusion. The development of CSPI in the third trimester of gestation in women who underwent an exacerbation of CMVI in the second trimester of pregnancy, in contrast to CCPI with a similar infectious pathology in pregnant women, is characterized by a more pronounced increase in vascular resistance in the uterine artery basin against the background of endothelial dysfunction.

Cardiometabolic risk is unraveled by color Doppler ultrasound of the clitoral and uterine arteries in women consulting for sexual symptoms

Female sexual dysfunction (FSD) may be a mirror of a poor cardiometabolic state. In a small pilot study enrolling 71 women with FSD, we previously demonstrated that clitoral Pulsatility Index (PI) evaluated by using color Doppler ultrasound (CDU), reflecting vascular resistance, was associated with cardiometabolic risk factors. Data on uterine CDU in this context are lacking. First, to confirm previously reported data on the direct association between clitoral PI and cardiometabolic risk factors on a larger study population of women consulting for sexual symptoms; second, to investigate eventual similar correlations between cardiometabolic risk factors and CDU parameters of the uterine artery. We also ascertained whether uterine artery PI, similarly to what had previously been observed for clitoral artery PI, was directly related to body image uneasiness and psychopathological symptoms, assessed by validated questionnaires. N = 230 women consulting our clinic for sexual symptoms were examined with clitoral CDU and blood sampling and were asked to fill out the Female Sexual Function Index, the Middlesex Hospital Questionnaire (MHQ) and the Body Uneasiness Test (BUT). In a subgroup of women (n = 164), we also performed transvaginal CDU with measurement of uterine artery parameters. At multivariate analysis, we found a direct association between clitoral PI and body mass index (BMI) (p = 0.004), waist circumference (WC) (p = 0.004), triglycerides (p = 0.006), insulin (p = 0.029) and HOMA-IR (p = 0.009). Furthermore, a correlation between obesity and Metabolic Syndrome (MetS) and a higher clitoral PI was observed (p = 0.003 and p = 0.012, respectively). Clitoral PI was also correlated with MHQ-S (p = 0.010), a scale exploring somatized anxiety symptoms, and BUT-B Positive Symptom Distress Index (p = 0.010), a measure of body image concerns. Similarly, when investigating the uterine artery, we were able to demonstrate an association between its PI and BMI (p < 0.0001), WC (p = 0.001), insulin (p = 0.006), glycated haemoglobin (p = < 0.0001), and HOMA-IR (p = 0.009). Women diagnosed with obesity and MetS showed significantly higher uterine PI values vs. those without obesity or MetS (p = 0.001 and p = 0.004, respectively). Finally, uterine PI was associated with BUT-A Global Severity Index (p < 0.0001) and with several other BUT-A subdomains. Vascular resistance of clitoral and uterine arteries is associated with cardiometabolic risk factors and body image concerns in women consulting for sexual symptoms. If further confirmed in different populations, our data could suggest CDU, a common examination method, as a useful tool for an identification—and possible correction—of cardiometabolic risk factors.

Frequency of cesarean section in pregnant women with risk factors for preeclampsia: prospective cohort study

Background: Preeclampsia is a disorder of pregnancy associated with new-onset hypertension after the 20th week of gestation. The aim of this study is to examine frequency of cesarean delivery in pregnant women with risk for developing preeclampsia compared with pregnant women with normal pregnancy. Methods: The prospective study included 240 pregnant women. The experimental group had 120 pregnant women with preeclampsia risk factors. The control group had 120 pregnant women with no pregnancy risk factors. The method of delivery completion was analyzed. Results: In the experimental group, 88 (73.3%) pregnant women completed delivery vaginally, by cesarean section in 32 (26.7%). In the control group of vaginally deliveries were 105 (87.5%), by cesarean section 15 (12.5%). The difference in the frequency of method of delivery between the experimental and control groups is not random (p = 0.009). The chance of completing a delivery by cesarean section 2.54 times is higher in the experimental than in the control group. In the control group, it was found that the RI of uterine arteries in women who delivered by cesarean section was statistically significantly higher than in vaginal delivery (p = 0.038). Conclusion: Cesarean section is the most commonly used surgical procedure to complete delivery in pregnant womens with risk factors for preeclampsia, which confirmed our study.

Carotid arterial wall stiffness correlates positively with impedance of the umbilical and uterine arteries in women with preeclampsia.

This study aimed to determine whether the stiffness of the arterial walls of women with preeclampsia (PE) differs from that of healthy controls and to evaluate its association with fetal and uterine artery Doppler variables and perinatal outcomes in PE. We enrolled 30 women with PE and 30 normotensive pregnant women. Carotid artery stiffness and Doppler variables of the uterine, umbilical, and fetal middle cerebral arteries and the ductus venosus were measured in both groups. Measurements of the common carotid artery were performed by the Aloka ultrasonic echo-tracking technique. Stiffness of the carotid artery wall of women with PE was significantly higher than that of healthy controls. It was positively correlated with the pulsatility index of the uterine and umbilical arteries and negatively correlated with the cerebroplacental ratio in women with PE. In women with PE, the carotid artery augmentation index showed negative correlations with birth weight and Apgar score. The stiffness of the carotid arteries of women with PE is increased, and this increase is positively correlated with the impedance of the umbilical and uterine arteries.

Hormone therapy in menopausal women with fibroids: is it safe?

Menopause is an important transition in the life of women. It has been estimated that by the year 2030, worldwide 1.2 billion women will be menopausal. The most bothersome symptoms of menopause are believed to be due to declines in estrogen levels in postmenopausal women. Thus, hormone therapy is an effective treatment option for menopausal women, although prolonged use of hormone therapy is associated with a slightly increased risk of breast cancer, thromboembolism, and stroke. A literature search for studies evaluating the effects of hormone therapy in menopausal women with asymptomatic fibroids demonstrated variable effects of hormone therapy on the volume and size of the fibroids. Some studies have demonstrated an increase in size of pre-existing asymptomatic fibroids and formation of new fibroids with higher doses of progestogen in combination therapy. The finding of low resistance index in uterine arteries of women with asymptomatic fibroids is associated with an increased risk of fibroid growth, and thus making the measurement of pulsatility index of uterine arteries a possible screening tool before initiating hormone therapy in menopausal women with fibroids. Although the effect of hormone treatment is variable and statistically insignificant in many cases, the newer selective estrogen receptor modulators having tissue-specific estrogen agonistic and antagonistic actions such as raloxifene have a favorable clinical profile and may be better alternatives in women with asymptomatic fibroids.

Plavix versus Low Dose Aspirin Impact on Blood Flow of the Uterine Artery in Women with Unexplained Recurrent Miscarriage

Plavix versus Low Dose Aspirin Impact on Blood Flow of the Uterine Artery in Women with Unexplained Recurrent Miscarriage

Vascular changes responsible for the reduced effectiveness of obliteration of uterine arteries in women with advanced cervical cancer.

IntroductionHaemorrhages from the genital tract remain a major threat to the life of patients with advanced cervical cancer. It is possible to achieve haemostasis by both surgical techniques and the procedure of endovascular uterine artery embolization. However, in some women with loco-regionally advanced cervical cancer the obliteration of the uterine arteries is not effective.AimEvaluation of morphological changes in uterine arteries in patients with advanced cervical cancer and comparison of their changes with the achieved haemostatic effect of obliteration.Material and methodsThe prospective study included a group of 8 women with cervical cancer at a clinical stage of IIB to IIIC according to the FIGO classification. 3D quantitative coronary angiography (QCA) was performed before uterine embolization. The haemostatic effect of uterine artery embolization was compared with observed vascular changes.ResultsMean uterine artery length in patients who achieved complete hemostasis: 39.5 mm – right uterine artery; 38.7 mm – left uterine artery. Mean uterine artery length in patients who achieved partial satisfactory haemostasis: 32 mm – right uterine artery; 30.5 mm – left uterine artery. Mean uterine artery length in patients who achieved unsatisfactory haemostasis: 10.5 mm – right uterine artery; 19 mm – left uterine artery.ConclusionsShortening of uterine arteries worsens prognosis of the haemostatic effect of their obliteration in patients with advanced cervical cancer.

Is Prostatic Artery Embolization Similar to Uterine Artery Embolization?

Recently, arterial embolization has been proposed as a safe and effective treatment for benign prostatic hyperplasia (BPH) [1]. Nonetheless, prostatic arterial embolization (PAE) is not a new procedure; it has been used for almost 40 years to control prostatic bleeding [2]. In 2000, De Merritt et al. [3] reported a case of embolization to treat hematuria after prostate biopsy in a patient with BPH. Interestingly, embolization not only stopped the bleeding, but also reduced the size of the gland and led to improvement in lower urinary tract symptoms. This observation sparked interest in a potential new application for embolotherapy. Early proponents of this new application noticed some similarities between prostatic artery embolization (PAE) and the well-established uterine artery embolization (UAE) procedure. UAE for treatment of symptomatic fibroids is now considered an excellent alternative to hysterectomy based on level I scientific evidence [4]. But what is the relationship between embolization for uterine fibroids and BPH? There are indeed some similarities. Both diseases are the most common benign tumors of the female and male pelvis, respectively. Both diseases have a tissue structure characterized by the presence of stromal and smooth muscle components, which are intrinsically hormone-dependent for their development and growth—estrogen and testosterone, respectively. Although considered benign tumors, both illnesses cause symptoms that produce a deep impact on quality of life, and usually are treated with conventional medical and surgical therapies, intrinsically associated with risks and morbidity, including sexual dysfunction. In contrast, embolization is a minimally invasive alternative that delivers embolic agents with the aim of causing targeted and controlled tissue ischemia and necrosis of the offending tumors. However, aside from these similarities, there are also many differences, which should be kept in mind for those who have experience in UFE and intend to explore the PAE field. Uterine fibroids affect premenopausal, therefore young, women up to the fifth decade of life, whereas BPH affects men starting from the fifth decade of life, with most symptomatic patients requiring treatment when they are even older. As a consequence, many BPH patients have significant atherosclerotic changes in their vessels, which make endovascular procedures more difficult and challenging. Uterine arteries in women with fibroids have a fairly constant anatomic location, distribution, and course, and their diameter grows proportionally to the size of the leiomyomatous uterus. In contrast, prostatic arteries are subject to numerous anatomic variations in terms of their origin and distribution, while remaining quite small in diameter, even when the prostate reaches fairly large volumes. It is also not uncommon to find more than one prostatic artery on each side [5]. In an anatomic description published recently, two main arterial pedicles to the prostate have been identified: the superior and inferior prostatic pedicles [5]. The former provides the main arterial supply of the prostate, in addition to both the inferior bladder and N. Kisilevzky (&) Interventional Radiologist at Endovascular Center, Rua Guararapes 682, City Lapa, SP CEP 05077051, Brazil e-mail: dr.nestor@embolution.com.br

Sildenafil Citrate Rescues Fetal Growth in the Catechol- O -Methyl Transferase Knockout Mouse Model

Preeclampsia and fetal growth restriction are responsible for the majority of maternal and perinatal morbidity and mortality associated with complicated pregnancies. Although their etiologies are complex and multifactorial, both are associated with increased uterine artery resistance. Sildenafil citrate is able to rescue the dysfunction observed ex vivo in uterine arteries of women with preeclampsia. The ability of sildenafil citrate to increase uterine artery vasodilation, thereby decreasing uterine artery resistance and, hence, ameliorated preeclampsia and fetal growth restriction, was tested in a mouse model of preeclampsia, the catechol-O-methyl transferase knockout mouse (COMT(-/-)). COMT(-/-) and C57BL/6J mice were treated (0.2 mg/mL in drinking water, n=6-12) from gestational day 12.5 to 18.5. Measures of pup growth, including body weight, crown/rump length, and abdominal circumference, were reduced in COMT(-/-) mice; this was normalized after treatment with Sildenafil. COMT(-/-) mice also demonstrated abnormal umbilical Doppler waveforms, including reverse arterial blood flow velocity. This was normalized after treatment with Sildenafil. Abnormal uterine artery Doppler waveforms were not demonstrated in COMT(-/-) mice, although ex vivo responses of uterine arteries to phenylephrine were increased; moreover, treatment with Sildenafil did improve ex vivo sensitivity to an endothelium-dependent vasodilator. The data presented here demonstrate that Sildenafil can rescue pup growth and improve abnormal umbilical Doppler waveforms, providing support for a potential new therapeutic strategy targeting fetal growth restriction.

Flujo sanguíneo de las arterias uterinas en mujeres con dismenorrea primaria

ObjectiveTo identify the parameters of blood flow in the uterine arteries in women with primary dysmenorrhea. MethodsWe selected women attending the Nuestra Señora de Chiquinquirá and Central Dr. Urquinaona hospitals in Maracaibo, Venezuela. There were 40 women with primary dysmenorrhea (group A) and 40 women without dysmenorrhea (group B). Blood flow in the uterine arteries, women's general characteristics, Doppler blood flow parameters in the uterine arteries and symptom severity were evaluated. ResultsThe mean age was 28.3 ± 5.8 years in group A and 26.4 ± 5.0 years in group B (P=ns). Doppler ultrasound evaluation was performed on the second day of menstruation in all women in both groups. The pulsatility index, resistance index and systolic / diastolic ratio of the uterine arteries in women with a diagnosis of primary dysmenorrhea were significantly higher than in controls (P<.05). The uterine artery resistance index showed a moderate, positive and significant correlation with pain intensity (r=0.570; P<.05). ConclusionWomen with dysmenorrhea showed alterations in uterine artery blood flow compared with women without dysmenorrhea.

A comparison of endometrial and subendometrial vascularity assessed by three-dimensional ultrasonography and power Doppler angiography between healthy fertile women and women with unexplained primary recurrent miscarriage

We compared the characteristics of endometrial-subendometrial vascularity 7 days after ovulation of a natural cycle by transvaginal three-dimensional ultrasonography and power Doppler angiography between 88 patients with unexplained recurrent miscarriage and 46 healthy fertile women. Endometrial vascularization index, flow index, and vascularization flow index, as well as subendometrial vascularization index and vascularization flow index, were reduced significantly in the group with unexplained recurrent miscarriage.

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.

Altered responsiveness of small uterine arteries in women with idiopathic menorrhagia

This study was undertaken to study vascular reactivity of small myometrial arteries in women with idiopathic menorrhagia. Small myometrial arteries were isolated from 6 patients with idiopathic menorrhagia and 4 controls. The contractile responses to thromboxane mimetic (U46619) and endothelin-1 were assessed before and after incubation with N(w)-nitro-L arginine methyl ester alone or in combination with indomethacin (Indo). Endothelium-dependent dilation to bradykinin and basal tension were compared before and after incubation with N(w)-nitro-L arginine methyl ester alone, or with N(w)-nitro-L arginine methyl ester in combination with indomethacin. Constriction to endothelin-1 was enhanced in idiopathic menorrhagia arteries (P < .05). Idiopathic menorrhagia arteries demonstrated enhanced basal tension after incubation with N(w)-nitro-L arginine methyl ester, which was further exaggerated by indomethacin. NOS inhibition had no effect on basal tension in controls, but basal tension was enhanced after inhibition of cyclooxygenase-derived products (P < .05). Bradykinin-mediated dilation was significantly increased in idiopathic menorrhagia (P < .05). The presence of functional alterations in small myometrial arteries could contribute to idiopathic menorrhagia.

1168 The phenomenon of fatigue in young people

Objectives: To evaluate the effects of sequential continuous hormone replacement therapy (HRT) on myoma size and on pulsatility index (PI) of uterine arteries and to verify the correlation between uterine artery flow impedance and the growth rate of myoma in women receiving HRT. Methods: In a prospective 1-year study 60 postmenopausal women were enrolled into three study-groups to receive continuous transdermal 17β-oestradiol 0.05 mg/day plus nomegestrolo acetate 5 mg/day sequentially added: 20 patients (group A) unaffected by uterine myomas, 20 patients (group B) with single asymptomatic myoma <3 cm/14 cm3, 20 patients (group C) with single asymptomatic myoma >3 cm/14 cm3. The changes in myoma volume and in PI were assessed by means of transvaginal ultrasonographic scan every 3 months. The patients with myoma were divided into two subgroups: quiescent myoma (B1, C1) and growing myoma (B2, C2). Results: No significant increase of uterine fibroids volume was found after 1-year HRT (24.14±20.02→28.81±30.02 cm3). Six out of eight myomas growing during HRT belonged to group C. The uterine artery basal PI value of group A was significantly higher (P<0.01) than the corresponding PI in group B and C. At 3 months follow-up, uterine artery PI was significantly higher (P<0.01) than the basal value in both group B (1.70±0.22→1.88±0.16) and C (1.59±0.28→1.92±0.21). The baseline PI values in group B1 and C1 were significantly higher than the baseline values observed in group B2 and C2 (1.76±0.17 vs. 1.32±0.02, 1.76±0.16 vs. 1.24±0.08) and significantly lower than those observed in group A (2.39±0.47). After 3 months of HRT, the PI values were not significantly higher than the baseline values in groups B1 and C2 (1.76±0.17→1.90±0.17; 1.24±0.08→1.74±0.16), while they were significantly higher in group C1 (1.76±0.16→2.01±0.17). Conclusions: Sequential continuous HRT does not increase the volume of the uterine myoma. The findings of very low resistance index in the uterine arteries of women with growing myoma may indicate the risk of growth of the neoplasia during HRT. The assessment of PI in the uterine arteries could be helpful in predicting the growth rate of the myomas before starting HRT.

Colour Doppler analysis of ovarian and uterine arteries in women with hypoestrogenic amenorrhoea.

This is a clinically-controlled study designed to investigate uterine and ovarian blood flow in patients with hypoestrogenic amenorrhoea. Twelve women with hypoestrogenic amenorrhoea and 13 eumenorrhoeic subjects (controls) were enrolled. Colour and pulsed Doppler was used to visualize the uterine and ovarian arteries and the blood vessels within the ovarian stroma in both groups. Four blood flow indices were calculated: the pulsatility index, the resistance index, the peak systolic velocity and the end-diastolic velocity. Peak systolic velocity underwent the most significant change in amenorrhoeic patients, being significantly lower in comparison with that of controls, both in the uterine (P = 0.0009) and ovarian (P = 0.001) arteries. Compared with controls, the end-diastolic velocity of the ovarian artery was significantly lower (P = 0.039) in amenorrhoeic patients, and was also lower in the uterine artery (though not statistically significantly so). A reduction in blood flow was also evident in the ovarian stroma in amenorrhoeic patients. The significant reduction in blood flow observed in hypoestrogenic amenorrhoea suggests that estrogens play an important role in regulating both uterine and ovarian blood flow.

Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization.

To prospectively study and classify the anastomoses between the ovarian and uterine arteries in women undergoing uterine fibroid embolization, and to compare the presence of such with procedural failures and premature menopause. Angiographic ovarian artery-to-uterine artery anastomoses were studied in 76 consecutive patients undergoing uterine fibroid embolization. Mean patient age was 44.7 years (range, 29-56 years). Clinical follow-up consisted of a standard questionnaire. Procedural failure and complications were compared with the presence of various types of ovarian artery-to-uterine artery connections. Three types of anastomoses were identified. In type I (33 [21.7%] of 152 arteries), flow from the ovarian artery to the uterus was through anastomoses with the main uterine artery. In type II (six arteries [3.9%]), the ovarian artery supplied the fibroids directly. In type III (10 arteries [6.6%]), the major blood supply to the ovary was from the uterine artery. Seven patients (9%) were considered to have clinical failure, with three of the six women with type II anastomoses being in this group. Three of the five women who experienced menopause after fibroid embolization had bilateral ovarian artery-to-uterine artery anastomoses that were classified as high risk. Delineation of ovarian artery-to-uterine artery anastomosis is of practical relevance in avoiding nontarget ovarian embolization, in identification of those who would be at risk of uterine artery embolization or ovarian failure, and in those in whom the ovarian artery can be embolized safely.

Acupuncture in reproductive medicine: Overview and summary of recent studies

The use of acupuncture in the area of reproductive medicine is relatively new, and it has been rather poorly investigated in the past. When muscle afferents are stimulated by acupuncture in somatic segments related to the innervation of the ovaries and the uterus, functional changes occur in the neural substrate that may influence reproductive function and result in peripheral, segmental and central effects. The aims of the present studies are as follows. •To determine whether electro-acupuncture (EA) can reduce high blood flow impedance in the uterine arteries of women during in vitro fertilization (IVF) and embryo transfer (ET). •To determine whether EA as an anaesthetic method can be an alternative to pharmacological anaesthetic methods during oocyte aspiration in IVF. •To elucidate whether EA can modify the release of neuropeptides, gonadotropins, and gonadal steroids and induce ovulation in women with polycystic ovary syndrome (PCOS) and anovulation. •To evaluate the effects of EA on neuroendocrinological parameters in rats with estradiol valerate (EV)-induced PCO by analysing nerve growth factor (NGF) and corticotropin-releasing factor (CRF) tissue concentrations in the brain, the adrenal glands, and the ovaries. In conclusion, the results of these studies show that EA merits consideration as an alternative or complement to traditional pharmacological treatments in reproductive medicine for improvement of uterine artery blood flow, for pain relief during oocyte aspiration, and for ovulation induction in women with PCOS. The effects can most likely be attributed to an inhibition of excessive sympathetic tone and to activation of antinociceptive systems

Elevated blood flow resistance in uterine arteries of women with unexplained recurrent pregnancy loss.

Uterine perfusion appears to regulate uterine receptivity. However, vascular changes in recurrent pregnancy loss (RPL) remain poorly studied. One hundred and twenty one women were enrolled into this study: normal women with sterility caused by male factor (control group: n = 72) and women with RPL (n = 49). Women with uterine anomaly, impaired glucose tolerance, abnormal thyroid function, or anti-phospholipid antibodies were excluded from the study. In the mid-luteal phase of a non-pregnant cycle, transvaginal pulsed Doppler ultrasonography of the uterine artery was performed. Uterine arterial pulsatility index (PI), endometrial thickness, serum estradiol, progesterone, and nitrite/nitrate concentrations were determined. In the RPL group, the PI in the uterine artery of women with antinuclear antibodies was significantly higher than that of women without antinuclear antibodies (P < 0.05). Among women without antinuclear antibodies, the mean (+/-SD) uterine artery PI in the RPL group (2.44 +/- 0.41) was also significantly higher than in the control group (2.19 +/- 0.40; P < 0.01). The PI was inversely correlated with serum progesterone levels (r = -0.47, P < 0.01). Elevated uterine arterial impedance is associated with RPL. Pulsed Doppler ultrasonography is useful in identifying women with unexplained RPL who have impaired uterine circulation.

Effects of hormone replacement therapy on postmenopausal uterine myoma

Objectives: To evaluate the effects of sequential continuous hormone replacement therapy (HRT) on myoma size and on pulsatility index (PI) of uterine arteries and to verify the correlation between uterine artery flow impedance and the growth rate of myoma in women receiving HRT. Methods: In a prospective 1-year study 60 postmenopausal women were enrolled into three study-groups to receive continuous transdermal 17β-oestradiol 0.05 mg/day plus nomegestrolo acetate 5 mg/day sequentially added: 20 patients (group A) unaffected by uterine myomas, 20 patients (group B) with single asymptomatic myoma <3 cm/14 cm 3, 20 patients (group C) with single asymptomatic myoma >3 cm/14 cm 3. The changes in myoma volume and in PI were assessed by means of transvaginal ultrasonographic scan every 3 months. The patients with myoma were divided into two subgroups: quiescent myoma (B1, C1) and growing myoma (B2, C2). Results: No significant increase of uterine fibroids volume was found after 1-year HRT (24.14±20.02→28.81±30.02 cm 3). Six out of eight myomas growing during HRT belonged to group C. The uterine artery basal PI value of group A was significantly higher ( P<0.01) than the corresponding PI in group B and C. At 3 months follow-up, uterine artery PI was significantly higher ( P<0.01) than the basal value in both group B (1.70±0.22→1.88±0.16) and C (1.59±0.28→1.92±0.21). The baseline PI values in group B1 and C1 were significantly higher than the baseline values observed in group B2 and C2 (1.76±0.17 vs. 1.32±0.02, 1.76±0.16 vs. 1.24±0.08) and significantly lower than those observed in group A (2.39±0.47). After 3 months of HRT, the PI values were not significantly higher than the baseline values in groups B1 and C2 (1.76±0.17→1.90±0.17; 1.24±0.08→1.74±0.16), while they were significantly higher in group C1 (1.76±0.16→2.01±0.17). Conclusions: Sequential continuous HRT does not increase the volume of the uterine myoma. The findings of very low resistance index in the uterine arteries of women with growing myoma may indicate the risk of growth of the neoplasia during HRT. The assessment of PI in the uterine arteries could be helpful in predicting the growth rate of the myomas before starting HRT.

Blood flow changes in the ovarian and uterine arteries in women with normal and polycystic ovaries

This review summarizes the haemodynamic changes in the ovarian and uterine arteries, as revealed by transvaginal colour Doppler ultrasonography, (i) in women with normal ovaries (group 1), (ii) in women with the polycystic ovary syndrome who ovulate in response to clomiphene citrate (group 2) and (iii) in women with polycystic ovaries who have a regular ovulatory menstrual cycle (group 3). In each group blood flow velocities in the intraovarian arteries increased during the menstrual cycle in the dominant ovary and remained high in the mid-luteal phase. There was no significant change in pulsatility index. In group 2, the longitudinal haemodynamic changes in the intraovarian arteries were similar to those seen in women with normal ovaries. However, the follicular and ovarian stromal blood flow velocities were greater in group 2 compared with the normal group. There was a significant increase in the pulsatility index of the uterine artery during the follicular phase of the menstrual cycle and a subsequent decrease into the midluteal phase. Uterine artery pulsatility index was also significantly greater at the baseline ultrasound scan in group 2. In group 3, the longitudinal haemodynamic changes in the intraovarian arteries were similar to those in group 1. Furthermore, the intraovarian vascular changes were similar to those in group 2, but velocities were significantly greater than in group 1. There was an increase in uterine artery pulsatility index during the follicular phase of the menstrual cycle and a subsequent decrease into the mid-luteal phase. The uterine artery Doppler changes were similar to those seen in group 2. In conclusion, women with polycystic ovaries have significant differences in ovarian and uterine artery haemodynamics. Increased ovarian stromal blood flow within the polycystic ovary may help to explain the increased ovarian responsiveness that women with polycystic ovaries show after administration of gonadotrophins.