The Research On The Hemodynamics Of Intraovarian And Uterine Artery With Transvaginal Color Doppler Sonography In Assisted Reproductive

objectives:In this research,Transvaginal Color Doppler sonography (TV-CDS)can be used to monitor ovarian stromal,the blood flow of uterine artery and endometrial-subendometrial blood flow which for investigating:(1)In Controlled ovarian hyperstimulation cycle the change of ovarian stromal hemodynamics and the blood flow of uterine artery.(2)The relationship between the ovarian responsiveness,the dose of Gn and the PI,RI,PSV of ovarian stromal blood flow on D₁(The first day of Gn in COH).(3)The relationship between the PI,RI,PSV of ovarian stromal blood flow and the outcome of pregnancy.(4)Effects of Operation on fallopian tube on ovarian blood flow and response.(5) The relationship between the PI,RI of the blood flow of uterine artery and the thickness of endometrium,the outcome of pregnancy.(6)The relationship between endometrial-subendometrial blood flow distribution pattern and the outcome of pregnancy.Methods:one hundred and twenty patients undergoing IVF-ET or ICSI-ET were recruited from the Reproductive Center of The First Affiliated Hospital of Guang Xi Medical University from August 2006 to December 2006.The patients have regular menstrual cycles(Operation on fallopian tube have sixty-six and fifty-four have none).The range of the patients age was 23-39 years.They had been infertile between 1 and 12 year. Grouping according to age,basal FSH,endometrial thickness,days of Gn administrated,dose of Gn,number of ovarian,operation on fallopian tube,PI,RI and pregnancy outcome referred the result.The main reasons of infertility are Fallopian tube occlusion and male azoospermia.All of them were confirmed by hyesterosalpingography,B-mode sonography,endocrine check and laparoscope.Systemic diseases are excluded in all patients(for exampile hypertefision,diabetes,hyperthyreosis).endometriosis and adenomyosis are exclude.Operation on ovary are excluded in all patients.There are no ovarian cysts or the diameters of cysts are less than 10mm in the basal state.Controlled ovarian hyperstimulation used in this research for all patients.Index measuration:1,The time-resolved fhoroimmunoassay was used to measure endocrine level of basal state(the third day of natural menstruation);2,The morphology of uterus and ovary,the index of blood: TV-CDS was used to monitor the blood flow of uterus and ovary in the D₁,after Medication four days(D₄),the day of injection HCO(D_HCG),D_OPU,the day of embryo transfer(D_ET),meanwile monitor the size of follicle,the number of follicles.Monitor the endometrial-subendometrial blood flow distribution pattern in D_HCGand D_ET.A model:There are blood flow in endometrial and subendometrial.B model:There are blood flow in Subendometrial but not in endometrial.C model:There are not blood flow in endometrial and subendometrial.Pregnancy criterion:There is gestation sac in palace or abortion,or eccyesis,or pregnancy in more place after four to five weeks for ET,if have the floss by the pathology examination,The all of them is clinic pregnancy.The clinic pregnancy is the standard of the research.Results:1,In COH cycle the change of ovarian stromal hemodynamics and the blood flow of uterine artery.The blood stream resistance of ovarian stromal shows the decreasing trend after treatment with Gn,but there is an increase after the day of HCG administration.But there was no significant difference of them.The blood flow resistance of uterine artery shows a decreasing trend after treatment with Gn,but there is an increase after the day of HCG administration.But there was no significant difference of them.2,The relationship between the ovarian responsiveness,the dose of Gn and the PI,RI,PSV of ovarian stromal blood flow on D₁ There is positive correlation between PI,RI and the dose of Gn(r=0.309,P=0.023;r=0.575,P＜0.001),but PSV do not correlate with it.The research shows that the higher of the vascular resistance is, the longer of treatment with Gn is after divided the patients into three groups according to the days of treatment(P＜0.05).Ovarian stromal blood flow PI,PSV show no correlation with the basal FHS level,the number of antral follicles,preovulative follicles and retrieved oocytes(P＞0.05);RI does not correlate with the basal FHS level and the number of antral follicles,but do inverse correlate with the preovulative follicles and retrieved oocytes(r=-0.53,p＜0.001; r=-0.319,p=0.019).PI,RI increase and PSV decreases with the increase of ovary response.3,The relationship between the PI,RI,PSV of ovarian stromal blood flow on D₁ and the outcome of pregnancy.Ovarian stromal blood flow on D₁ PI,RI of pregnancy group are lower than that of non-pregnancy(P＜0.05),PSV is not different between two groups.The patients were divided into two groups according to PI:≤0.85 and＞0.85,the plantation rate and pregnancy rates are significantly different between them,the figures are 41.2%,70.8%and 20.3%,30.0%respectively.4,Effects of Operation on fallopian tube On ovarian blood flow and response.The RI was singificant higher in the operated side than that incontralateral side on D₁ and D_HCG(P＜0.05),but the PSV was lower in the operated side than that in contralateral side on D_HCG(P＜0.05);the PSV was lower in bilateral Operation on fallopian tube than that tubal infertility with existing salpinx(p＜0.05).The number of antral follicles and preovulative follicles and retrieved oocytes in the operated side was lower than that in contralateral side in unilateral Operation on fallopian tube(p＜0.05)5,The relationship between the PI,RI of the blood flow of uterine artery and the thickness of endometrium,the outcome of pregnancy.The thickness of endometrium in D_HCGis no correlation with the PI and RI.the higher of vascular resistance of uterine artery,the thinner of endometrium is after the patients were divided into three groups according to the thickness of endometrium of D_HCG(P＞0.05).There is no difference in Ovarian stromal blood flow between the pregnancy and the non-pregnancy in D₁ and D_HCG.6,The relationship between endometrial-subendometrial blood flow distribution pattern and the outcome of pregnancy.The patients were divided into three groups according to endometrial-subendometrial blood flow distribution pattern in D_HCGand D_ET, the pregnancy rates are significantly different between of them,the figures are 66.?%and 42.1%,18.2%respectively in D_HCG(p=0.023).the figures are 65.4%and 50.0%,18.8%respectively in D_ET(p=0.013).The thickness of endometrium in D_HCGbetween A group and C group,B group and C group is significant difference(P=0.001,P=0.024),but the thickn -ess of endometrium in D^ETis no significant difference between the three groups(P＞0.05).Conclusions:1 The use of Gn changed the ovarian stromal and uterine artery Hemodynamics,whichcauses the disappearance of great decrease of blood flow resistance.However,it is an important symbol of the spontaneously in COH cycle occurrence of ovulation.So it is not easy to ovulate.2 The PI,RI of ovarian stromal blood flow on day 3 are valuable sign to the ovarianresponse.With the increase of PI,RI,the dose of Gn increase and number of ovum retrieved decrease,which indicates that the dose of Gn given to these patients whose PI,RI are too high should be enhanced,whereas,the dose should be reduced in order to avoid the occurrence of OHSS.3 PI,RI of ovarian stroma on day 3 especially the PI is valuable to the prediction of IVF-ET outcome.When PI≤0.85,the plantation rate and the pregnancy rate will increase to 41.2%and 70.8%,but when PI＞0.85,the rates will decrease to 20.3%and 30.0%.which indicate that when PI≤0.85,the number of embryos transferred should be reduced, and then the pregancy rate will keep high and the occurrence rate of mufti-pregnancy will decrease simultaneously.4 Operation on fallopian tube influences the blood flow of ovarian stromal,so the ovarian responsiveness decreased.If the patients that have been Operation on fallopian tube,the dose of Gn should be increased in COH.The Hydrosalpinx patients's ovarian function should be checked- up before operating on fallopian tube prophylactic for IVF-ET.In operation,the damage should be diminution and avoidly impaired the ovarian blood flow.5 There is no relationship between the PI,RI of uterine artery and the thickness of endometrium and the outcome of pregnancy.PI,RI of uterine artery can not to prediction of IVF-ET outcome.6 The pregnancy rate is obviously higher if the patients have the endometrial-subendometrial blood flow in D_RCGand D_ET.So endometrial-subendometrial blood flow are valuable to prediction of IVF-ET outcome. which indicates when endometrial-subendometrial blood flow is bad, medicine that could improve the endometrial receptivity should be considered.