Value Of Transvaginal Ultrasonography In Ovulation Prediction And Assessment Of Ovarian Reserve

Objective:To evaluate the value of transvaginal ultrasonography in follicular development,ovulation prediction and ovarian reserve function evaluation.Methods:272 women who underwent transvaginal ultrasound examination in our hospital Air Force Hangzhou Special Service Center(Former Hangzhou Naval Sanatorium)from October 2016 to April 2018were selected as subjects,106 healthy women were selected as the control group,and the remaining 166 cases were infertility.Blood samples were collected on the 3rd day of the natural menstrual cycle,sex hormones[follicle stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)]were detected by automatic immunofluorescence analyzer.The patients were examined by GE VOLUSON E8 color Doppler ultrasonography.The ovarian size,shape,follicle growth and development were observed and recorded,and the number of antral follicles(AFC)was counted.Uterine volume and mean ovarian volume(MOV)were calculated,ovarian perfusion indexs[peak systolic velocity(PSV),end diastolic velocity(EDV),peak systolic/end diastolic velocity(S/D),pulsatile index(PI)and resistance index(RI)]were obtained.According to ovarian reserve function,166 infertile patients were divided into the normal ovarian reserve function group(normal group,94 cases)and decreased ovarian reserve function group(descent group,72 cases),the relative indicators were compared.Ovarian reserve function ultrasound parameters and pregnancy outcome prediction screening using ROC curve,Calculate cutoff,sensitivity,specificity,and area under the ROC curve.Results:1.272 menstrual cycles were observed in 272 subjects,76 normal follicular ovulation cycles(45.78%)were monitored in 166 infertile patients,90 abnormal follicular cycles(54.22%)were observed,25(27.78%)were anovulatory,21(23.08%)were ovulatory,19(21.11%)were polycystic ovary,and 25(27.78%)were luteinized unruptured follicle syndrome(LUFS).There was no significant difference in follicular development among all subjects in different age groups(p>0.05).2.Transvaginal ultrasound examination of ovarian artery blood flow spectrum,from pre-follicular to ovulation to corpus luteum to corpus luteum atrophy ovarian artery blood flow spectrum showed a low-speed and high-resistance type.The blood flow velocity of primordial follicles were the lowest in primordial follicle formation,then began to increase,reached the highest at the end of ovulation and early luteal phase,then gradually decreased.There were significant differences in ovarian artery blood flow velocity and RI in different cycles(p<0.05),but no significant differences in PI(p>0.05).3.(1)There was no significant difference in age,body mass index(BMI)and uterine volume between the control group,the normal group and the descent group(p>0.05).(2)The infertility time of the normal group was shorter than that of the descent group(p<0.05).(3)The FSH,FSH/LH of the normal group were significantly lower than those of the descent group,and the normal group E2 is significantly higher than the lower group(p<0.05),but there was no significant difference between the two groups in LH(p>0.05).(4)There was no significant difference in FSH?E2?LH and FSH/LH between the normal group and the control group(p>0.05).(5)The AFC,follicle number,MOV and endometrial thickness in the normal group were significantly higher than those in the descent group(p<0.05),but there was no significant difference between the control group and the normal group(p>0.05).(6)PSV and EDV in the normal group were significantly higher than those in the descent group(p<0.05),but there was no significant difference in PSV and EDV between the normal group and the control group(p>0.05).(7)There was no significant difference in S/D,PI and RI between the normal group,descent group and control group(p>0.05).4.FSH was negatively correlated with E2,AFC,MOV and endometrial thickness(r=-0.821,-0.851,-0.704,-0.712,p all<0.001),and FSH was negatively correlated with PSV and EDV(r=-0.913,-0.718,p all<0.001),and FSH was positively correlated with FSH/LH(r=0.711,p<0.001).5.Multivariate logistic regression analysis was used to analyze the predictors of ovarian reserve function.The results showed that age,AFC and MOV entered the regression equation.Ovarian reserve function was lower in older,lower AFC and smaller MOV.6.Ultrasound parameters of ovarian reserve function predict pregnancy outcome ROC curve results:AFC cutoff value is 8.0,sensitivity 84.04,specificity 88.89,AUC:0.881;MOV cutoff value is 5.6,sensitivity is 82.98,specificity is 90.28,AUC:0.869;PSV cutoff value is 10.87,sensitivity is 91.49,specificity is 84.72,AUC:0.836;EDV cutoff value is 3.99,sensitivity is 89.36,specificity is 84.72,AUC:0.822.Conclusion:Transvaginal ultrasonography has a certain clinical value in observing follicular growth and ovulation.Observing the total number of sinus follicles,ovarian volume and ovarian blood flow perfusion in bilateral ovaries by transvaginal color Doppler ultrasonography at 2-3 days of menstrual cycle(i.e.early follicular phase)can predict ovarian reserve function in infertile patients.It can help to screen out the patients with low ovarian response as soon as possible.Ultrasound monitoring of follicles is simple,accurate,rapid,economical and non-invasive.It can help the patients find out the cause of infertility and guide the clinical selection of more reasonable and effective superovulation treatment.