Human Reproduction, Vol. 10, No. 7, pp. 1633-1637, 1995
© 1995 European Society of Human Reproduction and Embryology
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Physiology: Healthy and atretic follicles: vaginosonographic detection and follicular fluid hormone profiles
1Fukuda Ladies Clinic 30-9 Kariya, Ako, Hyogo-Pref.(678-02), Japan 2Laboratory of Reproductive Biology, Department of Obstetrics and Gynaecology, University Hospital of Copenhagen Section 5712, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
Correspondence: 3To whom correspondence should be addressed
The health status of human preovulatory follicles was prospectively studied by non-invasive transvaginal ultrasound. Daily ultrasound scans were performed from the time when the follicle measured 15 mm in diameter until formation of corpus luteum or oocyte retrieval. Based on the ultrasound scans two types of follicles were defined: type A follicles showed a cloud visualized as a cone projecting into the follicular fluid with the base of the cone positioned on the follicle wall. A light spot seen at the tip of the cloud in the majority of scans was presumed to be the oocyte-cumulus complex. Type B follicles showed an echo free space without a cloud. Two groups of infertility patients were studied: Group I received intrauterine insemination; 106 patients undergoing a total of 263 cycles (188 spontaneous cycles and 75 clomiphene citrate cycles). Group II received in-vitro fertilization (IVF); 22 patients undergoing a total of 52 cycles (31 spontaneous cycles and 21 clomiphene cycles). In the first group, the ovulatory potential of the follicle is associated with the ultrasound characteristics. From the IVF patients the follicular fluid was harvested and assessed for the free concentration of the following steroids: oestradiol, progesterone, testosterone and androstendione. The endocrine health status of the follicle was associated with the ultrasound characteristics of the follicle. In patients of group 1, 288 type A follicles ovulated out of a total of 298 follicles (97%). None of the type B follicles ovulated (0/14). In patients of group II, oocytes were obtained in 79% of the type A follicles (50/63), whereas 7% of the type B follicles yielded an oocyte (1/14). The follicular fluid hormone profile showed significantly lower free oestradiol, free oestradiol/testosterone ratio and oestradiol/androstenedione ratio and higher free testosterone and free androstenedione in type B follicles compared to type A follicles. The hormone status and the high oocyte recovery rate suggest that type A follicles are healthier than type B follicles, which seem to have undergone atretic changes. It is concluded that non-invasive transvaginal ultrasound with a good degree of accuracy predicts the health status of preovulatory follicles. Healthy follicles have a cloud with a light spot at the tip, whereas almost all atretic follicles lack this characteristic.
Key words: atretic follicle/follicular fluid/free steroid hormone/healthy follicle/transvaginal ultrasound
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