Human Reproduction, Vol 12, 1772-1777, Copyright © 1997 by Oxford University Press
M Bloechle, T Schreiner, I Kuchler, P Schurenkamper and K Lisse
The purpose of the present study was to evaluate the use of colour Doppler
sonography of ascendent uterine artery perfusion in 91 patients undergoing
in-vitro fertilization (IVF)-embryo transfer treatment after ovarian
stimulation with a depot formulation of goserelin and recombinant human
follicle stimulating hormone according to the long protocol. Resistance
index (RI), pulsatility index (PI), maximum peak velocity (Vmax) and
minimum diastolic velocity (Vmin) were assessed for the left and right
ascending uterine artery on day 1 of ovarian stimulation, on day -2 [the
day of human chorionic gonadotrophin (HCG) application] and on day +14 (12
days after embryo transfer). The data of 75 patients who had at least two
cleaved preimplantation embryos available for transfer were analysed: 21
patients became pregnant resulting in a pregnancy rate of 28% (21/75).
After exclusion of biochemical, ectopic and abortive pregnancies (n = 5),
the data from 54 non-pregnant patients and 16 pregnant patients were
analysed. No differences with respect to patient age, current cycle number,
indication for IVF treatment, endometrial thickness at day -2 and serum
oestradiol and serum progesterone concentrations at day -2 were found
between the pregnant and non-pregnant groups. Compared to the non- pregnant
patients the ascendent uterine artery flow of the pregnant patients showed
significantly lower RI (P < 0.009) and PI (P < 0.03) values at the
beginning of ovarian stimulation. Vmax and Vmin did not differ between the
two groups. On day -2 no differences in RI, PI, Vmax and Vmin were found
between pregnant and non-pregnant patients. On day +14 the flow in the
ascendent uterine arteries of the pregnant patients showed significantly
lower RI (P < 0.008) and PI (P < 0.03) values and significantly
higher Vmax (P < 0.003) and Vmin (P < 0.0001) values. RI (P <
0.009) and PI (P < 0.003) values had decreased significantly and Vmax (P
< 0.0002) and Vmin (P < 0.0001) had increased significantly on day
+14 compared to the previous observation times in both the pregnant and
non-pregnant groups. A significant correlation between the increase of
serum progesterone concentrations and the decrease of RI (r = 0.68, P <
0.009), and the increase of Vmin (r = 0.67, P < 0.01) was only detected
in the pregnant group. In conclusion, the differences found in RI and PI
values at the beginning of ovarian stimulation were not clinically helpful
as there was a wide overlap between non-pregnant and pregnant patients. The
parameters currently used in colour Doppler assessment of uterine artery
perfusion are not clinically helpful in discriminating prospectively which
patients will and will not become pregnant in an IVF programme. In pregnant
patients, increasing progesterone concentration is correlated with a
significant decrease in impedance to uterine perfusion in the late luteal
phase.
ARTICLES
Colour Doppler assessment of ascendent uterine artery perfusion in an in-vitro fertilization-embryo transfer programme after pituitary desensitization and ovarian stimulation with human recombinant follicle stimulating hormone
Gemeinschaftspraxis im Lutzow Center, Berlin, Germany.
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