Pre-hCG 3D and 3D power Doppler assessment of the follicle for improving pregnancy rates in intrauterine insemination cycles

Abstract

BACKGROUND:The assessment of follicular maturity at the time of human chorionic gonadotropin (hCG) is one of the key factors for the success of all assisted reproductive techniques.AIM:To assess follicles by three dimensional (3D) and 3D power Doppler (PD) before giving hCG to improve pregnancy rates in intrauterine insemination (IUI) cycles.DESIGN:Prospective randomized study.MATERIALS AND METHODS:Ultrasound for pre-hCG follicular assessment was performed over a period of 10 months for all 1000 cycles of IUI. Follicular assessment was performed using a transvaginal multifrequency volume probe. Follicles considered mature by 2D US and color Doppler were assessed by 3D and 3D PD. These values were independently evaluated for the conception and the non-conception groups.RESULTS:Conception rates were 32.3 and 27% respectively and individually when the perifollicular resistance index was < 0.50 and the peak systolic velocity was > 11 cm/s 10-12 h before hCG. Conception rates of 32% were achieved with a follicular volume between 3 and 7 cc. The conception rate was 32.3% in the cumulus group. A perifollicular vascularity index of between six and 20 gave conception rates of 35% and perifollicular flow index of 27-43 gave conception rates of 33%.CONCLUSIONS:3D ultrasound is much more accurate for volume assessment of the follicle. Presence of cumulus increases the surety of the presence of a mature ovum in the follicle. 3D and 3D PD when used with 2D US and color Doppler for pre-hCG follicular assessment would definitely improve pregnancy rates in IUI cycles.

Three-dimensional Ultrasound in Evaluation of the Ovary

“…3D and power Doppler ultrasound examination before giving hCG may help to assess more accurately follicular diameter and volume measurement and to identify the presence of cumulus. This will evaluate the parameters of perifollicular vascularity to ensure the presence of a mature ovum in the follicle that may improve pregnancy rates in intrauterine insemination cycles [32]. The follicular volume is higher in the anovulatory intrauterine insemination cycle [33].…”

Doppler ultrasound investigation of female infertility

“…However, they found that periovulatory subfollicular VI and VFI were lower in pregnant women [ 29 ]. Another study by Panchal and Nagori [ 30 ] showed that pregnancy rates were higher when the perifollicular RI was <0.50, and the PSV was >11 cm/s on the day of IUI trigger. Furthermore, they found that perifollicular VI values between 6 and 20 and a perifollicular FI >27 led to higher pregnancy rates [ 30 ].…”

“…Another study by Panchal and Nagori [ 30 ] showed that pregnancy rates were higher when the perifollicular RI was <0.50, and the PSV was >11 cm/s on the day of IUI trigger. Furthermore, they found that perifollicular VI values between 6 and 20 and a perifollicular FI >27 led to higher pregnancy rates [ 30 ]. However, the findings remain controversial, and there are no definite references as to which vascularity parameters on the day of trigger increase the chances of pregnancy during IUI.…”

Role of Color Doppler and Three-dimensional Ultrasound in Infertility

“…Color Doppler is a high-throughput, sophisticated imaging technique for the assessment of uterine anomalies, intrauterine pathology, tubal patency, polycystic ovaries, ovarian follicular monitoring, endometrial receptivity, failed and/or ectopic pregnancy, male infertility, and uterine, endometrial, and ovarian vascularity 1-6 . Human chorionic gonadotropin (hCG) three dimensional power Doppler assessment of the follicle was implicated in improving pregnancy rates in intrauterine in seminal cycle 7 . Three dimensional volume reconstruction by the virtual organs computer-aided analysis (VOCL) technique allows ovarian volume calculation, and automatic volume calculation software provides the follicular count and mean volumetric calculation 8 .…”