Relationship of ovarian stromal blood flow at the baseline ultrasound scan to subsequent follicular response in an in vitro fertilization program

Objective : To determine whether ovarian perifollicular blood flow (PFBF) in the early follicular phase (EFP) was associated with treatment outcome. Design : Retrospective longitudinal cohort study. Setting : Tertiary referral centre/university hospital. Patients : Thirty-four women underwent 37 IVF cycles, which resulted in 35 embryo transfers. Interventions : Serial transvaginal scans using power Doppler ultrasound during the follicular phase. Ovarian PFBF of follicles ≥ 5 mm was subjectively assessed using a modified grading system (grades 0-4). Main outcome measures : Ovarian PFBF and pregnancy. Results : Treatment cycles were retrospectively divided into two groups: Group 1 (n = 20) had cycles with at least one small (5-10 mm) or medium (11-14 mm) size follicle(s) of high grade (2-4) PFBF on cycle day 5 or 6 or 7; and Group 2 (n = 17), had cycles that did not. Group 1 had a significantly higher proportion of high grade large follicles in the late follicular phase (35% vs. 21%) (OR 2.0; 95% CI 1.1-3.7) and higher clinical pregnancy rate (47% vs. 12%) (OR 6.3; CI 1.1-35.7) compared to Group 2. Conclusion : High grade ovarian PFBF in the EFP during IVF is associated with both high grade PFBF in the late follicular phase and a higher clinical pregnancy rate.

Section: Discussionmentioning

confidence: 99%

“…Similarly, Bassil et al (27) demonstrated that a lower IOA RI two days before HMG injections started is associated with an increased oocyte retrieval rate. A number of studies have shown that IOA PSV assessed on day 3 (26) or on the day of downregulation (28) is significantly lower in poor responders.…”

Section: Discussionmentioning

confidence: 99%

Power Doppler ultrasound assessment of follicular vascularity in the early follicular phase and its relationship with outcome of in vitro fertilization

Shrestha

Costello

Sjöblom

et al. 2006

“…Gonadotropin stimulation was commenced upon confirmation of pituitary quiescence with a concomitant reduction in the dose of buserelin to 200 µg/day. Recombinant follicle stimulating hormone (FSH), Gonal-F ® (Serono Canada Inc, Ontario Canada) or Puregon ® (Organon Canada Ltd, Ontario Canada) were started as a dose on the basis of woman's age, antral follicle count, basal FSH concentrations, and intraovarian stromal blood flow (20). Human chorionic gonadotropin (hCG) (Profasi ® , Serono Canada Ltd), 10,000 IU was administered subcutaneously when at least three follicles ≥18 mm in diameter were observed.…”

Section: Methodsmentioning

confidence: 99%

Reproductive Performance of Couples Discordant for Hepatitis B and C Following IVF Treatment

Pirwany

Phillips

Kelly

et al. 2004

Purpose : To examine the reproductive performance of hepatitis B (HBV) and C (HCV) discordant couples following IVF-ET. Methods : A retrospective cohort study of 25 IVF-ET cycles in HBV and HCV discordant couples was performed. Thirteen patients in the study cohort were discordant for HBV (10 males and 3 females), and 12 (9 males and 3 females) for HCV. Twenty-seven consecutive age matched patients comprised the control group. All patients underwent controlled ovarian hyperstimulation using the long downregulation protocol followed by IVF or ICSI. Results : Patients in the three groups (HBV, HCV, and controls) had similar ages, and day 3 FSH concentrations. Despite comparable response to COH, and similar fertilization, and cleavage rates in the three groups, couples discordant for HBV or HCV had significantly poorer implantation and pregnancy rates (7.7%, 0% respectively) compared with controls (41%). Conclusions : Despite comparable response to COH, HBV and HCV positive discordant couples, have significantly lower implantation and pregnancy rates compared with age-matched controls.

“…Possible markers include female age, early follicular serum FSH (18), estradiol and inhibin B concentrations (19), and ultrasonographic parameters including ovarian volume (20), antral follicle count (21), and peak ovarian stromal blood flow velocity (7). Further work is required on selecting stimulation protocols and appropriate starting doses of gonadotropins for women identified to be at increased risk of poor ovarian response.…”

Section: Discussionmentioning

confidence: 99%

“…The same starting dose may be used for all women, or the starting dose can be individualized based on predictors of ovarian response such as female age, early follicular phase serum FSH concentration (5), ultrasonographic criteria (3,6,7) and previous follicular response to ovarian stimulation. Subsequently, the dose may be held constant throughout stimulation, increased or decreased in a fixed manner, or titrated according to the ovarian response.…”

Section: Introductionmentioning

confidence: 99%

A Randomized, Double-Blind, Multicenter Study Comparing a Starting Dose of 100 IU or 200 IU of Recombinant Follicle Stimulating Hormone (Puregon�) in Women Undergoing Controlled Ovarian Hyperstimulation for IVF Treatment

Tan

Child

Cheung

et al. 2005

Purpose : To compare the efficiency and efficacy of two starting doses of recombinant FSH (follitropin-β, Puregon) in women undergoing IVF treatment. Methods : This prospective, randomized, double-blind, multicentric (N = 6) study included 192 women undergoing IVF using the long protocol of GnRH agonist who received either 100 IU or 200 IU of r-FSH per day. Gonadotropin dose adjustment was allowed after day 4 of stimulation. Results : The average (SD) number of oocytes retrieved was 10.9 (5.4) and 12.2 (5.6) in the 100 IU and 200 IU group respectively (p = 0.067). The total doses of Puregon administered were 1887 IU and 2559 IU in the 100 IU and 200 IU group respectively. The number of transferable embryos, and the rates of pregnancies, cancelled cycles, miscarriages and adverse events including OHSS were comparable between the two groups. Conclusions : Women undergoing IVF have similar outcomes whether recombinant FSH is commenced in a dose of 100 IU or 200 IU for the first 4 days of stimulation.