The Role of Blood Flow in Corpus Luteum Measured by Transvaginal Two-Dimensional and Three-Dimensional Ultrasound in the Prediction of Early Intrauterine Pregnancy Outcomes

Han, Huijuan; Mo, Xinhai; Ma, Yunsheng; Zhou, Yuqing; Zhang, Bo

doi:10.3389/fphar.2019.00767

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…The mechanisms through which different routes of exogenous progesterone may act synergistically have not been fully clarified. In natural conception, the corpus luteum secretes progesterone into microvessels that feed into the pelvic vasculature and, in turn, the systemic circulation ( Takasaki et al , 2009 ; Han et al , 2019 ). It is thus plausible to consider that low serum progesterone levels may constitute a proxy marker of a hypoprogestogenic state and insufficient luteal support ( Verhaegen et al , 2012 ).…”

Section: Discussionmentioning

confidence: 99%

The effect of frozen embryo transfer regimen on the association between serum progesterone and live birth: a multicentre prospective cohort study (ProFET)

Melo

Wood²,

Πέτσας³

et al. 2022

Human Reproduction Open

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STUDY QUESTION What is the association between serum progesterone levels on the day of frozen embryo transfer (FET) and the probability of live birth in women undergoing different FET regimens? SUMMARY ANSWER Overall, serum progesterone levels <7.8 ng/ml were associated with reduced odds of live birth, although the association between serum progesterone levels and the probability of live birth appeared to vary according to the route of progesterone administration. WHAT IS KNOWN ALREADY Progesterone is essential for pregnancy success. A recent systematic review showed that in FET cycles using vaginal progesterone for endometrial preparation, lower serum progesterone levels (<10 ng/ml) were associated with a reduction in live birth rates and higher chance of miscarriage. However, there was uncertainty about the association between serum progesterone levels and treatment outcomes in natural cycle FET (NC-FET) and hormone replacement therapy FET (HRT-FET) using non-vaginal routes of progesterone administration. STUDY DESIGN, SIZE, DURATION This was a multicentre (n = 8) prospective cohort study conducted in the United Kingdom between January 2020 and February 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS We included women having NC-FET or HRT-FET treatment with progesterone administration by any available route. Women underwent venepuncture on the day of embryo transfer. Participants and clinical personnel were blinded to the serum progesterone levels. We conducted unadjusted and multivariable logistic regression analyses to investigate the association between serum progesterone levels on the day of FET and treatment outcomes according to the type of cycle and route of exogenous progesterone administration. Our primary outcome was the live birth rate per participant. MAIN RESULTS AND THE ROLE OF CHANCE We studied a total of 402 women. The mean (standard deviation) serum progesterone level was 14.9 (7.5) ng/ml. Overall, the mean adjusted probability of live birth increased non-linearly from 37.6% (95% confidence interval [CI] 26.3%-48.9%) to 45.5% (95% CI 32.1%-58.9%) as serum progesterone rose between the 10th (7.8 ng/ml) and 90th (24.0 ng/ml) centiles. In comparison to participants whose serum progesterone level was ≥7.8 ng/ml, those with lower progesterone (<7.8 ng/ml, 10th centile) experienced fewer live births (28.2% versus 40.0%, adjusted odds ratio [aOR] 0.41, 95% CI 0.18-0.91, P = 0.028), lower odds of clinical pregnancy (30.8% versus 45.1%, aOR 0.36, 95% CI 0.16-0.79, P = 0.011) and a trend towards increased odds of miscarriage (42.1% versus 28.7%, aOR 2.58, 95% CI 0.88-7.62, P = 0.086). In women receiving vaginal progesterone, the mean adjusted probability of live birth increased as serum progesterone levels rose, whereas women having exclusively subcutaneous progesterone experienced a reduction in the mean probability of live birth as progesterone levels rose beyond 16.3 ng/ml. The combination of vaginal and subcutaneous routes appeared to exert little impact upon the mean probability of live birth in relation to serum progesterone levels. LIMITATIONS, REASONS FOR CAUTION The final sample size was smaller than originally planned, although our study was adequately powered to confidently identify a difference in live birth between optimal and inadequate progesterone levels. Further, our cohort did not include women receiving oral or rectal progestogens. WIDER IMPLICATIONS OF THE FINDINGS Our results corroborate existing evidence suggesting that lower serum progesterone levels hinder FET success. However, the relationship between serum progesterone and the probability of live birth appears to be non-linear in women receiving exclusively subcutaneous progesterone, suggesting that in this subgroup of women, high serum progesterone may also be detrimental to treatment success. STUDY FUNDING/COMPETING INTERESTS This work was supported by CARE Fertility and a doctoral research fellowship (awarded to P.M.) by the Tommy’s Charity and the University of Birmingham. M.J.P. is supported by the NIHR Birmingham Biomedical Research Centre. S.F. is a minor shareholder of CARE Fertility, but has no financial or other interest with progesterone testing or manufacturing companies. P.L. reports personal fees from Pharmasure, outside the submitted work. G.P. reports personal fees from Besins Healthcare, outside the submitted work. M.W. reports personal fees from Ferring Pharmaceuticals, outside the submitted work. The remaining authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT04170517

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Section: Discussionmentioning

confidence: 99%

The effect of frozen embryo transfer regimen on the association between serum progesterone and live birth: a multicentre prospective cohort study (ProFET)

Melo

Wood²,

Πέτσας³

et al. 2022

Human Reproduction Open

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“…Its high‐frequency probe can significantly improve the resolution, thus showing clearer images of pelvic organs, and showing blood flow information such as vascular morphology and microvascular perfusion at the scar. This method has a wide range of application, without requirement of holding urine and waiting and without interference from obesity, abdominal scar, and intestinal gas and other problems [22] 25 . Color Doppler ultrasound is also an effective means of diagnosing CSP, which is safe, rapid, and accurate 26 .…”

Section: Discussionmentioning

confidence: 99%

“…This method has a wide range of application, without requirement of holding urine and waiting and without interference from obesity, abdominal scar, and intestinal gas and other problems [22]. 25 Color Doppler ultrasound is also an effective means of diagnosing CSP, which is safe, rapid, and accurate. 26 Transvaginal color Doppler ultrasonography can more clearly show the size of the uterus, the location, and specific condition of CSP, contributing to the analysis of the internal uterine bleeding in patients and subsequent treatment.…”

Section: Discussionmentioning

confidence: 99%

The Role of Transvaginal Two‐Dimensional Ultrasound Combined With Color Doppler in the Evaluation of Ovarian Function and Fertility After Uterine Artery Embolization

Shi¹,

Ge²,

et al. 2021

J of Ultrasound Medicine

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Objective Our study seeks to assess the value of transvaginal two‐dimensional ultrasound combined with color Doppler in evaluating ovarian function and reproductive function after uterine artery embolization (UAE). Methods Totally 64 cases with cesarean scar pregnancy (CSP) were collected. Their information was recorded, including baseline information, intraoperative and postoperative information, preoperative and postoperative uterine receptivity, and preoperative and postoperative levels of sex hormones in serum. Finally, the patients were followed up to observe whether they were pregnant after treatment. Results In comparison with 24 hours after UAE, decreases were found in endometrial blood flow pulsatility index (PI), endometrial thickness, ovarian artery peak end‐systolic velocity (Vs), ovarian artery resistance index (RI), and the ratio of Vs to peak end‐diastolic velocity (S/D) 1 and 3 months after embolization, while Vd increased markedly 3 months after embolization. In addition, in terms of sex hormones, a significant increase was revealed in the level of follicle‐stimulating hormone, while the reduction in the levels of luteinizing hormone (LH), estrogen (E2), prolactin (PRL), and progesterone (P) in the first month and the third month of menstrual resumption compared with those before treatment. From the follow‐up data, there were 50 cases of pregnancy, including 45 cases of intrauterine pregnancy, 2 cases of tubal pregnancy, and 3 cases of recurrent CSP. Conclusion UAE is a safe and effective method to prevent massive hemorrhage of CSP. Transvaginal two‐dimensional ultrasound combined with color Doppler can more accurately evaluate its therapeutic effect and provide a basis for effective treatment.

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“…If pregnancy is achieved, the RI remains low at approximately 0.45 and continues to remain so during the first trimester until the luteal-placental shift occurs. Han et al [ 28 ] showed that increased PI and RI in the blood flow surrounding the corpus luteum during the first trimester was associated with pregnancy termination. The meaning of Doppler that can be used clinically is summarized in Table 1 .…”

Section: Ovarian Blood Flowmentioning

confidence: 99%

Doppler ultrasound investigation of female infertility

2023

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This study reviewed recent advances in the use of Doppler ultrasonography for the management and prediction of female infertility outcomes of assisted reproductive technology (ART). Color or power Doppler and three-dimensional power Doppler ultrasound can be used to measure vessels near the ovaries, uterus, and endometrium to assess blood flow. Increased blood flow and reduced resistance to the ovaries, uterus, and endometrium are associated with improved pregnancy outcomes, and their measurement has been suggested as a key factor in ART procedural outcomes.Perifollicular vascularity indices can help predict oocyte quality and maturity. Likewise, endometrial and uterine vascularity could be associated with endometrial receptivity and may assist with embryo transfer timing and pregnancy outcome predictions. With the advancement of Doppler ultrasound technology, this highly potent examination will be used more widely in routine clinical settings for the treatment of female infertility.

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The Role of Blood Flow in Corpus Luteum Measured by Transvaginal Two-Dimensional and Three-Dimensional Ultrasound in the Prediction of Early Intrauterine Pregnancy Outcomes

Cited by 6 publications

References 27 publications

The effect of frozen embryo transfer regimen on the association between serum progesterone and live birth: a multicentre prospective cohort study (ProFET)

The effect of frozen embryo transfer regimen on the association between serum progesterone and live birth: a multicentre prospective cohort study (ProFET)

The Role of Transvaginal Two‐Dimensional Ultrasound Combined With Color Doppler in the Evaluation of Ovarian Function and Fertility After Uterine Artery Embolization

Doppler ultrasound investigation of female infertility

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