Journal of Assisted Reproduction and Genetics

, Volume 21, Issue 11, pp 387–395 | Cite as

Longitudinal Assessment of Ovarian Perifollicular and Endometrial Vascularity by Power Doppler Ultrasound in Pregnant and Non-Pregnant Cycles in the IVF Setting

  • S. M. Shrestha
  • M. F. Costello
  • P. Sjoblom
  • G. McNally
  • M. J. Bennett
  • S. J. Steigrad
  • G. J. Hughes


Purpose: This longitudinal study aimed to compare ovarian perifollicular and endometrial blood flow (PFBF and EBF, respectively) during the follicular phase in pregnant and non-pregnant IVF cycles.

Methods: Serial transvaginal scans were performed in 15 subjects undergoing IVF treatment. Both PFBF and EBF were subjectively graded (grades 0–4 for PFBF and grades 1–3 for EBF). After confirmation of clinical pregnancy, the treatment cycles were grouped into ‘Pregnant’ and ‘Non-pregnant’ cycles. Ovarian PFBF and EBF were retrospectively compared between the two groups.

Results: In pregnant cycles, the proportion of large (⩾15 mm) follicles with high (2–4) grade PFBF increased with time throughout the follicular phase, and the proportion of large follicles with poor (0–1) grade PFBF decreased. In non-pregnant cycles these trends were reversed. There was no difference in EBF between the two groups.

Conclusion: The pattern of ovarian PFBF but not EBF may be predictive of treatment outcome.

Clinical pregnancy endometrial vascularity follicular vascularity in vitro fertilisation power Doppler ultrasound 


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  1. 1.
    Healy DL, Trounson AO, Andersen AN: Female infertility: Causes and treatment. Lancet 1994; 343: 1539–1544Google Scholar
  2. 2.
    Mahutte NG, Arici A: Failed fertilization: Is it predictable? Curr Opin Obstet Gynecol 2003; 15(3): 211–218Google Scholar
  3. 3.
    Daya S: Gonadotrophin-releasing hormone agonist protocols for pituitary desensitization in in vitro fertilization and gamete intrafallopian transfer cycles (Cochrane Review). In The Cochrane Library, Issue 1, Chichester, UK: John Wiley and Sons, Ltd., 2003Google Scholar
  4. 4.
    Adamson D, Lancaster P, de Mouzon J (Co-ordinator), Nygren K-G (Chairman), Zegers-Hochschild F (International working group for registrars on assisted reproduction and IFFS task force): World collaborative report on assisted reproductive technology, 1998. In Reproductive Medicine in the Twenty First Century. DL Healy, GT Kovacs, R McLachlan, O Rodriguez-Armas (eds), UK, The Parthenon Publishing Group Ltd., 2001, pp 209–219Google Scholar
  5. 5.
    Chui DK, Pugh ND, Walker SM, Gregory L, Shaw RW: Follicular vascularity—the predictive value of transvaginal power Doppler ultrasonography in an in-vitro fertilization programme: A preliminary study. Hum Reprod 1997; 12: 191–196Google Scholar
  6. 6.
    Bhal PS, Pugh ND, Chui DK, Gregory L, Walker SM, Shaw RW: The use of transvaginal power Doppler ultrasonography to evaluate the relationship between perifollicular vascularity and outcome in in-vitro fertilization treatment cycles. Hum Reprod 1999; 14: 939–945Google Scholar
  7. 7.
    Borini A, Maccolini A, Tallarini A, Bonu MA, Sciajno R, Flamigni C: Perifollicular vascularity and its relationship with oocyte maturity and IVF outcome. Ann N Y Acad Sci 2001; 943: 64–67Google Scholar
  8. 8.
    Coulam CB, Goodman C, Rinehart JS: Colour Doppler indices of follicular blood flow as predictors of pregnancy after in-vitro fertilization and embryo transfer. Hum Reprod 1999; 14: 1979–1982Google Scholar
  9. 9.
    Zaidi J, Campbell S, Pittrof R, Tan SL: Endometrial thickness, morphology, vascular penetration and velocimetry in predicting implantation in an in vitro fertilization program. Ultrasound Obstet Gynecol 1995a; 6(3): 191–198Google Scholar
  10. 10.
    Coulam CB, Rinehart JS: Subendometrial flow as a predictor of pregnancy after in vitro fertilisation. Fertil Steril 1998; 70(Suppl 1): S106–S107 (Abstract)Google Scholar
  11. 11.
    Yang JH, Wu MY, Chen CD, Jiang MC, Ho HN, Yang YS: Association of endometrial blood flow as determined by a modified colour Doppler technique with subsequent outcome of in-vitro fertilization. Hum Reprod 1999; 14(6): 1606–1610Google Scholar
  12. 12.
    Chien LW, Au HK, Chen PL, Xiao J, Tzeng CR: Assessment of uterine receptivity by the endometrial-subendometrial blood flow distribution pattern in women undergoing in vitro fertilization-embryo transfer. Fertil Steril 2002; 78: 245–251Google Scholar
  13. 13.
    Contart P, Baruffi RL, Coelho J, Mauri AL, Petersen C, Franco Junior JG: Power Doppler endometrial evaluation as a method for the prognosis of embryo implantation in an ICSI program. J Assist Reprod Genet 2000; 17(6): 329–334Google Scholar
  14. 14.
    Barnett SB, Ter Haar GR, Ziskin MC, Rott HD, Duck FA, Maeda K: International recommendations and guidelines for the safe use of diagnostic ultrasound in medicine. Ultrasound Med Biol 2000; 26(3): 355–366Google Scholar
  15. 15.
    Zaidi J, Jurkovic D, Campbell S, Pittrof R, McGregor A, Tan SL: Description of circadian rhythm in uterine artery blood flow during the peri-ovulatory period. Hum Reprod 1995b; 10(7): 1642–1646Google Scholar
  16. 16.
    MacSweeney JE, Cosgrove DO, Arenson J: Colour Doppler energy (power) mode ultrasound. Clin Radiol 1996; 51(6): 387–390Google Scholar
  17. 17.
    Rubin JM, Bude RO, Carson PL, Bree RL, Adler RS: Power Doppler US: A potentially useful alternative to mean frequency-based color Doppler US. Radiology 1994; 190(3): 853–856Google Scholar
  18. 18.
    Costello MF, Sjoblom P, Shrestha SM: Use of Doppler Ultrasound Imaging of the ovary during IVF Treatment as a Predictor of Success. In The Infertility Manual, KA Rao, PR Brinsden, H Sathananthan (eds), New Delhi, JAYPEE Brothers Medical Publishers, 2003, pp 344–349Google Scholar
  19. 19.
    Anasti JN, Kalantaridou SN, Kimzey LM, George M, Nelson LM: Human follicle fluid vascular endothelial growth factor concentrations are correlated with luteinization in spontaneously developing follicles. Hum Reprod 1998; 13: 1144–1147Google Scholar
  20. 20.
    Gaulden ME: Maternal age effect: The enigma of Down syndrome and other trisomic conditions. Mut Res 1992; 296: 69–88Google Scholar
  21. 21.
    Van Blerkom J: Intrafollicular influences on human oocyte developmental competence: Perifollicular vascularity, oocyte metabolism and mitochondrial function. Hum Reprod 2000; 15(Suppl. 2): 173–188Google Scholar
  22. 22.
    Strohmer H, Herczeg C, Plockinger B, Kemeter P, Feichtinger W: Prognostic appraisal of success and failure in an in vitro fertilization prograam by transvaginal Doppler ultrasound at the time of ovulation induction. Ultrasound Obstet Gynecol 1991; 1: 272–274Google Scholar
  23. 23.
    Steer CV, Campbell S, Tan SL, Crayford T, Mills C, Mason BA, Collins WP: The use of transvaginal color flow imaging after in vitro fertilization to identify optimum uterine conditions before embryo transfer. Fertil Steril 1992; 57(2): 372–376Google Scholar
  24. 24.
    Steer CV, Tan SL, Dillon D, Mason BA, Campbell S: Vaginal color Doppler assessment of uterine artery impedance correlates with immunohistochemical markers of endometrial receptivity required for the implantation of an embryo. Fertil Steril 1995; 63(1): 101–108Google Scholar
  25. 25.
    Sterzik K, Grab D, Sasse V, Hutter W, Rosenbusch B, Terinde R: Doppler sonographic findings and their correlation with implantation in an in vitro fertilization program. Fertil Steril 1989; 52(5): 825–828Google Scholar
  26. 26.
    Puerto B, Creus M, Carmona F, Civico S, Vanrell JA, Balasch J: Ultrasonography as a predictor of embryo implantation after in vitro fertilization: A controlled study. Fertil Steril 2003; 79(4): 1015–1022Google Scholar
  27. 27.
    Tsai HD, Chang CC, Hsieh YY, Lee CC, Lo HY: Artificial insemination. Role of endometrial thickness and pattern, of vascular impedance of the spiral and uterine arteries, and of the dominant follicle. J Reprod Med 2000; 45(3): 195–200Google Scholar
  28. 28.
    Yalti S, Gurbuz B, Ficicioglu C, Canova H: Doppler evaluation of the uterine, intraovarian, stromal and spiral arteries on the day of human chorionic gonadotrophin administration in controlled ovarian hyperstimulation. J Obstet Gynaecol 2003; 23(4): 402–406Google Scholar
  29. 29.
    Kupesic S, Bekavac I, Bjelos D, Kurjak A: Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures. J Ultrasound Medicine 2001; 20(2): 125–134Google Scholar
  30. 30.
    Applebaum M: The uterine biophysical profile. Ultrasound Obstet Gynaecol 1995; 5: 67–68Google Scholar
  31. 31.
    Rosenfeld CR, Worley RJ: The effect of systemic infusions of dehydroisoandrosterone on the distribution of uterine blood flow in ovine pregnancy. Am J Obstet Gynecol 1978; 130(4): 385–390Google Scholar
  32. 32.
    Fanchin R, Righini C, Schonauer LM, Olivennes F, Cunha Filho JS, Frydman R: Vaginal versus oral E(2) administration: Effects on endometrial thickness, uterine perfusion, and contractility. Fertil Steril 2001; 76: 994–998Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  • S. M. Shrestha
    • 1
    • 2
  • M. F. Costello
    • 1
    • 2
  • P. Sjoblom
    • 1
    • 2
  • G. McNally
    • 3
  • M. J. Bennett
    • 1
  • S. J. Steigrad
    • 2
  • G. J. Hughes
    • 1
    • 2
  1. 1.School of Women’s and Children’s HealthUniversity of New South WalesSydneyAustralia
  2. 2.Department of Reproductive Medicine and IVF AustraliaRoyal Hospital for WomenSydneyAustralia
  3. 3.Department of Medical ImagingRoyal Hospital for WomenSydneyAustralia

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