Correlation between Perifollicular Vascularity and Outcome in Stimulated Intrauterine Insemination Treatment Cycles: A Study Using Two-Dimensional Transvaginal Power Doppler Ultrasound


Objective: The aim of this study is to assess any potential relationship between perifollicular vascularity and occurrence of pregnancy in cases of stimulated IUI cycles using the subjective grading system by 2D transvaginal power Doppler ultrasonography. Design: A prospective cross sectional cohort study. Method: This is a prospective cross-sectional cohort study of 90 stimulated IUI treatment cycles. Selected women were prescribed clomiphene citrate combined with highly purified urinary follicle stimulating hormone. All patients underwent serial transvaginal ultrasound scans starting from day 6 to 7 of the cycle. Perifollicular Doppler blood flows were assessed in dominant follicles ≥18 mm. The patients then were categorized into 3 groups (high vascularity group {G3 & G4}, low vascularity group {G1 & G2} and mixed grades group). Other parameters measured included number of follicles ≥ 18 mm in both ovaries, endometrial thickness and estradiol (E2) level . Human chorionic gonadotropin (hCG) injection 10,000 IU IM was given to the patient when the dominant follicle reached 18 mm in diameter. At that time, the endometrium was evaluated as regards endometrial thickness. IUI was carried out using prepared/“washed” semen (husband). All patients received luteal support in the form of progesterone from day of IUI for 14 days. Serum Β-hCG was estimated 2 weeks after insemination. Results: In this study, from all 90 cases only 8 cases got pregnant with pregnancy rate of 8.88% (6 cases got pregnant in high grade vascularity group; 2 cases in mixed grades group and no cases got pregnant in low grade group). There was statistically significant difference among the 3 groups as regarding the pregnancy rate (P value = 0.02). There is statistically significant difference in perifollicular resistance index (RI) and pulsatility index (PI) between pregnant and non pregnant cases (P value = 0.016 and 0.047 respectively). In this study, there is no statistically significant difference between pregnant and non pregnant cases as regarding endometrial thickness and E2 level at the day of hCG administration (P value = 0.39 and 0.76 respectively). Conclusion: Perifollicular blood-flow assessment by 2D transvaginal power Doppler is a good predictive for the outcome of stimulated IUI cycles.

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Madkour, N. , Nossair, W. , Arafa, E. , Abdelghany, A. , Mohamed, E. and Abdelsalam, W. (2014) Correlation between Perifollicular Vascularity and Outcome in Stimulated Intrauterine Insemination Treatment Cycles: A Study Using Two-Dimensional Transvaginal Power Doppler Ultrasound. Open Journal of Obstetrics and Gynecology, 4, 973-980. doi: 10.4236/ojog.2014.415137.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Ragni, G., Anselmino, M., Nicolosi, A.E., Brambilla, M.E., Calanna, G. and Somigliana, E. (2007) Follicular Vascularity Is Not Predictive of Pregnancy Outcome in Mild Controlled Ovarian Stimulation and IUI Cycles. Human Reproduction, 22, 210-214.
[2] Du, B., Takahashi, K., Ishida, G.M., Nakahara, K., Saito, H. and Kurachi, H. (2006) Usefulness of Intraovarian Artery Pulsatility and Resistance Indices Measurement on the Day of Follicle Aspiration for the Assessment of Oocyte Quality. Fertility and Sterility, 85, 366-370.
[3] Coulam, C.B., Goodman, C. and Rinehart, J.S. (1999) Color Doppler Indices of Follicular Blood Flow as Prediction of Pregnancy after in-Vitro Fertilization and Embryo Transfer. Human Reproduction, 14, 1979-1982.
[4] Steer, C.V., Campbell, S., Tan, S.L., Crayford, T., Mills, C., Mason, B.A. and Collins, W.P. (2003) The Use of Transvaginal Color Flow Imaging after in Vitro Fertilization to Identify Optimum Uterine Conditions before Embryo Transfer. Fertility and Sterility, 57, 372-376.
[5] Costello, M.F., Shrestha, S.M., Sjoblom, P., McNally, G., Bennett, M.J., Steigrad, S.J. and Hughes, G.J. (2006) Power Doppler Ultrasound Assessment of the Relationship between Age and Ovarian Perifollicular Blood Flow in Women Undergoing in Vitro Fertilization Treatment. Journal of Assisted Reproduction and Genetics, 23, 359-365.
[6] Jarvela, I.Y., Sladkevicius, P., Kelly, S., Ojha, K., Nargund, G. and Campbell, S. (2002) Three-Dimensional Sonographic and Power Doppler Characterization of Ovaries in Late Follicular Phase. Ultrasound in Obstetrics & Gynecology, 20, 281-285.
[7] Nargund, G., Bourne, T., Doyle, P., Parsons, J., Cheng, W., Campbell, S. and Collins, W. (1996) Associations between Ultrasound Indices of Follicular Blood Flow, Oocyte Recovery and Preimplantation Embryo Quality. Human Reproduction, 11, 109-113.
[8] Chui, D.K.C., Pugh, N.D., Walker, S.M., Gregory, L. and Shaw, R.W. (1997) Follicular Vascularity—The Predictive Value of Transvaginal Power Doppler Ultrasonography in an in-Vitro Fertilization Programme: A Preliminary Study. Human Reproduction, 12, 191-196.
[9] Zhang, Y., Yang, J. and Xu, W.M. (2008) Study on Relationship between Perifollicular Blood Flow and in Vitro Fertilization-Embryo Transfer. Journal of Nanjing Medical University, 22, 57-60.
[10] Oyesanya, O.A., Parsons, J.H., Collins, W.P., et al. (1996) Prediction of Oocyte Recovery Rate by Transvaginal Ultrasonography and Color Doppler Imaging before Human Chorionic Gonadotropin Administration in in Vitro Fertilization Cycles. Fertility and Sterility, 65, 806-809.
[11] Shrestha, S.M., Costello, M.F., Sjoblom, P., McNally, G., Bennett, M., Steigrad, S.J. and Hughes, G.J. (2006) Power Doppler Ultrasound Assessment of Follicular Vascularity in the Early Follicular Phase and Its Relationship with Outcome of in Vitro Fertilization. Journal of Assisted Reproduction and Genetics, 23, 161-169.
[12] Malhotra, N., Bahadur, A., Singh, N., Kalaivani, M. and Mittal, S. (2014) Role of Perifollicular Doppler Blood Flow in Predicting Cycle Response in Infertile Women with Genital Tuberculosis Undergoing in Vitro Fertilization/Intra Cytoplasmic Sperm Injection. Journal of Human Reproductive Sciences, 7, 19-24.
[13] Van Blerkom, J. (1996) The Influence of Intrinsic and Extrinsic Factors on the Developmental Potential and Chromosomal Normality of the Human Oocyte. Journal of the Society for Gynecologic Investigation, 3, 3-11.
[14] Van Blerkom, J., Antczak, M. and Schrader, R. (1997) The Developmental Potential of the Human Oocyte Is Related to the Dissolved Oxygen Content of Follicular Fluid: Association with Vascular Endothelial Growth Factor Levels and Perifollicular Blood Flow Characteristics. Human Reproduction, 12, 1047-1055.
[15] Bhal, P.S., Pugh, N.D., Chui, D.K., Gregory, L., Walker, S.M. and Shaw, R.W. (1999) The Use of Transvaginal Power Doppler Ultrasonography to Evaluate the Relationship between Perifollicular Vascularity and Outcome in in-Vitro Fertilization Treatment Cycles. Human Reproduction, 14, 939-945.
[16] Chien, L.W., Au, H.K., Chen, P.L. and Tzeng, C.R. (2002) Assessment of Uterine Receptivity by the Endometrial-Subendometrial Blood Flow Distribution Pattern in Women Undergoing in-Vitro Fertilization Embryo Transfer. Fertility and Sterility, 78, 245-251.
[17] Chen, S.-L., Wu, F.-R., Luo, C., Chen, X., Shi, X.-Y., Zheng, H.-Y. and Ni, Y.-P. (2010) Combined Analysis of Endometrial Thickness and Pattern in Predicting Outcome of in Vitro Fertilization and Embryo Transfer: A Retrospective Cohort Study. Reproductive Biology and Endocrinology, 8, 30.
[18] Chenette, P.E., Sauer, M.V. and Paulson, R.J. (1990) Very High Serum E2 Levels Are Not Detrimental to Clinical Outcome of in Vitro Fertilization. Fertility and Sterility, 54, 858-863.
[19] Kosmas, I.P., Kolibianakis, E.M. and Devroey, P. (2004) Association of Estradiol Levels on the Day of hCG Administration and Pregnancy Achievement in IVF: A Systematic Review. Human Reproduction, 19, 2446-2453.
[20] Lozano, D.H.M., et al. (2007) The 3D Vascular Status of the Follicle after hCG Administration Is Qualitatively Rather than Quantitatively Associated with Its Reproductive Competence. Human Reproduction, 22, 1095-1099.
[21] Ng, E.H., Chan, C.C., Tang, O.S., Yeung, W.S. and Ho, P.C. (2006) The Role of Endometrial and Subendometrial Blood Flows Measured by Three-Dimensional Power Doppler Ultrasound in the Prediction of Pregnancy during IVF Treatment. Human Reproduction, 21, 164-170.
[22] Kupesic, S., Kurjak, A., Bjelos, D. and Vujisic, S. (2003) Three-Dimensional Ultrasonographic Ovarian Measurements and in Vitro Fertilization Outcome Are Related to Age. Fertility and Sterility, 79, 190-197.

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