TITLE:
Correlation between Perifollicular Vascularity and Outcome in Stimulated Intrauterine Insemination Treatment Cycles: A Study Using Two-Dimensional Transvaginal Power Doppler Ultrasound
AUTHORS:
Nadia M. Madkour, Wael S. Nossair, Essa M. Arafa, Amany M. Abdelghany, Ekramy A. Mohamed, Walid A. Abdelsalam
KEYWORDS:
Perifollicular Vascularity, IUI, 2D Power Doppler Ultrasound
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.15,
November
19,
2014
ABSTRACT: 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 pregnantin
low grade group). There was statistically significant difference among the 3 groups
as regardingthe 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.