Clinical significance of ovarian stromal blood flow in assessment of ovarian response in stimulated cycle for in vitro fertilization

Aashima Arora, Shalini Gainder, Lakhbir Dhaliwal, Vanita Suri


Background: Several ultrasound parameters have been examined to predict the ovarian response to gonadotropins. The only parameter that has been conclusively proven to predict ovarian response is the antral follicle count. It has been suggested that ovarian blood flow may play a crucial role in the development of ovarian follicles. The present study was planned to prospectively analyse the effect of ovarian stromal blood flow on ovarian responsiveness in terms of number of oocytes retrieved in stimulated cycle for IVF.

Methods: Fifty subjects between 22 to 37 years of age with male factor, tubal factor or unexplained infertility underwent controlled ovarian stimulation by the standard “Long protocol”. Ovarian stromal blood flow was recorded on baseline transvaginal sonography on day 2 or 3 of cycle and was correlated with number of oocytes retrieved in IVF cycle.

Results: The ovarian stromal blood flow was found to be negatively correlated with age. The number of follicles formed in a subject after stimulation with gonadotropins was negatively correlated with ovarian stromal resistance index and pulsatility index.

Conclusions: Ovarian blood flow predicts ovarian responsiveness and hence provides a non-invasive and cost effective prognostic factor of IVF outcome.


Ovarian stromal blood flow, IVF outcome

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Adamson D, Lancaster P, de Mouzon J, Nygren KG, Zegers Hochschild F. World collaborative report on assisted reproductive technology, 1998. In DL Healy, GT Kovacs, R McLachlan, O Rodriguez-Armas (eds), Reproductive medicine in the twenty first century. The Parthenon Publishing Group Ltd., UK. 2001:209-19.

Chang MY, Chiang CH, Hsieh TT, Soong YK, Hsu

KH. Use of the antral follicle count to predict the outcome of assisted reproductive technologies. 1998;69:505-10.

Ng EHY, Tang OS, Ho PC. The significance of the number of antral follicles prior to stimulation in predicting ovarian response in an In-vitro fertilization programme. Hum Reprod. 2000;15:1937-42.

Hsieh YY, Chang CC, Tsai HD. Antral follicle counting in predicting the retrieved oocyte number after ovarian hyperstimulation. J Assist Reprod Genet. 2001;18:320-4.

Ng EHY, Yeung WSB, Fong DYT, Ho PC. Effect of age on hormonal and ultrasound markers of ovarian reserve in Chinese women with proven fertility. Hum Reprod. 2003;18:2169-74.

Ng EHY, Chan CCW, Yeung WSB, Ho PC. Effect of age on ovarian stromal flow measured by three dimensional ultrasound with Power Doppler in Chinese women with proven fertility. Hum Reprod. 2004;19:2132-37.

Zaidi J, Barber J, Kyei-mensah A, Bekir J, Campbell S, Tan SL. Relationship of ovarian stromal blood flow at the baseline ultrasound scan to subsequent follicular response in an in vitro fertilization program. Obstet Gynecol. 1996;88:779-84.

Engmann L, Sladkevicius P, Agrawal R, Bekir JS, Campbell S, Tan SL. Value of ovarian stromal blood flow velocity measurement after pituitary suppression in the prediction of ovarian responsiveness and outcome of in vitro fertilization treatment. 1999;71:22-9.

NgEHY, Oi Shan Tang, Carina Chi Wai Chan, Pak Chung Ho. Ovarian stromal blood flow on the prediction of ovarian response during in vitro fertilization treatment. Hum Reprod. 2005;20:3147-51.