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Objective: To evaluate whether endometrial or ovarian parameters as measured using 3D power Doppler ultrasound would predict the outcome in frozen embryo transfer (FET) cycles., Methods: Thirty women with no known gynecological pathology undergoing FET were recruited. The FET was carried out in the natural menstrual cycle 3-4 days after the first positive LH test result. Blood samples for hormonal analysis were collected, and three-dimensional (3D) ultrasonographic examination was performed on the day of the FET and repeated with analysis of the total hCG one week later., Results: The demographic, clinical, and embryological characteristics were similar between the pregnant (15/30) and nonpregnant groups (15/30). There were no differences between the groups in endometrial/subendometrial thickness, volume, or vascularization index (VI). The endometrial triple-line pattern was more often present in the pregnant group on the day of the FET (93.3% vs. 40.0%, 95% CI 25.5-81.2%). No differences in the ovaries were observed on the day of the FET. At the second visit, the triple-line pattern was still more often present in those patients who had conceived (91.7% vs. 42.9%, 95% CI 18.5-79.1%), and their corpus luteum was more active as judged by the rise in 17-hydroxyprogesterone and estradiol levels. No differences were observed in the dominant ovarian vasculature., Conclusions: According to our results, measurement of power Doppler indices using 3D ultrasound on the day of the FET does not provide any additional information concerning the outcome of the cycle. The existence of the triple-line pattern on the day of the FET seems to be a prognostic sign of a prosperous outcome after FET. The dominant ovary in the pregnant group seems to be already activated one week after the FET.

Objective: To evaluate the impact of the regressing corpus luteum on the hormone secretion during hCG stimulation. The hCG stimulation test in the early follicular phase has been used to assess the capacity of the ovarian theca cells to secrete steroids., Design: A prospective observational study., Setting: University hospital., Patient(s): The study group consisted of 11 women with confirmed ovulation in the past cycle (corpus luteum positive [CL+]) and the control group of 11 women using oral contraceptive pills (OC; no CL)., Intervention(s): An hCG test (5,000 IU IM) was performed 2 to 4 days after menstrual bleeding, and the ovarian response was measured at 0, 48, and 96 hours after injection., Main Outcome Measure(s): Changes in serum concentrations of P, 17-hydroxyprogesterone (17-OHP), androstenedione (A), T, E(2), and vascular endothelial growth factor (VEGF), and in ovarian vasculature and volume (three-dimensional power Doppler ultrasonography) were measured., Result(s): Secretion of P and 17-OHP increased after hCG injection in the CL group, whereas no change was observed in women on OCs (P < or = .001). Concomitant increases were observed in volume and vasculature of the ovary with a CL (P<.05), but not in the contralateral ovary or in women on OCs. The changes in volume and vasculature correlated with levels of P and 17-OHP (P<.05)., Conclusion(s): The regressing corpus luteum from the past menstrual cycle reactivates and secretes steroids in response to hCG stimulation performed during the early follicular phase, which should be taken into account when comparing hormone profiles of ovulatory and anovulatory women.

Objective: To study the predictive value of initial low response (LR) in IVF/intracytoplasmic sperm injection (ICSI)., Design: Retrospective analysis., Setting: Two Finnish fertility centers., Patient(s): A total of 3,846 IVF/ICSI cycles performed from 1994 to 2002., Intervention(s): Consecutive cycles in the same subject were identified. The study groups consisted of subjects who had three treatment cycles and at least one LR cycle (n = 80)., Main Outcome Measure(s): Pregnancy rate (PR), total gonadotropin dose, and embryo quality., Result(s): Only 2.5% (2/80) of subjects had a LR in all three consecutive cycles. In 43 women an initial LR was followed by >/=1 normal response (NR) cycle, and in 35 women an initial NR was followed by >/=1 LR cycle. The PR/cycle was similarly low in women with an initial LR and an initial NR (10.1% vs. 16.2%). An increase in gonadotropin dose resulted in a higher number of oocytes in women with an initial LR (from 2.1 +/- 0.9 to 6.7 +/- 2.7) but the PR/cycle remained low, compared to the overall mean PR (27.2%). In cycles in which top quality embryos were transferred, subjects with an initial LR had a lower PR than women with an initial NR (17.8% vs. 41.2%)., Conclusion(s): An initial LR is a predictor of poor outcome in subsequent cycles, even if ovarian response is improved by increasing the gonadotropin dose or a top quality embryo is replaced.

Objective: To evaluate whether power Doppler predicts ovarian response to gonadotrophin stimulation during in vitro fertilization (IVF)., Methods: Forty-five women were divided into low-reserve (n = 12) and normal-reserve (n = 33) ovarian groups, according to antral follicle count. Transvaginal three-dimensional power Doppler ultrasonographic examinations were performed after pituitary downregulation and after gonadotrophin stimulation. The antral follicle count, ovarian volume, vascularization index, flow index, vascularization flow index, and mean gray value were measured and related to the number of oocytes retrieved and the pregnancy rate., Results: The number of oocytes retrieved correlated with the antral follicle count (R =.458, P =.004) and ovarian volume (R =.388, P <.016) but not with vascularization index, flow index, vascularization flow index, or mean gray value after pituitary suppression. There was an increase in vascularization index (P <.017), flow index (P <.001), and vascularization flow index (P <.007) during gonadotrophin stimulation in the normal-ovary group but not in the low-ovarian-reserve group., Conclusion: According to our results, quantification of power Doppler signal in the ovaries after pituitary suppression does not provide any additional information to predict the subsequent response to gonadotrophin stimulation during IVF. The increase in ovarian power Doppler signal during gonadotrophin stimulation is related to the antral follicle count observed after pituitary suppression.

Objective: To evaluate the changes taking place in the ovaries during pituitary down-regulation., Design: Prospective observational study of women undergoing IVF treatment., Setting: A tertiary referral center for assisted reproduction., Patient(s): Forty women who received the long buserelin acetate treatment protocol. Transvaginal three-dimensional power Doppler ultrasound examinations before and after pituitary down-regulation., Intervention(s): Ovarian volume, number of follicles, vascularization index (VI), flow index (FI), vascularization flow index (VFI), and mean gray value (MG)., Result(s): Before the pituitary down-regulation, the dominant ovary was larger in volume and had a lower MG than the nondominant ovary. After the down-regulation, there was a significant decrease in the volume and number of follicles and an increase in MG. After pituitary down-regulation, the dominant and nondominant ovaries did not differ from each other in any of the parameters. Polycystic ovaries were larger than normal ones before and after the down-regulation, without any differences in MG, VI, FI, or VFI. Right and left ovaries did not differ from each other after the down-regulation., Conclusion(s): The differences observed between dominant and nondominant ovaries seem to disappear after pituitary down-regulation. In addition, polycystic ovaries were always larger than the normal ones, but no differences could be detected in the stromal brightness or vascularity either before or after the administration of GnRH agonist therapy.