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Abstract
In vitro fertilization (IVF) presented a new hope to many couples who would otherwise have absent or minimal chance of conception.
The introduction of the use of high resolution transvaginal ultrasound and more recently, transvaginal color Doppler and power Doppler in addition to three dimensional (3-D) ultrasonography increased the predictive power of sonography in IVF outcomes.
Dramatic changes in the ovarian vasculature are associated with follicle growth. Many studies have been performed to predict low response to ovulation-inducing agents through the use of Doppler sonography in the early follicular phase of controlled ovarian hyper-stimulation (COH).
Peak systolic blood flow velocity (Vs) of the ovarian stromal vessels in the early follicular phase has been proposed as an independent predictive measurement of ovarian response.
Doppler sonography performed on the second or third day of the cycle showed that Vs measurement strongly correlated with the number of developing follicles the number of mature oocytes collected and the pregnancy rate were greater in the group having Vs ?10cm/sec or more than in the group having Vs ?10cm/sec.
The intraovarian stromal pulsatility index PI strongly correlated with the number of developing follicles >17 mm and number of oocyte collected.
It is time consuming process to examine all follicles by color Doppler ultrasonography, so utility of color Doppler indices of dominant follicular blood flow for prediction of clinical factors in the IVF and embryo transfere ET cycles has been proved to be significant.
In has been proved by the use of 3D power Doppler that the follicles containing occytes able to produce a pregnancy have a distinctive and more uniform peri-follicular vascular network.
Successful implantation during IVF and ET depends on many factors including embryo quality and uterine receptivity.
The measurement of the impedance to uterine artery blood flow in IVF cycles has provided an indirect estimation of endometrial receptivity. Many teams have reported a significant decrease of PI in patient whom pregnancy follows, whereas others have failed to show such modifications.
A much logic approach has been provided by introducing ultrasonogaphic score of endometrial parameters thickness and pattern, myometrial echo-genicates, uterine artery blood flow parameters (PI proto-diastolic notch and diastolic blood flow) and sub-endometrial vascularization. This score has been shown to be significantly correlated with implantation rate.
Also, the use of color Doppler sonography during follicular aspiration in patients undergoing IVF may reduce the risk of blood vessel injury.