Modifications in uterine and intraovarian artery impedance in cycles of treatment with exogenous gonadotropins: effects of luteal phase support.

OBJECTIVE

To determine the effects of induction of multiple ovulation and of luteal P supplementation on the impedance to blood flow in the uterine and intraovarian arteries during the luteal phase.

DESIGN

A prospective study using transvaginal color flow Doppler imaging.

SETTING

A university-based infertility center.

PATIENTS

Fifty-six women with unexplained or male factor-related infertility undergoing IUI.

INTERVENTIONS

The patients were studied either during spontaneous cycles (n = 16) or in cycles of induction of multiple follicular development with purified FSH (n = 40). In 18 treated cycles, the luteal phase was supplemented with natural P.

MAIN OUTCOME MEASURES

The pulsatility index was recorded from uterine and intraovarian arteries on the day of E2 peak and 5 and 10 days thereafter. On the same days, E2 and P plasma levels were measured by RIA.

RESULTS

The intraovarian pulsatility index was significantly lower in FSH-treated than in spontaneous cycles on the day of E2 peak. Also, the uterine pulsatility index was significantly lower in treated cycles than in spontaneous cycles on the day of E2 peak and 5 days thereafter. In the late luteal phase, P supplementation was correlated with a significant decrease in uterine pulsatility index as compared with both spontaneous cycles and FSH-treated cycles without luteal support.

CONCLUSIONS

Multiple follicular development is associated with a significant reduction in the impedance to perifollicular blood flow. Progesterone, as well as E2, seems able to decrease the impedance to blood flow in uterine arteries in women.