OP18.03: Three-dimensional ultrasonography (3D-US) and power Doppler angiography (PDA) measurements to predict ovarian response

18th World Congress on Ultrasound in Obstetrics and Gynecology

Radiological hysterosalpingography is the first method used to evaluate tubal patency, and has changed very little during the past decades. With the increasing number of tubal infertility cases there is an obvious need for a better assessment tool. Imagined years ago, sonographic hysterosalpingography evolved along with the ultrasound machine development, turning into a handy investigation method which may be reconsidered. Objectives: Our study purpose is to create an objective standard for evaluation of tubal function based on transvaginal sonographic evaluation after saline solution infusion. Methods: We performed the procedure on 32 patients over a period of 10 months, as part of the routine assessment of the infertile couple. We created a scoring system which includes five parameters (tubal fluid passage, fluid spillage in the pouch of Douglas, adhesions visualized in the peritoneal pouch, visualization of the fimbriae, pain intensity), each of them graded from 0 to 2. Results: We divided the patients into three groups. Group A included 10 patients with a score of 7 or higher, suggestive for good tubal function. Group B was mad of 11 patients with a score between 4 and 7, and group C, 11 patients with a score lower than 4. The first group was directed to intrauterine insemination (IUI), with a total of 6 pregnancies after 4 cycles. In group C patients we performed a laparoscopic evaluation of the pelvis, which in all cases confirmed tubal damage. In group B we advised 3 IUI cycles, with 1 successful pregnancy, followed by laparoscopic evaluation, which showed a significant discordance with sonographic results. Conclusions: Sonographic hysterosalpingography is a useful technique which offers good details about pelvic anatomy, and with an objective scoring system may differentiate patients who would benefit from IUI and in vitriol fertilization.

OP18.02 Effect of rising hCG levels on the human corpus luteum during early pregnancy ¨ ¨ A. Tekay I. Y. Jarvel a, Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland Background: During early pregnancy the most important task of the corpus luteum (CL) is to produce sufficient progesterone until the luteoplacental shift occurs. Progesterone (P) production is closely related to the extensive vasculature surrounding and supplying the CL. The synthesis of both P and factors controlling the vasculature in the CL is regulated by hCG, which is released initially at rising levels from the placenta. The primary aim of this research was to evaluate changes in the CL vasculature during early pregnancy. Methods: Twenty naturally conceived pregnancies were examined weekly from week 5 to week 11. At each visit, blood samples were obtained to determine the concentrations of human chorionic gonadotrophin (hCG), P and 17-OH progesterone (17-OHP). The vasculature in the ovaries was assessed using 3-dimensional (3-D) power Doppler ultrasonography. Results: The vascular supply in the ovary containing the CL was greatest at week 5, and thereafter, declined continuously until week 11. The decrease in the vasculature correlated with the decrease in 17-OHP. Mean hCG levels reached a maximum at week 8. P levels reached the nadir at week 7 and increased after that. Conclusions: Vasculature in the CL appears to be created already by the fifth week of pregnancy and it does not enlarge despite of rising hCG levels, confirming the fact that the hCG-induced CL rescue is only temporary. The activity of the CL during pregnancy can be measured noninvasively by assessing its vasculature with 3-D ultrasonography.

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Oral poster abstracts

OP18.03 Three-dimensional ultrasonography (3D-US) and power Doppler angiography (PDA) measurements to predict ovarian response T. Borkowski, Y. Gilboa, L. Gindes, A. Horowitz, S. Dor, R. Achiron Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel Objectives: The purpose of this study was to try to predict poor or good ovarian response by three-dimensional ultrasonography (3DUS) and power Doppler angiography (PDA) in patients who are on IVF program. Study Design: A prospective clinical study of 46 women who underwent IVF treatments. 3D-US parameters included ovarian volume and antral follicular count (AFC) while PDA included: vascularisation index (VI), flow index (FI), and vascularisation flow index (VFI). All ultrasound examination were performed in early proliferative phase of the cycle. Results: Thirty one women with normal response and 15 women with poor response were analyzed. We have found that age, AFC, number of eggs derived and frozen, level of E2 in the day of HCG administration differs significantly in the poor comparing to good responders. The levels of FSH, ovarian indexes (VI, FI, VFI), ovarian volume and pregnancy rate. did not differ between the two groups. There was no correlation between the flow indexes and FSH. Conclusions: 3D-US and power Doppler angiography indexes could not be used for predicting poor or good ovarian response. The antral follicular count was the only parameter that statistically distinguishes between low ovarian responds and control.

OP18.04 Role of the three-dimensional ultrasound in the evaluation of the uterine cavity in women undergoing assisted reproductive technologies K. Ojha1 , S. Tse2 , D. J. Gillott2 , E. Iammorrone2 , J. G. Grudzinskas2 1

Obsterics and Gynaecology, St George’s Hospital, London, United Kingdom, 2 Bridge Fertility Centre, London, United Kingdom Introduction: The availability of 3D Ultrasound (3DUS), a new imaging technique, enabled us to assess the uterine cavity with high resolution. The aim of our study was to evaluate the uterine cavity with 3D US and to assess if there is a correlation with implantation in women undergoing Assisted Reproductive Technologies. Materials and Methods: 78 women underwent 3D US (GE Voluson 730) of the uterine cavity prior to treatment. Correlation between the uterine cavity morphology and positive pregnancy rate has been examined. Results: A regular uterine cavity was observed in 61 women (group A) and 17 women showed an irregular uterine cavity (group B). In group A there were 10 women with intramural and/or subserosus fibroids. The irregularities observed in Group B were: 4 arcuated uterus, 7 polyps, 5 sub-mucosus fibroids and 1 anaecogenic area. There was no difference between group A and B in terms of age (37.1 ‘‘b 4.3 vs 37.2’’ b 4.8). The number of oocytes collected was similar between the two groups (8.4 ‘‘b 4.0 vs 8.6’’ b 5.6) as were the number of embryos derived (5.0 ‘‘b 2.9 vs 4.6’’ b 3.5) and the number of embryos transferred (1.9 ‘‘b 0.3 vs 1.7’’ b 0.4). The positive pregnancy rate was 34.4% in group A and 29.4% in group B (P > 0.05). Of the 10 women in group A with intramural and/or sub-serosus fibroids we observed 40% positive pregnancy rate. Conclusions: Pregnancy rates among women with a normal uterine cavity, but with the presence of fibroids showed a slightly higher incidence than women with an irregular cavity. Though this is not statistically significant it does indicate that the presence of intramural or sub-serosus fibroids do not negatively impact on pregnancy rates.

Ultrasound in Obstetrics & Gynecology 2008; 32: 308–397