Luteal phase defect: comparison between Doppler velocimetry, histological and hormonal markers.
The aim of this prospective study was to investigate the relationship between the ultrasonographic appearance of the endometrium, histological dating by biopsy, hormonal profile and impedance within the segmental uterine and ovarian circulation for assessment of luteal phase function. A total of 61 infertile patients undergoing endometrial biopsy were studied by transvaginal B-mode and color and pulsed Doppler ultrasound. Uterine, radial, spiral, ovarian and intraovarian artery impedance throughout the natural ovarian cycle were related to histological and hormonal markers of uterine receptivity. Plasma levels of follicle stimulating hormone, luteinizing hormone (LH) and estradiol were measured on cycle days 5 and 10 and measurements were continued daily until the detection of the LH surge. Endometrial biopsy was performed 7 days after ultrasonically and hormonally detected ovulation. Progesterone levels were evaluated on the day of endometrial biopsy and 3 days later. After all the data were collected, the patients were divided into two groups, according to the histopathology: 15 patients with normal endometrial dating and 43 patients with a delayed endometrial pattern (i.e. luteal phase defect). One patient with an asynchronous endometrium and two anovulatory subjects were excluded from further evaluation. A significant difference between patients with a luteal phase defect and the control group was obtained for impedance in the uterine (p < 0.05), radial (p < 0.05), spiral (p < 0.001), ovarian (p < 0.05) and intraovarian arteries (p < 0.001) during the luteal phase. The endometrium showed secretory transformation when serum levels of progesterone were higher than 15 ng/ml. Segmental uterine and ovarian artery perfusion demonstrates a significant correlation with histological and hormonal markers of uterine receptivity. Therefore, blood flow impedance in the corpus luteum and spiral arteries may aid in assessing luteal phase adequacy.
Kupesić
S
S
Department of Obstetrics and Gynecology, Medical School, University of Zagreb, Croatia.
Kurjak
A
A
Vujisić
S
S
Petrović
Z
Z
D000328:Adult; D001783:Blood Flow Velocity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000098:blood supply / Q000000981:diagnostic imaging*; D013599:Systole; D018608:Ultrasonography, Doppler; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed; D014594:Uterine Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging*