Utero-ovarian blood flow characteristics of pituitary desensitization.
BACKGROUND
Down-regulation in assisted reproduction treatment cycles is monitored by suppression of ovarian/pituitary hormones and/or measurement of endometrial thickness.


METHODS
This prospective longitudinal study reports on utero-ovarian characteristics of pituitary desensitization. A total of 75 patients were recruited; 32 had IVF treatment, 20 frozen--thawed embryo transfer cycles and 23 patients were recipients of donated oocytes. All received early follicular-phase down-regulation and had colour flow Doppler velocimetry of the utero-ovarian arteries < or =3 days before the start of menses and after 21 days of gonadotrophin-releasing hormone (GnRH) analogue treatment. Ovarian volume, endometrial thickness, pituitary and ovarian hormone concentrations were recorded at each scan.


RESULTS
Significant changes (P < 0.05) were noted in these and utero-ovarian vasculature during the down-regulation period, with good correlation between resistance index and oestradiol estimations. Neither the type of GnRH analogue nor age influenced the changes in utero-ovarian blood flow. Ovarian artery resistance index was the best Doppler predictor for pituitary suppression and a mean discriminatory cut-off value of 0.867 +/- 0.025 was found to have the highest specificity and positive predictive value.


CONCLUSIONS
This study has, for the first time, defined cut-off values for satisfactory pituitary suppression with high positive predictive value and specificity in an early follicular phase long protocol of GnRH analogue down-regulation using colour flow Doppler.
Dada
T
T
Assisted Conception Unit, St James's University Hospital, Leeds, UK. Babs@tdada.freeserve.co.uk
Salha
O
O
Allgar
V
V
Sharma
V
V
D000328:Adult; D000375:Aging; D001158:Arteries; D001783:Blood Flow Velocity; D002064:Buserelin / Q000494:pharmacology; D004624:Embryo Transfer; D004717:Endometrium / Q000033:anatomy & histology; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005498:Follicular Phase / Q000187:drug effects; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives*; D006801:Humans; D008137:Longitudinal Studies; D017274:Nafarelin / Q000494:pharmacology; D018587:Oocyte Donation; D010048:Ovarian Cysts / Q000503:physiopathology; D010053:Ovary / Q000033:anatomy & histology / Q000098:blood supply*; D010902:Pituitary Gland / Q000187:drug effects* / Q000502:physiology; D011446:Prospective Studies; D011673:Pulsatile Flow; D012372:ROC Curve; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed; D014599:Uterus / Q000098:blood supply*; D014655:Vascular Resistance
D017274:Nafarelin; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D002064:Buserelin