title: Cerebral blood flow is increased during controlled ovarian stimulation.
abstract: Estrogen appears to enhance cerebral blood flow (CBF). An association between CBF and physiologically altered hormonal levels due to menstrual cycle, menopause, or exogenous manipulations such as ovariectomy or hormone replacement therapy has been demonstrated. The purpose of this study was to determine the association between ovarian stimulation and CBF in vivo by measuring blood flow in the internal carotid artery (ICA) after pituitary suppression and during controlled ovarian stimulation in women undergoing in vitro fertilization treatment cycles. ICA volume flows were measured by angle-independent dual-beam ultrasound Doppler in 12 women undergoing controlled ovarian stimulation. Measurements were performed after pituitary/ovarian suppression, in the late follicular phase, and at midluteal phase. Blood flow in the ICA increased by 22.2% and 32% in the late follicular and midluteal phases compared with the respective values obtained during ovarian suppression (P < 0.0005 and P < 0.0001, respectively). There was a significant correlation between increments in estrogen levels and increments in CBF when the late follicular phase was compared with the ovarian suppression period (r = 0.8, P < 0.001). Mean blood flow velocity significantly increased (by 15.7% and 16.9%, respectively) and cerebral vascular resistance significantly decreased (by 17.6% and 26.5%) during the late follicular and midluteal phases compared with respective measures during ovarian suppression. There was a significant correlation between an increase in estrogen levels and a decrease in cerebral vascular resistance when the late follicular phase was compared with the ovarian suppression period (r = -0.6, P < 0.05). These changes imply sex hormone-associated intracranial vasodilation leading to increased CBF during controlled ovarian stimulation.
authors.affiliation: Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel 31096.
authors.forename: Ori
authors.initials: O
authors.lastname: Nevo
authors.forename: Jean F
authors.initials: JF
authors.lastname: Soustiel
authors.forename: Israel
authors.initials: I
authors.lastname: Thaler
mesh_terms: D001783:Blood Flow Velocity / Q000187:drug effects; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000187:drug effects*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004334:Drug Administration Schedule; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000097:blood; D005307:Fertilization in Vitro; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008597:Menstrual Cycle / Q000097:blood / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods; D011374:Progesterone / Q000008:administration & dosage / Q000097:blood; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance / Q000187:drug effects; D014664:Vasodilation / Q000187:drug effects*
chemical_list: D005300:Fertility Agents, Female; D011374:Progesterone; D004958:Estradiol