title: Endometrial blood flow is impaired in women with polycystic ovarian syndrome who are clinically hyperandrogenic.
abstract: OBJECTIVE
  To quantify endometrial and subendometrial blood flow in Caucasian women with polycystic ovarian syndrome (PCOS) and to determine whether these values differ according to the phenotypic expression of PCOS.
  
  
  METHODS
  Transvaginal pelvic ultrasound was performed on the 3(rd)-5(th) day of the menstrual cycle in 36 women with PCOS and 36 controls to examine the endometrial and subendometrial vascularity. The subendometrial and endometrial blood flow indices (vascularizaton index (VI), flow index (FI) and vascularization flow index (VFI)) were measured using three-dimensional power Doppler angiography. Uterine artery blood flow was assessed through analysis of two-dimensional (2D) pulsed-wave Doppler waveforms. Analysis was performed to compare PCOS with non-PCOS women, and subgroup analysis was performed of the PCOS women categorized according to their phenotypic manifestation.
  
  
  RESULTS
  There were no significant differences in endometrial volume, subendometrial vascularity and uterine artery blood flow between women with PCOS and controls after controlling for body mass index (BMI). On subgroup analysis, compared with anovulatory but clinically normoandrogenic women with polycystic ovaries (PCO) and with controls, women with PCO who were both clinically hyperandrogenic and anovulatory had significantly lower endometrial (VI: 0.57% vs. 1.11% and 0.86%, respectively, both P = 0.01; VFI: 0.14 vs. 0.42 and 0.28, respectively, both P = 0.02) and subendometrial (VI: 1.59% vs. 3.17% and 2.47%, P = 0.01 and 0.02, respectively; VFI: 0.50 vs. 1.67 and 0.96, P = 0.01 and 0.02, respectively) blood flow. Moreover, clinically hyperandrogenic but ovulatory women with PCO also had significantly lower endometrial blood flow (VI: 0.52% vs. 1.11%, P = 0.04) than did anovulatory but clinically normoandrogenic women with PCO. There were no differences in any of the 2D pulsed-wave Doppler measures of blood flow between the subgroups.
  
  
  CONCLUSIONS
  Subendometrial and endometrial blood flow is significantly impaired in women with PCOS who have clinical signs of hyperandrogenism.
authors.affiliation: Department of Obstetrics & Gynaecology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. lampomui@cuhk.edu.hk
authors.forename: P
authors.initials: P
authors.lastname: Lam
authors.forename: I
authors.initials: I
authors.lastname: Johnson
authors.forename: N
authors.initials: N
authors.lastname: Raine-Fenning
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D016022:Case-Control Studies; D004717:Endometrium / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications* / Q000503:physiopathology; D021621:Imaging, Three-Dimensional; D008597:Menstrual Cycle / Q000502:physiology*; D010641:Phenotype; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies; D014463:Ultrasonography