title: Perifollicular blood flow and its relationship with endometrial vascularity, follicular fluid EG-VEGF, IGF-1, and inhibin-a levels and IVF outcomes.
abstract: OBJECTIVE
  The aim of this study is to investigate the association of perifollicular blood flow (PFBF) with follicular fluid EG-VEGF, inhibin-a, and insulin-like growth factor-1 (IGF-1) concentrations, endometrial vascularity, and IVF outcomes.
  
  
  METHODS
  Forty women with tubal factor infertility were included in a prospective cohort study. Each woman underwent IVF/ICSI procedure. Individual follicles of ≥16 mm (n = 156) were evaluated by power Doppler analysis and categorized as well-vascularized follicles (WVFs) or poorly vascularized follicles (PVFs). WVFs referred to those with perifollicular vascularity of 51-100 %. Each follicular fluid (FF) was individually aspirated and FF/serum EG-VEGF, inhibin-a, and FF IGF-1 levels were evaluated. Zones III-IV endometrial vascularity was classified as a well-vascularized endometrium (WVE). The presence of a WVE and mature oocytes, in addition to the embryo quality and clinical pregnancy rate (CPR), were recorded for each follicle. The main outcome measures were FF serum EG-VEGF, inhibin-a, IGF-1 levels, and WVE and IVF outcome per PFBF.
  
  
  RESULTS
  For WVFs, the level of FF EG-VEGF (p = 0.008), oocyte quality (p = 0.001), embryo quality (p = 0.002), a WVE (p = 0.001), and CPR (p = 0.04) increased significantly. The pregnant group was characterized by increased numbers of WVFs (p = 0.044), a WVE (p = 0.022), and increased levels of FF IGF-1 (p = 0.001) and serum EG-VEGF (p = 0.03). FF IGF-1 >50 ng/mL (AUC 0.72) had 75 % sensitivity and 64 % specificity for predicting CPR.
  
  
  CONCLUSIONS
  WVFs yield high-quality oocytes and embryos, a WVE, increased FF EG-VEGF levels, and increased CPRs.
authors.affiliation: Department of Obstetrics and Gynecology, Haydarpaşa Numune Training and Research Hospital, Tıbbiye cad. No:40 Üsküdar, Istanbul, Turkey. fisunvural@yahoo.com.tr.
authors.forename: Fisun
authors.identifier: http://orcid.org/0000-0002-1103-7357
authors.initials: F
authors.lastname: Vural
authors.affiliation: Department of Obstetrics and Gynecology, Assisted Reproductive Unit, Kocaeli University School of Medicine, Kocaeli, Turkey.
authors.forename: Birol
authors.initials: B
authors.lastname: Vural
authors.affiliation: Department of Obstetrics and Gynecology, Assisted Reproductive Unit, Kocaeli University School of Medicine, Kocaeli, Turkey.
authors.forename: Emek
authors.initials: E
authors.lastname: Doğer
authors.affiliation: Department of Obstetrics and Gynecology, Assisted Reproductive Unit, Kocaeli University School of Medicine, Kocaeli, Turkey.
authors.forename: Yiğit
authors.initials: Y
authors.lastname: Çakıroğlu
authors.affiliation: Department of Biochemistry, Kocaeli University School of Medicine, Kocaeli, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Çekmen
mesh_terms: D000328:Adult; D004717:Endometrium / Q000098:blood supply; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D015571:Follicular Fluid / Q000378:metabolism; D006801:Humans; D007247:Infertility, Female / Q000097:blood* / Q000473:pathology; D007265:Inhibins / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D006080:Ovarian Follicle / Q000098:blood supply; D011247:Pregnancy; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic; D042662:Vascular Endothelial Growth Factor, Endocrine-Gland-Derived / Q000097:blood*
chemical_list: D042662:Vascular Endothelial Growth Factor, Endocrine-Gland-Derived; C094377:inhibin-alpha subunit; D007265:Inhibins; D007334:Insulin-Like Growth Factor I
keywords: EG-VEGF; Endometrial blood flow; Endometrial vascularity; Follicular blood flow; Follicular vascularity; IGF-1; Inhibin-a