Quantification of ovarian stromal Doppler signals in poor responders undergoing in vitro fertilization with three-dimensional power Doppler ultrasonography

Objective: This was a prospective comparative clinical study to test the hypothesis that the decreased ovarian sensitivity to gonadotropins observed in women embarking on an in vitro fertilization (IVF) treatment may be due to changes in ovarian stromal blood flow. Study design: Three-dimensional (3D) power Doppler ultrasonographic indexes were used to quantify ovarian stromal blood flow and vascularization in poor responders. Forty patients undergoing an IVF cycle were collected and divided into two groups, a poor responder group (n = 17) (estradiol <600 pg/mL or ≤3 oocytes retrieved) and normal responder group (n = 23), based on their response to a standard down-regulation protocol for controlled ovarian stimulation. During ovarian stimulation, on the day of administration of human chorionic gonadotropin (HCG), patients underwent hormonal (serum E2), ultrasonographic (follicular number and diameter), and 3D power Doppler (ovarian stromal blood flow) evaluation. Results: Compared with poor responders, the serum estradiol levels on the day of administration of HCG, the number of follicles more than 14 mm, the number of oocytes retrieved, the number of embryos transferred, and the pregnancy rate were significantly higher in normal responders. The Vascularization Index, Flow Index, and Vascularization Flow Index were significantly lower (P < .05) in the poor responder (0.13 ± 0.11, 30.89 ± 10.35, and 0.05 ± 0.04, respectively) compared with the women with a normal response (1.20 ± 1.10, 43.88 ± 7.77, and 0.61 ± 0.57, respectively). Conclusion: The 3D power Doppler indexes of ovarian stromal blood flow in poor responders was significantly lower than normoresponders. This may help to explain the poor response during HCG administration in controlled ovarian stimulation.