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Ginekologia i Położnictwo medical project
ISSN 1896-3315 e-ISSN 1898-0759

Perifollicular vascularity as a potential variable affecting outcome in stimulated intrauterine insemination letrozole treated cycles: A study using transvaginal power Doppler


Author(s): Mohamed I Taema*

Aim: This is a clinical trial study that included 44 women with infertility attending the fertility unit of University hospital and undergoing ovulation induction with letrozole and intrauterine insemination. The study was conducted from October 2020 to June 2021.

Inclusion criteria: Normal folliculometry and ultrasound finding, infertile women aged 20-35 years, infertility more than 1 year (after 12 month of regular intercourse), Body mass index between 20-30 kg/m², Normal prolactin level, follicular stimulating hormone on day 3 <12 IU/ml, thyroid stimulating hormone, Tubal patency ensured by hystrosalpingy graph or by laparoscope, Total sperm count of husband ≥ 10 million.

Methods: Patients involved in this study were subjected for Ovulation induction began on the third day of the menstrual cycle for 5 days, with 5 mg of letrozole added Hmg 75 IU on day, On day 10-12 of the menstrual cycle, transvaginal ultrasound was performed for monitoring follicular and endometrial development and was repeated every 2 days to decide time of hCG administration, When one or more follicles are measured 17 mm. When ovum reach 18 mm in diameters, hCG 5,000 IU was administered. Approximately 36 hours after hCG administration, the rupture of follicles was confirmed by transvaginal ultrasound and then a single IUI was performed. On the day of HCG, trans-vaginal 2D power Doppler ultrasound was performed at Ultrasound Unit in zagazig University Hospital by the same operator after the patients had emptied their bladders, measurements included:, peri-follicular vascularity, It also included endometrial volume and thickness and endometrial pattern, number of mature follicles, and then pregnancy is confirmed by blood test.

Results: The study showed that according distribution modified grading system grade 1, n=1, grade 2, n=4 grade 3, n=12 grade 4, n=5 the distribution of all follicles studied (all >17 mm in diameter), 5 patient get pregnant, mean diameter in relation of diameter are not significant (the pregnant group) while 17 cases did not get pregnant (non-pregnant group). The mean base line serum FSH concentration also tended to be high in low grade vascularity cycle, but this difference was not significant. Primary infertility found to be 12 patients (55%), while secondary infertility found to be 10 patients (45%). There were 5 pregnancy giving pregnancy rate 22%, the follicles of high grade vascularity were associated with high pregnancy rate (grade 4=60%), (grade 3=16.6%),than cycles with low grade vascularity with no pregnancy occur in grade 1 and 2 vascularity group (grade 1, 2=0%) this result is significant .5 pregnant patients, 2 patients had endometrial thickness 8-10 mm, 3 patients had endometrial thickness 10-12 mm, zero patient had endometrial of 8 mm, In our study the pregnancy rate was 40% with distinct five line endometrial pattern, 23% with hazy five line Endometrial pattern, and 0% with no endometrial layering.

Conclusion: Perifollicular vascular perfusion appears to be an important factor in determining the outcome in stimulated IUI cycles, and may have clinical implications in assisted reproduction techniques.