o_1977r8vv9vk1ts2ms0kd8pksa.pdf

a Chapter 38 Three-Dimensional Doppler Ultrasound in Gynecology 559
Fig. 38.2. Three-dimensional Doppler was used to acquire volumes
ogy, and in the field of benign gynecology. Pan et al.
aimed 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
[4]. They used 3D power Doppler ultrasonographic
indexes 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. Compared with poor responders,
the serum estradiol levels on the day of administration
of HCG, the number of follicles > 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 in the poor responders compared
with the women with a normal response. They concluded
that the 3D power Doppler indexes of ovarian
stromal blood flow in poor responders was significantly
lower than those of normal responders. This
may help to explain the poor response during HCG
administration in controlled ovarian stimulation.
The British group used 3D power Doppler to examine
the periodic changes in endometrial and subendometrial
vascularity during the normal menstrual
cycle in 27 women without obvious menstrual dysfunction
or subfertility [5]. Doppler exam was performed
on alternate days from day 3 of the cycle until
ovulation and then every 4 days until menses. Virtual
organ computer-aided analysis and shell imaging
were used to define and to quantify the power Doppler
signal within the endometrial and sub-endometrial
regions producing indices of their relative vascularity.
Both the endometrial and sub-endometrial VI
and VFI increased during the proliferative phase,
peaking approximately 3 days prior to ovulation before
decreasing to a nadir 5 days post-ovulation;
thereafter, both vascular indices gradually increased