Usefulness of intraovarian artery pulsatility and

Usefulness of intraovarian artery pulsatility and
resistance indices measurement on the day of follicle
aspiration for the assessment of oocyte quality
Botao Du, M.D., Ph.D.,a,b Kazuhiro Takahashi, M.D., Ph.D.,a Gabriela M. Ishida, M.D., Ph.D.,a
Kenji Nakahara, M.D., Ph.D.,a Hidekazu Saito, M.D., Ph.D.,a,c and Hirohisa Kurachi, M.D., Ph.D.a哈尔滨医科大学附属第二医院妇科杜伯涛
aDepartment of Obstetrics and Gynecology, Yamagata University School of Medicine, Yamagata, Japan; bcurrent address: Department
of Obstetrics and Gynecology, The Second Affiliated Hospital, Harbin Medical University, Harbin, China; and ccurrent address:
Division of Reproductive Medicine, Department of Perinatal Medicine and Maternal care, National Center for Child Health and
Development, Setagaya, Tokyo, Japan
Objective: To examine the correlation between the pulsatility and resistance indices (PI and RI) of the intraovarian
artery on the day of follicle aspiration and the oocyte quality, intrafollicular oxidative stress, and luteinization.
Pulsatility index and RI on the day of hCG administration also were measured.
Design: Prospective study.
Setting: Obstetrics and gynecology department of a university medical school in Japan.
Patient(s): Thirty-five patients in an IVF-ET program.
Intervention(s): The PI and RI of the intraovarian artery were measured by transvaginal color ultrasonographic
pulsed wave Doppler on the day of hCG administration and the day of follicle aspiration. Follicular fluids and
the granulosa cells were collected at follicle aspiration.
Main Outcome Measure(s): The PI and RI of the intraovarian artery blood flow on the day of hCG administration
and of follicle aspiration, as well as the rate of development of mature oocytes, follicular fluid steroid levels, and
the incidence of apoptosis in the granulosa cells.
Result(s): The PI and RI on the day of follicle aspiration were correlated positively with the rate of mature
oocytes retrieved (PI: r
0.429; RI: r
0.348), were correlated negatively with the incidence of apoptotic mural
(PI: r
0.383; RI: r
0.459) and cumulus (PI: r
0.378; RI: r
0.469) granulosa cells, and were
negatively correlated with the concentration of P in the follicular fluid (PI: r
0.429; RI: r
0.359). The
PI and RI on the day of hCG administration were negatively correlated only with the total number of retrieved
oocytes (PI: r
0.393; RI: r
0.374).
Conclusion(s): The PI and RI of the intraovarian artery blood flow measured on the day of follicle aspiration may
be good indicators of the follicle luteinization and oxidation as well as of oocyte quality. (Fertil Steril
2006;85:
366?70. ©2006 by American Society for Reproductive Medicine.)
Key Words: Intraovarian artery blood flow, pulsatility index, resistance index, steroid hormone, apoptosis,
granulosa cells
Oxidative stress has a pivotal role in ovulation: some events
of ovulation are comparable to an inflammatory reaction.
Inflammatory-like changes first occur in the theca interna
and granulosa layers of follicles in response to hCG stimulation
in the luteinization process (1, 2). Various cytokines,
kinins, prostaglandins, proteolytic enzymes, nitric oxide, and
steroids are produced at the final stages of oocyte maturation
before the follicle rupture (1, 3, 4). These events have been
postulated to have effects on the blood flow in the ovaries
during the periovulatory period (5).
The pulsatility index (PI) and resistance index (RI) have
been used as parameters to estimate the changes of regional
tissue or organ blood flow (6). They reflect the impedance of
regional vessels (7) and are angle-independent parameters.
These indices have greatly facilitated the study of the blood
flow in the physiological and pathological states of various
organs (8?12).
Recently, the intraovarian artery blood flow measured by
pulsed wave Doppler also has been used to estimate the
ovarian response or the growth of ovarian follicles, and it
was concluded that the blood flow index in the early follicular
phase negatively correlated with the number of aspirated
follicles or of oocytes collected (13, 14). Nargund et al. (15)
also examined the correlation between ultrasound-derived
indices of blood flow in individual follicles on the day of, but
before, the administration of hCG and the subsequent recovery
of oocytes and production of preimplantation embryos.
They found that the detection of follicular blood flow was
correlated with the improvement in the recovery of oocytes.
Received February 24, 2005; revised and accepted July 22, 2005.
Supported in part by a Grant-in-Aid for Exploratory Research, No
16659444 (to HK) from the Ministry of Education, Culture, Sports,
Science and Technology of Tokyo, Japan; and in part by Grants-in-Aid
for the 21st Century Center of Excellence (COE) Program from the
Tokyo, Japan Society for the Promotion of Science.
Reprint requests: Kazuhiro Takahashi, M.D., Ph.D., Department of Obstetrics
and Gynecology, Yamagata University School of Medicine,
2-2-2 Iidanishi, Yamagata 990-9585, Japan (FAX: [phone];
E-mail: [e-mail]).
366 Fertility and Sterility Vol. 85, No. 2, February 2006 0015-0282/06/$32.00
Copyright ©2006 American Society for Reproductive Medicine, Published by Elsevier Inc. doi:10.1016/j.fertnstert.2005.07.1316