Ultrasound studies of vascular and morphological changes in the human corpus luteum during the menstrual cycle**Supported by the Swedish Medical Research Council, Stockholm, Sweden (project grant no. B95-17x-11237-01A; fellowship to T.H.B. grant no. 2873).††Presented in part at the 3rd International Meeting of the European Society of Endosonography in Gynecology and Obstetrics, Göteborg, Sweden, May 31 to June 3, 1995

Ovulation: Parallels With Inflammatory Processes

The midcycle surge of LH sets in motion interconnected networks of signaling cascades to bring about rupture of the follicle and release of the oocyte during ovulation. Many mediators of these LH-induced signaling cascades are associated with inflammation, leading to the postulate that ovulation is similar to an inflammatory response. First responders to the LH surge are granulosa and theca cells, which produce steroids, prostaglandins, chemokines, and cytokines, which are also mediators of inflammatory processes. These mediators, in turn, activate both nonimmune ovarian cells as well as resident immune cells within the ovary; additional immune cells are also attracted to the ovary. Collectively, these cells regulate proteolytic pathways to reorganize the follicular stroma, disrupt the granulosa cell basal lamina, and facilitate invasion of vascular endothelial cells. LH-induced mediators initiate cumulus expansion and cumulus oocyte complex detachment, whereas the follicular apex undergoes extensive extracellular matrix remodeling and a loss of the surface epithelium. The remainder of the follicle undergoes rapid angiogenesis and functional differentiation of granulosa and theca cells. Ultimately, these functional and structural changes culminate in follicular rupture and oocyte release. Throughout the ovulatory process, the importance of inflammatory responses is highlighted by the commonalities and similarities between many of these events associated with ovulation and inflammation. However, ovulation includes processes that are distinct from inflammation, such as regulation of steroid action, oocyte maturation, and the eventual release of the oocyte. This review focuses on the commonalities between inflammatory responses and the process of ovulation.

Bovine luteal blood flow: basic mechanism and clinical relevance

The introduction of transrectal colour Doppler sonography (CDS) has allowed the evaluation of luteal blood flow (LBF) in cows. Because appropriate angiogenesis plays a decisive role in the functioning of the corpus luteum (CL), studies on LBF may provide valuable information about the physiology and pathophysiology of the CL. Studies on cyclic cows have shown that progesterone concentrations in blood plasma can be more reliably predicted by LBF than by luteal size (LS), especially during the regression phase of the CL. In contrast with non-pregnant cows, a significant increase in LBF is seen in pregnant cows during the third week after insemination. However, because there are high interindividual variations in LBF between animals, LBF is not useful for the early diagnosis of pregnancy. Determination of LBF is more sensitive than LS for detecting the effects of acute systemic inflammation and exogenous hormones on the CL. Cows with low progesterone levels have smaller CL during the mid-luteal phase, but LBF related to LS did not differ between cows with low and high progesterone levels. In conclusion, LBF determined by CDS provides additional information about luteal function compared with LS and plasma progesterone concentrations, but its role concerning fertility in the cow is yet to be clarified.

Echogenic foci in the ovary: are they predictive of endometriosis?

OBJECTIVES

The purpose of this study was to determine whether sonographically depicted echogenic foci are more common in the ovaries of women with endometriosis when compared to the ovaries of women who do not have endometriosis.

METHODS

Two radiologists blinded to the pathologic results reviewed the preoperative pelvic sonograms of consecutive women with a surgical diagnosis of endometriosis between June 2006 and October 2007. Results were compared with the preoperative sonograms of a control group of women without surgical evidence of endometriosis. The presence of echogenic foci in the ovaries and ovarian masses was recorded.

RESULTS

Echogenic foci were present in the ovaries of 33 of 70 women (47%) with endometriosis and in the ovaries of 21 of 76 women (28%) without endometriosis (P = 0.015). When only patients with sonographically normal ovaries were evaluated by excluding endometriomas and other ovarian masses, echogenic foci were present in 8 of 23 women (35%) with endometriosis and in 10 of 42 women (24%) without endometriosis (P = .344).

CONCLUSIONS

Echogenic foci are more commonly seen on sonography in the ovaries of women with endometriosis than in those without endometriosis, but this result seems largely due to ovarian endometriomas with echogenic foci in the walls. Echogenic foci are not predictive of endometriosis in women with otherwise sonographically normal ovaries.

Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement

The Society of Radiologists in Ultrasound convened a panel of specialists from gynecology, radiology, and pathology to arrive at a consensus regarding the management of ovarian and other adnexal cysts imaged sonographically in asymptomatic women. The panel met in Chicago, Ill, on October 27-28, 2009, and drafted this consensus statement. The recommendations in this statement are based on analysis of current literature and common practice strategies, and are thought to represent a reasonable approach to asymptomatic ovarian and other adnexal cysts imaged at ultrasonography.

Effect of menstrual cycle phase on sprinting performance

This study examined the effects of menstrual cycle phase (MCP) upon sprinting and recovery as well as upon metabolic responses to such exercise. Eight females performed a repeated 30-s sprint on a non-motorised treadmill interspersed with a 2-min rest in three phases of the MCP, follicular (low 17beta-estradiol and progesterone), just prior to ovulation (midcycle trial, highest 17beta-estradiol concentration and low progesterone) and in the luteal phase (high 17beta-estradiol and high progesterone). MCP was verified later by radioimmunoassay of 17beta-estradiol and progesterone. Peak power output (PPO) and mean power output (MPO) were unaltered (P > 0.05) due to MCP [PPO for sprint 1: 463 (18) W vs. 443 (15) W vs. 449 (18) W; PPO for sprint 2: 395 (17) W vs. 359 (16) W vs. 397 (17) W; MPO for sprint 1: 302 (15) W vs. 298 (13) W vs. 298 (14) W; MPO for sprint 2: 252 (10) W vs. 248 (10) W vs. 259 (12) W for follicular, midcycle and luteal trial, mean (SEM), respectively]. Similarly, percentage recovery of PPO and MPO (the PPO or MPO during sprint 2 expressed as a percentage of the PPO or MPO during sprint 1) was also unchanged (P > 0.05). Blood lactate, blood pH and plasma ammonia after sprinting and estimated plasma volume were also unaltered by MCP (P > 0.05). These findings suggest that hormonal fluctuations due to MCP do not interfere with maximal intensity whole body sprinting and the metabolic responses to such exercise.

The effect of hysterectomy on ovarian blood supply and endocrine function

OBJECTIVE

To evaluate the effect of hysterectomy on ovarian blood supply by color Doppler ultrasonography and the relationship between ovarian blood supply and ovarian function.

METHODS

Fifty patients undergoing hysterectomy due to uterine myoma were recruited as the study group. Forty patients who received myomectomy served as the control group. The following ovarian arterial parameters were measured before operation, on day 5, 1 and 3 months after operation: peak systolic flow velocity (Vmax) and pulsatility index (PI). Blood samples were taken at the time of each Doppler scan for subsequent hormone analysis: serum estradiol, progesterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH).

RESULTS

In the study group, Vmax, FSH and LH levels were significantly higher, while PI, estradiol and progesterone levels were significantly lower, on day 5 compared to pre-operation and to those of the control group. One and 3 months postoperatively, PI, FSH and LH levels were significantly higher, while Vmax, estradiol and progesterone levels were significantly lower, compared to pre-operation and to those of the control group. Vmax and PI were significantly correlated with FSH (r = 0.440, p = 0.015; and r = -0.361, p = 0.043, respectively) on day 5 postoperatively, but not with estradiol, progesterone and LH. Vmax was significantly correlated with estradiol and progesterone (r = 0.417, p = 0.045; and r = 0.808, p < 0.001, respectively) 1 and 3 months postoperatively, but not with LH and FSH. There were no correlations between PI and the hormone parameters 1 and 3 months postoperatively.

CONCLUSIONS

Hysterectomy may impair ovarian blood supply and function. There is good correlation between Doppler parameters and endocrine parameters.

Luteal blood flow and luteal function

BACKGROUND

Blood flow in the corpus luteum (CL) is associated with luteal function. The present study was undertaken to investigate whether luteal function can be improved by increasing CL blood flow in women with luteal phase defect (LFD).

METHODS

Blood flow impedance in the CL was measured by transvaginal color-pulsed-Doppler-ultrasonography and was expressed as a resistance index (RI). The patients with both LFD [serum progesterone (P) concentrations < 10 ng/ml during mid-luteal phase] and high CL-RI (>/= 0.51) were given vitamin-E (600 mg/day, n = 18), L-arginine (6 g/day, n = 14) as a potential nitric oxide donor, melatonin (3 mg/day, n = 13) as an antioxidant, or HCG (2,000 IU/day, n = 10) during the subsequent menstrual cycle.

RESULTS

In the control group (n = 11), who received no medication to increase CL blood flow, only one patient (9%) improved in CL-RI and 2 patients (18%) improved in serum P. Vitamin-E improved CL-RI in 15 patients (83%) and improved serum P in 12 patients (67%). L-arginine improved CL-RI in all the patients (100%) and improved serum P in 10 patients (71%). HCG improved CL-RI in all the patients (100%) and improved serum P in 9 patients (90%). Melatonin had no significant effect.

CONCLUSION

Vitamin-E or L-arginine treatment improved luteal function by decreasing CL blood flow impedance. CL blood flow is a critical factor for luteal function.

Angiogenesis in the human corpus luteum

Angiogenesis is important for the formation and development of the corpus luteum and for maintenance of luteal function. Blood vessel regression is an important physiological phenomenon in the corpus luteum, which is associated with tissue involution during structural luteolysis. Angiogenesis actively occurs during the early luteal phase and is completed by the mid-luteal phase. Perivascular cells (pericytes) increase in number from the early luteal phase to the mid-luteal phase, suggesting that blood vessels are gradually stabilized until the mid-luteal phase. In the corpus luteum undergoing luteolysis, blood vessels and pericytes decrease in number, which is related to structural involution. In the corpus luteum of early pregnancy, the number of blood vessels with pericytes increases, suggesting that angiogenesis occurs again, accompanied by blood vessel stabilization. These changes in vasculature of the corpus luteum are regulated by the collaboration with vascular endothelial growth factor, which is involved in proliferation of vascular endothelial cells, and angiopoietins, which are involved in stabilization of blood vessels. This review focuses on angiogenesis, blood vessel stabilization and blood vessel regression during the divergent phases of luteal formation, luteal regression and luteal rescue by pregnancy. (Reprod Med Biol 2008; 7: 91-103).

A Practical Approach to the Ultrasound Characterization of Adnexal Masses

Because pelvic ultrasound is commonly used to evaluate adnexal masses, it is important to understand the most useful sonographic features for predicting benign and malignant masses. Determining whether an adnexal mass is of ovarian or extraovarian origin is key in arriving at the most likely diagnosis. Most adnexal masses are benign, and each of the most common benign ovarian lesions has a typical sonographic appearance. Additionally, most malignant ovarian neoplasms have a solid component with detectable flow by Doppler ultrasound, allowing one to strongly suggest the diagnosis. We will review an approach to the ultrasound diagnosis of adnexal masses that progresses through a series of 4 questions to help lead one to the most likely diagnosis.

Assessment of changes in volume and vascularity of the ovaries during the normal menstrual cycle using three-dimensional power Doppler ultrasound

BACKGROUND

Our aim was to describe changes in the volume and vascularization of both ovaries, the dominant follicle and the corpus luteum during the normal menstrual cycle using three-dimensional (3D) power Doppler ultrasound.

METHODS

Fourteen healthy volunteers underwent serial transvaginal 3D ultrasound examinations of both ovaries on cycle day 2, 3 or 4, then daily from cycle day 9 until follicular rupture and 1, 2, 5, 7 and 12 days after follicular rupture. The volume and vascular indices of the ovaries, the dominant follicle and the corpus luteum were calculated off-line using virtual organ computer-aided analysis (VOCAL) software.

RESULTS

The volume of the dominant ovary increased during the follicular phase, decreased after follicular rupture and then increased again during the luteal phase. Vascular indices in the dominant ovary and the dominant follicle/corpus luteum increased during the follicular phase, the vascular flow index (VFI) in the dominant follicle being on average (median) 1.7 times higher on the day before ovulation than 4 days before ovulation (P=0.003). The vascular indices continued to rise after follicular rupture so that VFI in the corpus luteum was on average (median) 3.1 times higher 7 days after ovulation than in the follicle on the day before ovulation (P=0.0002). The volume and vascular indices in the non-dominant ovary manifested no unequivocal changes during the menstrual cycle.

CONCLUSIONS

Substantial changes occur in volume and vascularization of the dominant ovary during the normal menstrual cycle. 3D power Doppler ultrasound may become a useful tool for assessing pathological changes in the ovaries, for example, in subfertile patients.

Utero-ovarian ultrasonographic and Doppler flow analyses in female childhood cancer survivors with regular menstruation and normal circulating follicle-stimulating hormone levels

OBJECTIVE

To analyze the hormonal, ultrasonographic, and color Doppler parameters in a population-based follow-up study of female childhood cancer survivors with regular menstrual cycle and normal early follicular FSH values.

DESIGN

Controlled, prospective clinical study.

SETTING

University hospital.

PATIENT(S)

Twenty-eight female patients affected by a malignant tumor during childhood and 14 age-matched healthy controls.

INTERVENTION(S)

Hormonal, ultrasonographic, and color Doppler analyses.

MAIN OUTCOME MEASURE(S)

In the midluteal phase of the cycle, the patients underwent hormonal assay of gonadotropins, E2, and P; ultrasonographic evaluation of the uterine and ovarian volume, the endometrial thickness, and of the corpus luteum characteristics; color Doppler analysis of uterine, intraovarian, and periluteal arteries.

RESULT(S)

A greater uterine volume and a better utero-ovarian vascularization was observed in controls in comparison with cancer survivors. In patients who suffered from childhood malignancies the P values were lower than in controls. On the basis of circulating P (> or < 20 nmol/L) values, we divided the former group in ovulatory and nonovulatory patients. We observed that even if there were no differences between ovulatory cancer survivors and controls, the nonovulatory group showed a reduced uterine volume associated with elevated resistance at the level of uterine and intraovarian arteries. Among these two groups the time elapsed between the diagnosis of cancer and menarche was shorter in nonovulatory than in ovulatory women, and was directly correlated with both uterine volume (r = 0.660) and ovarian volume (r = 0.597).

CONCLUSION(S)

Ultrasonographic and Doppler analyses may noninvasively study the subtle utero-ovarian modification after anticancer therapies.

Form and function of the corpus luteum during the human menstrual cycle

OBJECTIVE

To characterize the growth and regression of the corpus luteum (CL) during an interovulatory interval (IOI) using serial transvaginal ultrasonography.

METHODS

Fifty healthy women of reproductive age with a history of regular menstrual cycles underwent daily transvaginal ultrasonography for one IOI. Measurements of luteal area and luteal numerical pixel value (NPV) were recorded each day after ovulation until the CL could no longer be detected. Blood was drawn every third day during the IOI to measure serum concentrations of progesterone and estradiol-17beta.

RESULTS

Corpora lutea were of two morphological types: those with a central fluid-filled cavity (CFFC) (78%) and those without (22%). Eighty-eight percent of women exhibited a CL containing a CFFC 2 days after ovulation, followed by 34% 13 days after ovulation and 2% 27 days after ovulation. Luteal area, progesterone concentration and estradiol concentration increased for approximately the first 6 days following ovulation followed by a subsequent decline. Luteal NPV decreased from days 1 to 11 and increased during days 11-16. Changes in luteal area, NPV, progesterone and estradiol concentrations did not differ in women with two versus three waves of follicular development.

CONCLUSIONS

Peak luteal function, as determined by maximum luteal area, progesterone concentration and estradiol concentration, is observed 6 days following ovulation. Luteal NPV is reflective of morphological and endocrinological changes in the CL. The development of a CFFC during luteinization is a normal physiological phenomenon. The CL can be detected, but is not functional, during the follicular phase of the menstrual cycle.

An ultrasound-based approach to the assessment of infertility, including the evaluation of tubal patency

An optimal initial infertility investigation protocol would be a process that is diagnostically accurate, expeditious, cost-effective, reliable and as minimally invasive as possible. In addition, the investigation should provide the clinician with useful prognostic information regarding possible future treatment. At present, extensive use of invasive procedures such as diagnostic hysteroscopy and laparoscopy is the standard at many fertility centres. Recent advances in gynaecological ultrasonography have shown that ultrasound can replace routine invasive investigative procedures. An ultrasound-based approach would make the basic infertility investigation less time-consuming and less expensive, but at the same time more acceptable to the majority of patients. This chapter describes an ultrasound-based approach to the assessment of infertility. In addition, the role of ultrasonography for assessment of the pelvic organs as a basic part of the initial investigation of an infertile couple is discussed and compared to more traditional invasive methods.

Irregular or absent periods—what can an ultrasound scan tell you?

Transvaginal ultrasonography has increased our appreciation of the physiological changes in the ovary and endometrium that occur during the normal menstrual cycle. It has become a primary investigative tool in women with irregular or absent periods. Its usefulness in cases of primary amenorrhoea to assess anatomy is also undisputed although it may have limitations in terms of its specificity. However, the interpretation of ultrasound images in women with irregular menses or secondary amenorrhoea is not entirely straightforward. This is particularly true in the diagnosis of polycystic ovary syndrome, a condition of uncertain aetiology, which may present with oligoamenorrhoea. This chapter aims to discuss the benefits and limitations of ultrasound while taking into account the broad overlap between normal and abnormal physiology, some of which has still to be elucidated.

Intraovarian blood flow measured with color doppler ultrasonography inversely correlates with vascular density in the human corpus luteum of the menstrual cycle

OBJECTIVE

To evaluate the morphologic characteristics underlying the ultrasonographic appearance and blood flow dynamics in the human corpus luteum (CL) of the menstrual cycle.

DESIGN

Cross-sectional study.

SETTING

Umeå University Hospital, Umeå, Sweden.

PATIENT(S)

Twenty-six otherwise healthy women with proven fertility and a history of regular menstrual cycles, scheduled for elective hysterectomy or tubal sterilization.

INTERVENTION(S)

An ovulatory LH rise in urine was established and the CL age was determined according to the day after the LH rise. Before surgery, a standardized ultrasonographic examination of the CL, including B-mode and color Doppler ultrasonography measurements, was performed. Upon commencing the minilaparotomy, the CL was excised and measured using a digital slide-caliper. The volume density (percentage of CL volume occupied by blood vessels) of factor VIII-related antigen immunostained endothelial cells was determined.

MAIN OUTCOME MEASURE(S)

Pulsatility index obtained from intraovarian blood vessels supplying the CL and volume density of blood vessels in CL tissue. The CL maximal and minimal outer and inner dimensions were measured in vivo by ultrasonography and ex vivo by a digital slide caliper.

RESULT(S)

A statistically significant decrease of blood vessel density and an increased resistance to blood flow, as indicated by pulsatility index, was established during the course of corpus luteum development. An inverse correlation between pulsatility index and volume density of blood vessels was found. A high degree of agreement between ultrasonographic and anatomic measurements of surgically removed CL was found.

CONCLUSION(S)

Transvaginal ultrasonography in combination with intraovarian color Doppler flow measurements is a simple and reliable method to evaluate the size and vascularization of the human CL.

Luteal blood flow during the estrous cycle in mares

Transrectal color Doppler ultrasound was used for the noninvasive investigation of luteal blood flow during the estrous cycle in six mares. Color was displayed in Power-Mode, in which the number of color pixels on the ultrasound image is related to the number of moving blood cells. Three pictures with a maximum number of color pixels of the corpus luteum (CL) during an examination period of about 20 min were selected and digitized on a laptop equipped with an external frame grabber card. The intra-class correlation coefficient for the number of color pixels was 0.90. In all estrous cycles similar patterns of changes in (C), in the cross-sectional area of sectional planes of the CL (A), and in plasma progesterone levels (P) occurred. Variance component estimates for the effect of the mare on (C), (A) and (P) were 14, 23 and 4%, for the influence of day of estrous cycle they were 41, 5 and 58% and for the effect of estrous cycle they were 7, 5 and 5%, respectively. There were high positive correlations between cyclic changes in (C) and (P) (r = 0.58; P < 0.0001). The increase in (C) between Days 0 and 5 (Day 0: ovulation) remained at high levels until Day 7 and then decreased until Day 15. There were relationships between (C) and (A) (r = 0.37; P < 0.0001) and between (A) and (P) (r = 0.24; P < 0.05), but correlation coefficients were not as high as between (C) and (P). Differences in (C), (A) and (P) between estrous cycles within mares and between mares were not related to each other (P > 0.05). The results show that transrectal color Doppler sonography is a useful, noninvasive method for examining luteal blood flow in mares, and that there are cyclic changes and individual differences in the vascularization of the CL. The possible influence of luteal perfusion on fertility in mares needs to be investigated in further studies.

Doppler study of arterial and venous intraovarian blood flow in stimulated cycles

OBJECTIVE

To evaluate arterial and venous intraovarian blood flow in follicle stimulating hormone-stimulated cycles.

SUBJECTS AND METHODS

This was a prospective study of 76 follicle stimulating hormone-stimulated cycles carried out in 39 infertile patients who were included in a timed intercourse or intrauterine insemination program in a referral center for assisted reproduction. Transvaginal color and pulsed Doppler measurements of the follicular and luteal phase resistance index, pulsatility index, peak systolic velocity and maximum venous velocity were made and serum progesterone levels during the mid-luteal phase were recorded. Velocimetric parameters were established and then used to classify ovarian function as having a normal ovulatory cycle, or a cycle in which there was either luteal phase deficiency or a luteinized unruptured follicle.

RESULTS

In 52 normal ovulatory cycles, the luteal phase peak systolic and maximum venous velocities were significantly higher and resistance and pulsatility indices were significantly lower than those found in the follicular phase. In 15 women with luteal phase deficiency we did not find any differences in arterial velocimetric parameters when compared with normal ovulatory cycles. However, luteal phase maximum venous velocities were lower in the luteal phase deficiency cycles and there was a significant correlation between luteal phase maximum venous velocity and serum progesterone levels (r = 0.36). Luteinized unruptured follicle cycles (n = 9) did not show significant changes during the ovarian cycle and no 'luteal conversion' of the Doppler signal was identified.

CONCLUSIONS

Follicle stimulating hormone-stimulated cycles in infertile patients can have a high percentage of abnormal functional responses that can be diagnosed only by sonographic assessment, Doppler and the appropriate hormonal follow-up. Arterial and venous intraovarian blood flow remain unaltered during luteinized unruptured follicle cycles and serum progesterone levels correlated with luteal phase maximum venous velocity, which makes Doppler a potentially useful non-invasive test to assess ovulation and luteal function.

Trial protocol and sample result of a study comparing the Clearplan Easy Fertility Monitor with serum hormone and vaginal ultrasound measurements in the determination of ovulation

This paper presents a preliminary result from a study designed to evaluate the ability of the ClearPlan Easy Fertility Monitor to predict ovulation, compared with conventional methods of ovulation determination, i.e. serum hormone measurements (estradiol and luteinizing hormone) and vaginal ultrasound scans (follicle size and endometrium thickness). Fifty-five female volunteers will be monitored over 3 consecutive monthly cycles. Preliminary data gathered from one volunteer are included in this presentation. These data indicate that the ClearPlan Easy Fertility Monitor predicted ovulation as accurately as serum hormone measurements and vaginal ultrasound scans. The results show that this monitor has potential as a home-based ovulation predictor for couples attempting to conceive.

Potential fertility--defining the window of opportunity

The ClearPlan Easy Fertility Monitor predicts the times of high potential fertility, i.e. the times when sexual intercourse is most likely to result in conception. The test procedure identifies the times of specified changes in the concentration of urinary hormone metabolites during each ovarian cycle. The results are displayed in terms of prior knowledge about the time-specific probabilities of conception. This paper contains a summary of the scientific background that led to the development of the ClearPlan Easy Fertility Monitor.

Phase-dependent influence of nonsteroidogenic cells on steroidogenesis and prostaglandin production by the human corpus luteum

OBJECTIVE

To test the hypothesis that paraluteal cells in the human corpus luteum (CL) modulate steroidogenesis and prostaglandin production by the CL.

DESIGN

In vitro cell culture study using human luteal cells.

SETTING AND PATIENT(S)

Women (n = 7) with normal menstrual cycles who were undergoing operations for benign, nonovarian conditions during the midluteal phase (5-9 days after ovulation) or the late luteal phase (10-14 days after ovulation) at a university hospital.

INTERVENTION(S)

Steroidogenic and nonsteroidogenic human CL cells were isolated by mechanical and enzymatic digestion and density sedimentation. The cells were cultured (75,000 cells per well) for 24 hours either as a crude sample of all CL cells or as an enriched fraction of steroidogenic CL cells.

MAIN OUTCOME MEASURE(S)

Levels of progesterone, E2, prostaglandins F2alpha, E2, and I2 in conditioned medium.

RESULT(S)

Higher concentrations of progesterone, E2, and prostaglandins F2alpha, E2, and I2 were released into the media of the crude sample of all CL cells than into the enriched fraction of steroidogenic CL cells from the midluteal phase. No such difference was noted in CL cells from the late luteal phase.

CONCLUSION(S)

The paraluteal cells in the human CL stimulated progesterone and E2 synthesis. This may be mediated by an increase in prostaglandin production in the midluteal phase.

Association of thymidine phosphorylase concentration with ultrasound-derived indices of blood flow in ovarian masses

BACKGROUND

The aim of this study was to determine the relationship between the concentration of thymidine phosphorylase (a known angiogenic factor) and indices of blood flow in physiologic ovarian tissues and overt (benign and malignant) tumors.

METHODS

The ovaries of all patients were examined by transvaginal ultrasonography, with color Doppler imaging and pulsed Doppler spectral analysis, within the 24 hours preceding laparotomy. Ovaries removed at surgery were dissected into their main components (follicles, corpus luteum, and tumor) and, where possible, into areas of high blood velocity according to the results of color Doppler imaging. The concentration of thymidine phosphorylase was measured by an enzyme-linked immunosorbent assay.

RESULTS

Thirty-eight tissue aliquots (16 from normal ovaries and 22 from ovarian tumors) were obtained from 33 patients. Twenty-nine tissue samples (76%) came from areas of measurable (high) blood velocity. The concentration of thymidine phosphorylase was significantly higher in tissue associated with high blood velocity (median 17.9, range 1.8-78.3 units per mg of protein vs. median 6.8, range 1.3-24.7 units per mg of protein, respectively; P < 0.05, Mann-Whitney U test). All of 8 corpora lutea, 12 of 14 benign tumors, and 7 of 7 malignant tumors had measurable blood velocity. There was a significant correlation between the concentration of thymidine phosphorylase and the peak systolic velocity in benign tumors (correlation coefficient [r] = 0.79, P < 0.01) and malignant tumors (r = 0.87, P < 0.05).

CONCLUSIONS

High intratumoral peak systolic velocity as determined by transvaginal color Doppler imaging and spectral analysis reflects high production of thymidine phosphorylase. This finding may aid the development of antivascular therapy for patients with ovarian carcinoma.

Female Reproductive Arterial Blood Flow and Its Relation to Infertility

Transvaginal color Doppler offers a closer look at blood flow within the reproductive organs. Recent literature using this technique demonstrates that 1) blood flow in the uterine and ovarian arteries is related inversely to estrogen levels, 2) no significant difference is seen between right and left uterine arteries among fertile and infertile patients, and 3) high resistance in uterine and ovarian arteries is correlated directly with poor pregnancy outcome. The question remains: Is there an resistive index or pulsatility index value, representing a cut-off point, for predicting successful outcome in the patient undergoing in vitro fertilization?

A comparison of intratumoural indices of blood flow velocity and impedance for the diagnosis of ovarian cancer

The aim was to assess the value of blood flow velocity indices in an ultrasound-based test to discriminate between malignant and benign adnexal tumours. Fifty-one women (35 premenopausal and 16 postmenopausal) with persistent adnexal masses were scanned prior to surgery using transvaginal sonography with colour Doppler imaging. Intratumoural flow velocity waveforms obtained by pulsed Doppler sonography were used to determine the time averaged maximum velocity (TAMXV), peak systolic velocity (PSV), pulsatility index (PI) and resistance index (RI). The tumours were classified by histologic criteria (42 benign, 1 borderline and 8 malignant tumours). Two of the malignant and the single borderline tumour were stage I, five were stage III and one was stage IV. Detectable blood flow signals were found in all malignant and borderline tumours and in 33 of 42 (78.6%) of the benign tumours. TAMXV was the best parameter for discrimination of benign and malignant adnexal pathology and at a cut-off value of TAMXV > or = 12 cm/s to indicate malignancy, the sensitivity and specificity were 88.9% and 81.0%, respectively. At the same sensitivity level, this gave a better specificity than the PI < or = 0.90 (specificity 61.9%, P = 0.036), RI < or = 0.60 (specificity 54.8%, P = 0.010) and PSV > or = 16 cm/s (specificity 71.4%, P = 0.121). Discrimination between benign and malignant tumours was improved further by using two criteria rather than one. When the two criteria of a TAMXV of > or = 12 cm/s and a PI < or = 1.0 were applied simultaneously, the tumours could be characterised with a sensitivity of 88.9% and a specificity of 88.1%. Therefore, intratumoural PSV and TAMXV could be used to discriminate between benign and malignant adnexal tumours better than values for PI and RI. The best discrimination was achieved by using a combination of cut-off values for velocity and impedance parameters as two criteria to define malignancy.