Uterine perfusion and hormonal pattern in patients with polycystic ovary syndrome

Pulsatility and Resistance Indices of Uterine and Ovarian Arteries in Anovulatory Women With Polycystic Ovary Syndrome

ABSTRACT

We aimed to compare the ovarian and uterine artery blood flow of anovulatory patients with polycystic ovary syndrome (PCOS) with those of ovulatory women throughout the menstrual cycle using color Doppler ultrasound. Seventy-one women with PCOS, who were admitted to the infertility outpatient clinic of a training and research hospital, were included in the study. The patients were divided into 2 groups as anovulatory (group 1, n = 23) and ovulatory (group 2, n = 37). Each patient was followed up throughout her menstrual cycle and included in either group 1 or group 2. Anovulatory cycles were determined by consecutive ultrasound examinations, and the progesterone value was measured in the luteal period. Eleven patients were excluded from the study because they did not continue their follow-up. The uterine and ovarian artery pulsatility and resistance indices of all patients in both groups were evaluated 3 times throughout a menstrual cycle: 7th to 10th day, 13th to 17th day, and 21st to 25th day. It was observed that the uterine artery resistances of the patients with anovulatory cycles remained relatively high throughout the menstrual cycle compared with ovulatory cycles. Both pulsatility and resistance indices of uterine and ovarian arteries were significantly higher in anovulatory cycles compared with ovulatory cycles at all evaluation times throughout the menstrual cycle (P < 0.05). Ovarian artery resistance in anovulatory patients did not significantly change during the menstrual cycle. Anovulatory patients with PCOS have higher uterine and ovarian artery resistance than ovulatory artery resistance, and the former shows a significant decrease throughout the cycle.

Uterine Artery Doppler in Pregnancy: Women with PCOS Compared to Healthy Controls

The objective of this study was to investigate possible differences in uterine artery pulsatility index (UtAPI) between pregnant women with PCOS and healthy controls and to explore possible effects of metformin on UtAPI. Material and Methods. The study was conducted in a tertiary center. Forty-eight pregnant women diagnosed with PCOS before pregnancy and 124 healthy pregnant women were included. Women with PCOS were randomly assigned to metformin 2000 mg daily or a placebo. UtAPI was measured five times during 1st and 2nd trimesters of pregnancy in women with PCOS and four times in healthy controls. Results. There was no difference in UtAPI between PCOS women and healthy controls at any point in time (p = 0.34-0.77). In women with PCOS, randomly assigned to metformin 2000 mg or placebo, UtAPI was unaffected by metformin two hours after intake of the first dose of study medication (p = 0.34). All PCOS women, regardless of randomization, had higher UtAPI two hours after intake of study medication and a meal compared to before a meal (p = 0.02). Conclusions. In the first and second trimesters of pregnancy, there was no difference in UtAPI between women with PCOS and healthy controls. Metformin had no immediate effect on the UtAPI. Interestingly, blood flow decreased after a meal, suggesting that time since last meal should be taken into consideration when interpreting the results of UtAPI measurements in pregnancy. This trial is registered with ClinicalTrials.gov (NCT00466622) Metformin in Pregnant PCOS women (PregMet) (NCT00159536).

Immunological modes of pregnancy loss: inflammation, immune effectors, and stress

Inflammatory immune response plays a key role in reproductive failures such as multiple implantation failures (MIF), early pregnancy loss, and recurrent pregnancy losses (RPL). Cellular immune responses particularly mediated by natural killer (NK), and T cells are often dysregulated in these conditions. Excessive or inappropriate recruitment of peripheral blood NK cells to the uterus may lead to cytotoxic environment in utero, in which proliferation and differentiation of trophoblast is hampered. In addition, inadequate angiogenesis by uterine NK cells often leads to abnormal vascular development and blood flow patterns, which, in turn, leads to increased oxidative stress or ischemic changes in the invading trophoblast. T-cell abnormalities with increased Th1 and Th17 immunity, and decreased Th2 and T regulatory immune responses may play important roles in RPL and MIF. A possible role of stress in inflammatory immune response is also reviewed.

Effects of Cabergoline administration on uterine perfusion in women with polycystic ovary syndrome

Objectives: The aim of this study was to determine the effects of Cabergoline administration on uterine blood flow in women suffering from polycystic ovary syndrome (PCOS).

Methods: This study is a randomized, controlled, triple-blind trial which is tested on 40 women who were randomly divided into two groups of 20 people and using a randomized block design during which the subjects were assessed and included. They were suffering from polycystic ovarian syndrome. Inclusion criteria were classically defined PCOS criteria including: oligomenorrhea or amenorrhea, clinical or Laboratory findings based on increase in blood level androgen (testosterone) and ultrasound confirmation of PCOS. Exclusion criteria were Pregnancy, lactation, Dopamine Agonist Therapy. After selection of intervention and placebo groups, primary control Doppler ultrasound was done for both groups. Then a weekly dose of Cabergoline 0.5 mg was administered to intervention group for duration of 12 weeks. Placebo group were administered placebo in the same fashion. At the end of 12 weeks, Doppler ultrasound was performed and the results were recorded in the check lists.

Results: No significant difference was noticed in both groups with respect to their age, employment, level of education, type of infertility, duration of marriage, and results of RI and PI before intervention. Later PCOS patients under the treatment of Cabergoline showed a significant increase in uterine blood flow Pulsatility Index (PI) before 2.65±0.52 and after 1.98±0.52 and RI before 0.85 and after intervention 0.77), yet no significant difference were found in PCOS patient under the treatment of placebo.

Conclusion: PCOS patients were shown to have more resistance in uterine blood flow than healthy people; however, Cabergoline administration proved to increase uterine blood perfusion and regulate menstruation cycle.

Endometrial blood flow is impaired in women with polycystic ovarian syndrome who are clinically hyperandrogenic

OBJECTIVES

To quantify endometrial and subendometrial blood flow in Caucasian women with polycystic ovarian syndrome (PCOS) and to determine whether these values differ according to the phenotypic expression of PCOS.

METHODS

Transvaginal pelvic ultrasound was performed on the 3(rd)-5(th) day of the menstrual cycle in 36 women with PCOS and 36 controls to examine the endometrial and subendometrial vascularity. The subendometrial and endometrial blood flow indices (vascularizaton index (VI), flow index (FI) and vascularization flow index (VFI)) were measured using three-dimensional power Doppler angiography. Uterine artery blood flow was assessed through analysis of two-dimensional (2D) pulsed-wave Doppler waveforms. Analysis was performed to compare PCOS with non-PCOS women, and subgroup analysis was performed of the PCOS women categorized according to their phenotypic manifestation.

RESULTS

There were no significant differences in endometrial volume, subendometrial vascularity and uterine artery blood flow between women with PCOS and controls after controlling for body mass index (BMI). On subgroup analysis, compared with anovulatory but clinically normoandrogenic women with polycystic ovaries (PCO) and with controls, women with PCO who were both clinically hyperandrogenic and anovulatory had significantly lower endometrial (VI: 0.57% vs. 1.11% and 0.86%, respectively, both P = 0.01; VFI: 0.14 vs. 0.42 and 0.28, respectively, both P = 0.02) and subendometrial (VI: 1.59% vs. 3.17% and 2.47%, P = 0.01 and 0.02, respectively; VFI: 0.50 vs. 1.67 and 0.96, P = 0.01 and 0.02, respectively) blood flow. Moreover, clinically hyperandrogenic but ovulatory women with PCO also had significantly lower endometrial blood flow (VI: 0.52% vs. 1.11%, P = 0.04) than did anovulatory but clinically normoandrogenic women with PCO. There were no differences in any of the 2D pulsed-wave Doppler measures of blood flow between the subgroups.

CONCLUSIONS

Subendometrial and endometrial blood flow is significantly impaired in women with PCOS who have clinical signs of hyperandrogenism.

Color Doppler sonographic analysis of uterine and ovarian artery blood flow in women with polycystic ovary syndrome

PURPOSE

To study the blood flow patterns of utero-ovarian circulation in polycystic ovary syndrome (PCOS) and to assess their relationship with clinical, metabolic, and hormonal data.

METHODS

Forty-three women with PCOS and 43 age-matched healthy controls underwent Doppler examination of the utero-ovarian circulation in the follicular phase. Demographic, hormonal, and metabolic parameters were determined. Student's t-test, chi(2)-test, and Spearman correlation test were used for statistical analysis.

RESULTS

The ovarian artery pulsatility index (PI), resistance index (RI), and SD ratios were significantly lower in PCOS than in controls on the right side (p < 0.001, p = 0.02, p = 0.001, respectively) as well as on the left side (p < 0.001, p < 0.001, p < 0.001, respectively). The uterine artery systolic/diastolic (S/D) ratio was higher on both sides (p = 0.01) and the PI was higher on the left side (p = 0.02) in PCOS than in controls. The right uterine artery PI was positively correlated with luteinizing hormone and hemoglobin (r = 0.417, p = 0.043; r = 0.427, p = 0.033, respectively), the right uterine artery S/D was positively correlated with body mass index (r = 0.479, p = 0.015), and the left uterine artery PI was positively correlated with insulin (r = 0.458, p = 0.021).

CONCLUSION

Doppler sonography of the utero-ovarian circulation may contribute to the evaluation of PCOS patients and a better understanding of the pathophysiology of this syndrome.

Pituitary-ovarian response to the gonadotrophin-releasing hormone-agonist test in anovulatory patients with polycystic ovary syndrome: predictive role of ovarian stroma

OBJECTIVE

To evaluate the influence of ovarian stroma on basal and poststimulus androgen secretion in patients affected by secondary amenorrhoea and polycystic ovaries (PCO) at ultrasound (US).

DESIGN

Prospective study.

PATIENTS

Fifty-one patients with PCO selected from a group of 72 normal weight women aged 20-25 years affected by secondary amenorrhoea and 10 normal ovulatory controls.

METHODS

All subjects underwent US to evaluate volume, area, stromal area and stromal/total area ratio of both ovaries. Plasma levels of gonadotrophins, oestradiol (E2) and androgens were measured before and 24 h after GnRH-a injection. 60 min after stimulus LH and FSH were also assayed.

RESULTS

Thirty patients had increased ovarian stroma (IS) and 21 patients normal ovarian stroma (NS). Significantly higher LH levels characterized the IS group, both basally and after GnRH-a stimulation compared with NS and controls (P < 0.01). Baseline levels of androstenedione, testosterone and 17-OHprogesterone (17-OHP) were significantly higher in IS group. Moreover, 17-OHP hyper-response to GnRH-a was demonstrated in IS group in comparison to NS and control groups (P < 0.005).

CONCLUSIONS

Stroma evaluation may be of use in discriminating between different pathogenic factors in secondary amenorrhoea. This criterion may be applied to support the correct diagnosis of polycystic ovary syndrome (PCOS). Indeed, in line with the most recently proposed guidelines, patients affected by multifollicular ovaries could be classified as PCOS. The possibility of taking into account more than one US criterion or of carefully reanalysing the significance of increased stroma volume should be considered.

Impaired uterine perfusion associated with metabolic disorders in women with polycystic ovary syndrome

BACKGROUND

Risk factors for cardiovascular disease, including chronic anovulation, obesity, hyperandrogenism, hyperinsulinemia, and dyslipidemia, are commonly observed in women with polycystic ovary syndrome (PCOS). We evaluated uterine perfusion and its correlation with clinical and biochemical parameters in women with PCOS.

METHODS

We performed a pulsed Doppler study on uterine arterial blood flow in 25 women with PCOS and 45 control women with regular menstrual cycles. PCOS was diagnosed based on oligomenorrhea, polycystic ovaries determined by means of ultrasonography, and elevated luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio.

RESULTS

Women with PCOS had a significantly higher body mass index (BMI) and serum testosterone, and showed insulin resistance and dyslipidemia, including increased total cholesterol, triglyceride, low-density lipoprotein-cholesterol (LDL-C), and decreased high-density lipoprotein-cholesterol (HDL-C). The uterine arterial pulsatility index (PI) in women with PCOS was significantly higher than that in the control women during the follicular phase. The PI was correlated with BMI, LH/FSH ratio, or LDL-C/HDL-C ratio, whereas it was inversely correlated with the HDL-C level. Women with PCOS had reduced endometrial thickness and elevated uterine arterial PI in the luteal phase, in which implantation occurs.

CONCLUSIONS

Elevation of uterine arterial blood flow resistance is associated with risk factors for cardiovascular events. Furthermore, the impaired uterine perfusion in the luteal phase may cause endometrial dysfunction in women with PCOS.

Ultrasound evaluation of PCO, PCOS and OHSS

Polycystic ovary syndrome (PCOS) and the concomitant androgen excess may be particularly distressing and disruptive for women. Thus, PCOS requires a prompt diagnosis and adequate treatment. However, the criteria used for diagnosis and definition of PCOS are as heterogeneous as the pathology itself. The advent of ultrasonographic examination of the ovaries has provided the biggest single contribution to the diagnosis of PCOS, having a high concordance rate with laparoscopy and histological examination. In fact, the assessment of ovarian morphology by transvaginal ultrasound and Doppler flow analysis of both intra-ovarian and uterine arteries seems to provide an insight into the pathological state and the degree of progression of the disease, and may be useful in the prevention and management of ovarian hyperstimulation syndrome during ovarian stimulation.

Hyperinsulinemia and uterine perfusion in patients with polycystic ovary syndrome

OBJECTIVE

To determine whether hyperinsulinemia has a negative effect on uterine blood supply in patients with polycystic ovary syndrome (PCOS).

METHODS

Sixty-three patients with normal body mass index were included prospectively in the study: 48 had clinical and hormonal features of PCOS and 15 were normo-ovulatory. All patients underwent Doppler flow measurement of the uterine artery, and determination of serum concentrations of luteinizing hormone, follicle stimulating hormone, prolactin, estradiol, androgens, insulin and C-peptide during the early follicular phase of the menstrual cycle. The 48 PCOS-patients were divided into two groups according to the pulsatility index (PI) value of the uterine artery: Group 1, PI < 3; Group 2, PI >or= 3 and the groups were compared.

RESULTS

The mean PI of the uterine artery (3.01 +/- 1.0 vs. 1.93 +/- 0.3, respectively) and fasting levels of insulin (50.9 +/- 9.3 vs. 40.3 +/- 10.9) and C-peptide (366.9 +/- 118.4 vs. 243.6 +/- 120.3) of PCOS-patients were significantly higher than those of the control group. No correlation was found between insulinemia and C-peptide and PI of the uterine artery and no significant difference was found in insulin and C-peptide levels among the two groups of PCOS-affected patients. Only the serum level of dehydroepiandrosterone sulfate was significantly higher in Group 2, and a direct correlation was found between PI values of the uterine artery and DHEAS plasma levels.

CONCLUSION

Insulin and C-peptide do not seem to interfere with uterine perfusion in PCOS-affected patients.