The 3D vascular status of the follicle after HCG administration is qualitatively rather than quantitatively associated with its reproductive competence

Does Perifollicular Vascularity on the Day of Oocyte Retrieval Affect Pregnancy Outcome in an In Vitro Fertilization Cycle?

Background

The vascularization status of ovarian follicles affects reproductive competence of oocytes and in turn embryo quality by regulating its oxygen supply. Transvaginal power Doppler ultrasound can noninvasively map this vascularity of the ovarian follicles. Thus, we aimed to study the association of perifollicular vascularity and pregnancy outcome in women while on treatment for an in vitro fertilization cycle.

Material and Methods

A prospective study on 200 participants evaluated the vascularity of 1008 follicles on the day of oocyte retrieval to outline a map depicting perfusion of each follicle. The vascularity was graded based on percentage of the perifollicular outline in the map depicting vascularity which was Grade 1 ≤25%, Grade 2 26-50%, Grade 3 51-75%, Grade 4 76-100%.

Results

Of 1008 follicles aspirated, only 733 follicles were analyzed as per the exclusion criteria. Grades III and IV follicles were high vascular grade follicle whereas Grades I and II were low perfused follicles. Six hundred and twenty-seven oocytes were retrieved from 733 follicles with majority from Grade III and IV vascularity (75.8%: Grade III and IV vs. 24.2%: Grade I and II). The number of oocytes exhibiting maturity and their fertilization rates were significantly higher in high vascularity follicles. Three hundred and forty-one Grade I embryos formed and 89.1% were from better-perfused follicles versus 10.9% from lower ones.

Conclusions

The association between perifollicular perfusion and follicular oxygenation and oocyte maturation does exist which ultimately gets translated to quality of embryos. If other confounding factors such as endometrial receptivity and transfer technique are controlled, it influences the implantation potential too.

Tadalafil for Endometrial Growth in Clomiphene Citrate stimulated cycles in an IUI programma: A pilot study

AIM OF THE STUDY

The objective of this study was to assess the impact of tadalafil on endometrial growth, the uterine artery pulsatility index (PI) and the uterine artery resistance index (RI) in patients under clomiphene ovarian stimulation for intrauterine insemination (IUI).

METHODS

This randomized crossover study included 30 patients with a normal endometrium over 53 cycles, and 46 of those cycles in 23 patients were included in the analysis. In group A the patients were under 100 mg clomiphene daily for five days (2-6) and 5 mg tadalafil daily for 7 days (4-10). For Group B (control) the patients only received clomiphene. Measurements of the endometrium, PI, RI and estradiol determinations were taken on cycle days 4, 8 and 10.

RESULTS

We observed a better endometrial growth in Group A compared to Group B: 7.5 ± 2.1 mm vs 5.5 ± 1.2 mm, P < 0.0002 and 8.9 ± 1.8 mm vs 6.3 ± 1.8 mm, P < 0.0002 on days 8 and 10, respectively. Additionally, a progressive decrease in the RI was observed in Group A but not in Group B from day 8 (0.77 ± 0.15 vs 0.85 ± 0.18, P = 0.059) to day 10 (0.74 ± 0.20 vs 0.87 ± 0.14, P < 0.017). However, no differences were observed in PI or serum estradiol between Group A and Group B.

CONCLUSION

The use of tadalafil improved endometrial growth in patients under clomiphene ovarian stimulation with no significant effect on the uterine artery Pulsatility Index and serum estradiol.

Blood and lymphatic vasculature in the ovary: development, function and disease

BACKGROUND

The remodelling of the blood vasculature has been the subject of much research while rapid progress in the understanding of the factors controlling lymphangiogenesis in the ovary has only been reported more recently. The ovary undergoes cyclic remodelling throughout each menstrual/estrous cycle. This process requires significant vascular remodelling to supply each new cohort of growing follicles.

METHODS

Literature searches were performed to review studies on the ovarian lymphatic vasculature that described spatial, temporal and functional data in human or animal species. The role of ovarian blood and lymphatic vasculature in the pathogenesis of ovarian disease and dysfunction was also explored.

RESULTS

Research in a number of species including zebrafish, rodents and primates has described the lymphatic vasculature within the remodelling ovary, while recent research in mouse has confirmed hormonal regulation of lymphangiogenic growth factors, their receptors and also a role for the protease, ADAMTS1 in the development of the lymphatic vasculature. With a critical role in the maintenence of fluid homeostasis, the ovarian lymphatic vasculature is important for normal ovarian function and has been linked to syndromes involving ovarian fluid imbalance, including ovarian hyperstimulation syndrome and massive ovarian edema. The lymphatic vasculature has also been heavily implicated in the metastatic cancer process.

CONCLUSION

The spatial and temporal regulation of the ovarian lymphatic vasculature has now been reported in a number of species and the data also implicate the ovarian lymphatic vasculature in ovarian pathologies, including cancer and those linked with use of artificial reproduction technologies.

Aging gonads, glands, and gametes: immutable or partially reversible changes?

Decreased ovarian testosterone production, granulosa cell dysfunction, oocyte telomere shortening and mitochondrial defects, and sperm DNA fragmentation all contribute to reproductive aging. Maneuvers aimed at correcting these abnormalities, including reduction of oxidative stress, improved lifestyle and nutrition, and the role of supplements, are reviewed.