C. Battaglia

Doppler, ultrasonographic and endocrinological environment with regard to the number of small subcapsular follicles in polycystic ovary syndrome

The aim of this study was to evaluate how, in patients with polycystic ovary syndrome, the number of small subcapsular follicles correlates with uterine and ovarian blood flow and with specific hormonal parameters. At an ultrasonographic evaluation, 30 patients with polycystic ovary syndrome showed 5-10 (group I; n = 14) or > 10 (group II; n = 16) small follicles. These patients underwent ultrasonographic (ovarian volume and stroma echodensity; number, diameter and distribution of follicles) and color Doppler (uterine and intraovarian vessels) analyses, and hormonal assay. In group II, significantly lower pulsatility index values than in group I were observed in the ovarian stromal arteries. The Ferriman-Gallwey score, plasma androstenedione level and luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio results were significantly higher in group II than in group I. Androstenedione plasma levels correlated with the number of small follicles. Furthermore, the LH/FSH ratio correlated with both the number of small follicles and the stromal artery pulsatility index. The combined assessment of ovarian morphology by transvaginal ultrasound and color Doppler may provide insight into the pathological state of polycystic ovary syndrome.

A long-term treatment with gonadotropin-releasing hormone agonist plus a low-dose oral contraceptive improves the recovery of the ovulatory function in patients with polycystic ovary syndrome*

OBJECTIVE To evaluate the hormonal and clinical follow-up after the suspension of a longterm therapy with GnRH-agonist (GnRH-a) plus oral contraceptive (OC) in comparison to OC alone in patients with polycystic ovary syndrome (PCOS). DESIGN Hormonal (plasma LH, FSH, sex steroid levels) and clinical (Ferriman-Gallwey score and ultrasound) parameters were monitored at various moments during the 6 months of treatment and during the 6 months after treatment suspension. SETTING Physiopathology of Human Reproduction, University of Modena, Italy. PATIENT(S) Thirty patients with PCOS were enrolled and randomly subdivided in two groups of 15 each. INTERVENTION(S) Group A was treated with 3.75 mg IM GnRH-a plus OC. Group B was treated only with OC. RESULT(S) Both therapeutical regimens were effective in reducing androgenic milieu, Ferriman-Gallwey score, and ovarian volume within the 6th month of treatment. However, only patients treated with GnRH-a + OC showed a normal LH:FSH ratio, adequate plasma E2 and P levels, and ovulatory cycles during the 6 months of the after treatment follow-up. Patients treated with OC alone showed no beneficial effect after the 3rd month of the follow-up. CONCLUSION(S) These data support the evidence of a higher efficacy of the combined regimen (GnRH-a + OC) than OC alone in the treatment of patients with PCOS. In addition, the former regimen is associated with recovery of normal ovulatory cycles.

Prenatal ultrasonographic evidence of transient dacryocystoceles.

Although several textbooks document the large number of malformations and syndromes involving the face, the prevalence of many specific anomalies either is unknown or extremely low.1 The official guidelines of the AlUM do not specifi~ cally recommend an evaluation of the fetal face.2.J However, such an examination is not excessively time-consuming, does not require specialized technique, and may provide diagnostic information which significantly improves perinatal manage~ ment.4 Detailed visualization of facial anatomy easily identifies the less common and more benign anomalies, such as lacrimal duct cysts (dacryocystoceles).5 The present report describes the sonographic features and evolution of two transient dacryocystoceles.

Allergic reaction to a highly purified urinary follicle stimulating hormone preparation in controlled ovarian hyperstimulation for in vitro fertilization

We report a case of general hypersensitivity-like allergic reactions to intramuscular injections of highly purified urinary follicle stimulating hormone (uFSH-HP) successfully managed by using intramuscular recombinant FSH (rFSH). The patient underwent a first cycle of in vitro fertilization (IVF) and controlled ovarian hyperstimulation (COH) was achieved with a combination of gonadotropin releasing hormone against (GnRH-a) and uFSH-HP. Because, after oocyte recovery, no fertilization occurred, the couple subsequently entered an intracytoplasmic sperm injection (ICSI) program. During the COH, the woman developed general hypersensitivity-like allergic reactions with itching, redness and swelling. Although there was regular follicular growth, the allergic symptoms worsened and, on day 8 of COH, the stimulation cycle was suspended. A few months later, the patient entered a new ICSI cycle. COH was achieved by using a combination of GnRH-a and rFSH. The cycle was completed and the patient did not report any allergic reaction. To avoid allergic reaction to the protein components of the urine-derived FSH preparations, the use of rFSH is suggested in those patients who present local and/or general hypersensitivity-like allergic reactions.

Fetal abdominal cavernous hemangioma diagnosed by duplex Doppler velocimetry

A fetal abdominal wall mass was detected by ultrasound and analyzed by duplex Doppler showing a low resistence to blood flow through its vessels. The antenatal diagnosis of cavernous hemangioma was confirmed after birth.

WS03-10Vasoactive substances and infertility

The regulation and significance of ovarian and uterine haemodynamics in human reproductive pathophysiology has been largely studied. In women, ovarian vascularization seems to be responsible for the selection and maturation of follicles both in spontaneous and stimulated IVF cycles while endometrial receptivity is related to uterine blood flow and implicated in the achievement of pregnancy. In patients who underwent to IVF cycles, the PI of both uterine and spiral arteries is significantly lower in patients who became pregnant in comparison with nonpregnant and is associated with significantly lower endometrial cell thromboxane concentrations than non pregnant patients. In poor responders women it has been demonstrated the role of l‐arginine in improving uterine and follicular Doppler flow and in increasing ovarian response to gonadotrophin. Recently, in a total of 41 patients undergoing to assisted reproduction, an higher number of oocytes collected and embryos transferred was observed in normo‐responders than in poor‐responders patients. Furthermore follicular vascular endothelial growth factor (VEGF) resulted inversely correlated with retrieved oocytes (r = −0.942; p = 0.0017). In addition significant higher uterine and perifollicular Doppler flow resistances were observed in poor‐responders women. The pregnancy rate/cycle was significantly higher in normo‐responders (26%) than poor‐responders (6%; p = 0.037) patients.

WS04-03Doppler assessment of postmenopausal patient

Menopause is associated with an increase in the incidence of ischemic heart disease and stroke. Loss of ovarian function is characterized by significantly high values of blood and plasma viscosity. After the menopause, thromboxane production increases and correlates with duration of menopause. Large studies have shown that postmenopausal HRT is associated with reduction in the risk of cardiovascular disease. The aim of the study was to evaluate the plasma thromboxane and plasma viscosity in relation with Doppler flow parameters in postmenopausal patients treated with HRT. Thirty‐two postmenopausal (FSH > 40 UI/L and estradiol < 100 pmol/L) women (mean age ± SD, 54.7 ± 2.9 years) participated in the study and were submitted to continuous estradiol transdermal supplementation and 12‐day courses of medroxyprogesterone acetate every second month. Doppler resistances at the level of uterine and internal carotid arteries, thromboxane plasma levels and plasma viscosity were analyzed in basal condition and after 1, 3 and 6 months. During hormone supplementation, the pulsatility index significantly decreased at the level of analyzed arteries. Similarly, plasma thromboxane levels and plasma viscosity were significantly reduced. Significant correlations were found between thromboxane plasma concentrations, plasma viscosity and uterine artery resistances. Thus HRT seems to be responsible for both direct and indirect modifications at the level of the vessel wall physiology.