F. Raga

Use of three-dimensional ultrasonography for the study of normal and pathologic morphology of the human embryo and fetus: preliminary report.

Our objective was to determine whether three‐dimensional ultrasonography offers advantages over two‐dimensional sonography for the evaluation of normal and pathologic morphology of human embryos and fetuses at various stages of pregnancy. Our studies suggest that small fetal and embryonic malformations are better defined with 3D sonography. Our experience indicates that 3D sonography allows more detailed visualization of fetal internal structures. We believe that with technical improvements 3D sonography will permit a more complete evaluation of fetuses earlier in gestation than is possible with current 2D sonographic instruments.

Polycystic ovarian syndrome: assessment with color Doppler angiography and three-dimensional ultrasonography.

We conducted a three‐dimensional ultrasonographic evaluation of the size and structure of the ovaries of women who had clinical and biochemical findings suggestive of polycystic ovary syndrome. We carried out a comparative color Doppler frequency and color Doppler amplitude study of the vascular patterns of these ovaries. This study involved 65 women of reproductive age with polycystic ovary syndrome and 25 eumenorrheic women who were not taking hormonal contraceptives and who had a body mass index below 25 kg/m2. Compared to controls, women with polycystic ovary syndrome had larger ovaries and thicker stroma, increased impedance in the uterine arteries, increased stromal vascularity with decreased impedance that persisted throughout the menstrual cycle, and a lack of luteal conversion.

Control of intrauterine device insertion with three-dimensional ultrasound: is it the future?

A comparative study was designed to determine whether three‐dimensional transvaginal sonography (3D‐TVS) offered advantages over two‐dimensional transvaginal sonography (2D‐TVS) for the identification and location of IUDs in 66 asymptomatic women. Hysteroscopy was performed in cases in which there was a discrepancy between the information obtained by both methods (n = 14). In eight cases (12.2%) the IUD was misidentified with 2D‐TVS. In six cases (9.1%) it was not possible to identify the device model with 2D‐TVS. In two cases (3.0%) 2D‐TVS failed to identify the position of the device. In contrast, all IUDs were identified and located accurately with 3D‐TVS.

Normal uterine arterial blood flow in postmenopausal women assessed by transvaginal color Doppler sonography: the effect of hormone replacement therapy.

We used transvaginal color Doppler sonography to study the effect of hormone replacement on the uterine arterial blood flow for 203 postmenopausal women. The regimens studied involved estrogen replacement alone, continuous combined estrogen and progestogen, and estrogen followed sequentially by combined estrogen‐progestogen. The mean pulsatility index fell to 65% +/‐ 9% and the mean resistive index fell to 87% +/‐ 4% of baseline during the first month of therapy (P < 0.0001). The addition of a progestogen did not alter the effect of estrogen alone (P > 0.5). Our findings suggest that the increase in vascular flow occurs even in women who begin therapy long after menopause.

Transvaginal color Doppler assessment of endometrial status in normal postmenopausal women: the effect of hormone replacement therapy.

We used transvaginal color Doppler sonography to study the effects of hormone replacement therapy on the endometrial structure and vascular flow of 345 normal postmenopausal women. We studied women taking estrogen replacement alone, continuous combined estrogen and progestogen, and estrogen followed sequentially by estrogen‐progestogen combination. Endometrial measurements prior to the initiation of hormone replacement therapy were used as baseline values. An increase in endometrial thickness was seen soon after initiation of hormone replacement therapy (P < 0.0001). Hyperplasia or adenocarcinoma was found only when endometrial thickness was greater then 9 mm. No correlation was found between hormone replacement therapy and the occurrence of endometrial hyperplasia or adenocarcinoma.

Normal uterine arterial blood flow in postmenopausal women assessed by transvaginal color Doppler ultrasonography.

We used transvaginal color Doppler sonography to study uterine artery blood flow velocity waveforms in 345 normal postmenopausal women who had never been on hormone replacement therapy. Our objective was to establish the standard baseline flow values for normal postmenopausal women. The mean pulsatility index was 3.38 +/‐ 1.04 and the mean resistive index was 0.93 +/‐ 0.09. There was a positive correlation between arterial blood flow impedance and number of years since menopause. We believe that these levels may become important screening parameters for the detection of endometrial carcinoma in postmenopausal women.

Expression of vascular endothelial growth factor receptors in the endometrium of septate uterus

OBJECTIVE To compare the messenger RNA (mRNA) expression of vascular endothelial growth factor (VEGF) receptors (KDR, Flt-1, and sflt) in the different endometrial locations of septate uterus and normal uterus. DESIGN Prospective, observational study. SETTING University teaching hospital. PATIENT(S) Twelve women with complete septate uterus undergoing hysteroscopic metroplasty and 12 women with normal uterus. INTERVENTION(S) Endometrial tissue samples were obtained from the endometrium covering the septum and the endometrium lining the lateral wall of the uterus. Moreover, endometrial samples were obtained from patients with normal uterus. MAIN OUTCOME MEASURE(S) Differences in the mRNA expression of VEGF receptors between the endometrial samples of septate and normal uterus. RESULT(S) The mRNA expression of VEGF receptors, both KDR and Flt-1, was significantly lower in the endometrium lining the septum as compared with the endometrium covering the lateral wall of septate and normal uterus. Conversely, no differences were observed in mRNA expression in the soluble receptor sflt between the different endometrial samples studied. CONCLUSION(S) The results suggest that a local defect of both VEGF transmembranous receptors (KDR and Flt-1) in the endometrium covering the septal area may be responsible for the clinical comportment of this müllerian anomaly.

Does transvaginal color Doppler sonography differentiate between developing and involuting ectopic pregnancies

The objective of this study was to assess the addition of transvaginal color Doppler imaging to transvaginal ultrasonography and beta-human chorionic gonadotropin values to differentiate between developin and involuting ectopic pregnancies. Forty surgically confirmed ectopic pregnancies were classified into developing or involuting according to histopathologic findings. Results were compared retrospectively with the plasma beta-human chorionic gonadotropin values as well as the resistive index and pulsatility index obtained in corpora lutea and peritrophoblastic flow in serial examinations. Students t-test was used for comparison of means. Logistic regression analysis was applied to predict the binary dependent variable in women with a developing or involuting ectopic pregnancy by analyzing a set of independent variables, serum betahuman chorionic gonadotropin levels, and resistive and pulsatility indices of corpora lutea and adnexal masses. Twenty-seven ectopic pregnancies were developing and 13 were involuting. The women with developing ectopic pregnancies had significantly higher serum levels of beta-human chorionic gonadotropin than those with involuting ectopic pregnancies (P<0.05). Furthermore, women with developing ectopic pregnancies showed a 15 to 20% decrease in the resistive index and pulsatility index baseline every four days. In contrast, we were unable to distinguish between developing and involuting ectopic pregnancies by analyzing beta-human chorionic gonadotropin values at this early stage of gestation. The logistic regression model showed that a corpus luteum resistive index increase was the only marker that predicted involution of an ectopic pregnancy before day 49. Similarly, after day 49 an increase in tubal mass resistive index was the only parameter that consistently identifies an involuting tubal ectopic pregnancy. Our observations demonstrate that adnexal flow mapping with transvaginal color Doppler sonography can detect developing and involuting tubal ectopic pregnancies. Until the 49th day, an increase in corpus luteum resistive and pulsatility indices identifies an involuting ectopic pregnancy. After the 49th day, an increase in tubal mass resistive and pulsatility indices identifies an involuting ectopic pregnancy rotropin

Gonadotropin‐releasing hormone (GnRH)‐I regulation of interleukin (IL)‐1b and IL‐1 receptor antagonist expression in cultured human endometrial stromal cells

Aim:  Human endometrium is an active site of cytokine production and action. Among these cytokines, the interleukin‐1 (IL‐1) system seems to be relevant to the embryonic implantation process. We have previously reported the production of GnRH‐I by human blastocyst, as well as the presence of GnRH‐I receptor in human endometrium. This suggests a close interaction between the immune and endocrine systems through these cytokine mediators in embryonic implantation.

HDlive ultrasound images in assisted reproduction treatment

The volume ultrasound technology software known as the HDlive technique represents an innovative tool, a step towards an even more realistic anatomical visualization of pelvic organ structures. HDlive can help improve physician-patient communication with the aid of life-like images and might prove useful in the field of assisted reproduction treatment. The clinical application of this novel ultrasound technology in assisted reproduction treatment deserves scientific evaluation.