BLOOD-FLOW CHANGES IN THE OVARIAN AND UTERINE ARTERIES DURING THE NORMAL MENSTRUAL-CYCLE

OBJECTIVE: Our purpose was to study the hemodynamic changes in the ute rine and intraovarian vessels during the normal menstrual cycle and to relate the vascular changes to hormonal index values. STUDY DESIGN: S even women who had bilateral tubal patency, a normal pelvis on laparos copy, and regular ovulatory cycles underwent serial transvaginal ultra sonography on menstrual cycle day 2, daily from estimated day of ovula tion - 6, hourly from estimated day of ovulation - 2, or when the mean follicular diameter was >16 mm (whichever was earlier) until 6 hours after follicular rupture and once 7 days after follicular rupture. At each scan uterine and intraovarian blood flow was assessed with transv aginal color Doppler ultrasonography and serum concentrations of folli cle-stimulating hormone, luteinizing hormone, estradiol, and progester one assessed by fluoroimmunoassay. RESULTS: In one case there was evid ence of a luteinized unruptured follicle and the patient was therefore excluded from analysis. In the other six women there was spontaneous ovulation at a mean of 39 hours after the onset of the luteinizing hor mone surge. On the side with the dominant follicle, follicular and ova rian stromal peak systolic bloodflow velocity rose significantly durin g the menstrual cycle with no significant change in pulsatility index. The changes in blood flow velocity correlated significantly with chan ges in serum follicle-stimulating hormone, luteinizing hormone and pro gesterone concentrations. There were no significant changes in either blood flow velocity or pulsatility index in the contralateral ovary. U terine artery time-averaged maximum velocity on the side of the develo ping ovarian follicle increased during the menstrual cycle with no sig nificant change in the contralateral vessel. Uterine artery pulsatilit y index on the side of the developing follicle declined during the mid luteal phase and was significantly lower than on the contralateral sid e. The changes in time-averaged maximum velocity correlated with the c hanges in serum estradiol and progesterone concentrations. CONCLUSION: The vascular changes in the wall of the dominant ovarian follicle and ovarian stroma during the menstrual cycle are consistent with activit y of angiogenic-like factors. The decline in uterine artery resistance during the midluteal phase may reflect optimal vascularity for implan tation of the blastocyst.