ULTRASOUND DERIVED INDEXES OF FOLLICULAR BLOOD-FLOW BEFORE HCG ADMINISTRATION AND THE PREDICTION OF OOCYTE RECOVERY AND PREIMPLANTATION EMBRYO QUALITY

The principal aim of the study was to relate ultrasound-derived indice s of blood how in individual follicles on the day of, but before, the administration of human chorionic gonadotrophin (HCG) to the subsequen t recovery of oocytes and the production of preimplantation embryos. D ata mere obtained from 21 women (aged 29-43 years) with bilateral tuba l occlusion, who were undergoing treatment by in-vitro fertilization ( IVF) and embryo transfer. Transvaginal ultrasonography with colour Dop pler imaging and pulsed Doppler spectral analysis were used to measure follicular volume and derive indices of blood how. The end-points for each follicle were the volume, peak systolic velocity (PSV), pulsatil ity index (PI), and the recovery or non-recovery of an oocyte, the sub sequent production or non-production of a preimplantation embryo and t he morphological grade of each embryo. A total of 94 follicles were st udied; 74 oocytes were recovered (79%) and 40 embryos (33 grade I or I I) were produced. There were four clinical pregnancies (pregnancy rate 25.0% per transfer, 19.0% per patient). There was a significant corre lation between whether or not follicular blood flow was detected and w hether or not an oocyte was recovered (P <0.05, chi(2) test). The valu es for volume and PI were not clinically useful. The PSV (cm/s, mean /- SD) was higher in follicles that were associated with the productio n of an embryo (12.7 +/- 5.9) compared with those that were not (8.5 /- 5.0; P <0.05, Student's t-test). The probability of producing a gra de I or grade II embryo was 75% if the PSV was greater than or equal t o 10 cm/s. The corresponding value was 40% if the PSV was <10 cm/s and 24% if blood flow was not detected (i.e. PSV <3 cm/s). There was a si gnificant increase (P <0.05, Student's t-test) in the PSV before aspir ation in those follicles associated with the subsequent production of an embryo. We conclude that the value for PSV, before the administrati on of HCG, can be used to identify follicles with a high probability o f producing an oocyte and a high grade preimplantation embryo. The inf ormation may also be used to time the administration of HCG to achieve the optimum number and quality of embryos for patient management.