MODIFICATIONS IN UTERINE AND INTRAOVARIAN ARTERY IMPEDANCE IN CYCLES OF TREATMENT WITH EXOGENOUS GONADOTROPINS - EFFECTS OF LUTEAL-PHASE SUPPORT

Objective: To determine the effects of induction of multiple ovulation and of luteal P supplementation on the impedance to blood flow in the uterine and intraovarian arteries during the luteal phase. Design: A prospective study using transvaginal color flow Doppler imaging. Setti ng: A university-based infertility center. Patients: Fifty-six women w ith unexplained or male factor-related infertility undergoing IUI. Int erventions: The patients were studied either during spontaneous cycles (n = 16) or in cycles of induction of multiple follicular development with purified FSH (n = 40). In 18 treated cycles, the luteal phase wa s supplemented with natural P. Main Outcome Measures: The pulsatility index was recorded from uterine and intraovarian arteries on the day o f E(2) peak and 5 and 10 days thereafter. On the same days, E(2) and P plasma levels were measured by RIA. Results: The intraovarian pulsati lity index was significantly lower in FSH-treated than in spontaneous cycles on the day of E(2) peak. Also, the uterine pulsatility index wa s significantly lower in treated cycles than in spontaneous cycles on the day of E(2) peak and 5 days thereafter. In the late luteal phase, P supplementation was correlated with a significant decrease in uterin e pulsatility index as compared with both spontaneous cycles and FSH-t reated cycles without luteal support. Conclusions: Multiple follicular development is associated with a significant reduction in the impedan ce to perifollicular blood flow. Progesterone, as well as E(2), seems able to decrease the impedance to blood flow in uterine arteries in wo men.