HEALTHY AND ATRETIC FOLLICLES - VAGINOSONOGRAPHIC DETECTION AND FOLLICULAR-FLUID HORMONE PROFILES

The health status of human preovulatory follicles was prospectively st udied by non-invasive transvaginal ultrasound. Daily ultrasound scans were performed from the time when the follicle measured 15 mm in diame ter until formation of corpus luteum or oocyte retrieval, Based on the ultrasound scans two types of follicles were defined: type A follicle s showed a cloud visualized as a cone projecting into the follicular f luid with the base of the cone positioned on the follicle wall, A ligh t spot seen at the tip of the cloud in the majority of scans was presu med to be the oocyte-cumulus complex, Type B follicles showed an echo free space without a cloud, Two groups of infertility patients were st udied: Group I received intrauterine insemination; 106 patients underg oing a total of 263 cycles (188 spontaneous cycles and 75 clomiphene c itrate cycles), Group II received in-vitro fertilization (IVF); 22 pat ients undergoing a total of 52 cycles (31 spontaneous cycles and 21 cl omiphene cycles), In the first group, the ovulatory potential of the f ollicle is associated with the ultrasound characteristics. From the IV F patients the follicular fluid was harvested and assessed for the fre e concentration of the following steroids: oestradiol, progesterone, t estosterone and androstendione, The endocrine health status of the fol licle was associated with the ultrasound characteristics of the follic le, In patients of group I, 288 type A follicles ovulated out of a tot al of 298 follicles (97%), None of the type B follicles ovulated (0/14 ), In patients of group II, oocytes were obtained in 79% of the type A follicles (50/63), whereas 7% of the type B follicles yielded an oocy te (1/14). The follicular fluid hormone profile showed significantly l ower free oestradiol, free oestradiol/testosterone ratio and oestradio l/androstenedione ratio and higher free testosterone and free androste nedione in type B follicles compared to type A follicles, The hormone status and the high oocyte recovery rate suggest that type A follicles are healthier than type B follicles, which seem to have undergone atr etic changes, It is concluded that non-invasive transvaginal ultrasoun d with a good degree of accuracy predicts the health status of preovul atory follicles. Healthy follicles have a cloud with a light spot at t he tip, whereas almost all atretic follicles lack this characteristic.