MIDLUTEAL-PHASE VAGINAL COLOR DOPPLER ASSESSMENT OF UTERINE ARTERY IMPEDANCE IN A SUB FERTILE POPULATION

Objective: To compare the midluteal uterine artery impedance to blood flow as measured by the pulsatility index in women with different caus es of infertility with that of women with normal fertility and to corr elate this with endometrial thickness. Design: A prospective study of normal women undergoing insemination with donor semen and subfertile w omen with tubal damage, endometriosis, premature ovarian failure, anov ulation, or unexplained infertility. Setting: A tertiary infertility c enter. Patients: One-hundred sixty-one women (25 to 40 years of age) w ho were attending the clinic for subfertility treatment and 23 normal women who were having artificial insemination with donor sperm because their partners were azoospermic. Interventions: All women were examin ed by transvaginal ultrasonography, with color flow imaging and blood flow analysis, on day 21 of an unstimulated ovarian cycle. Main Outcom e Measures: The mean pulsatility index of the left and right uterine a rteries and the endometrial thickness. Results: The patients were grou ped according to the causes of infertility and compared with normal wo men. There were 23 women in the normal group (median pulsatility index , 1.91; range, 0.84 to 2.95), 35 with unexplained infertility (median pulsatility index, 2.45; range, 1.0 to 7.0), 91 with tubal damage (med ian pulsatility index, 2.65; range, 1.25 to 8.0), 8 with endometriosis (median pulsatility index, 2.32; range, 2.05 to 5.7), and 22 with ano vulatory infertility (median pulsatility index, 3.03; range, 1.6 to 7. 0). All the infertile groups had significantly different median pulsat ility indexes when compared with the normal group, and the pulsatility indexes correlated with endometrial thickness. Conclusions: The imped ance to uterine artery blood flow is significantly different in women with different causes of infertility as compared with women of normal fertility. Increased resistance to uterine blood flow in the midluteal phase may be an important contributing factor to some causes of infer tility and the cause of some previously ''unexplained'' infertility.