LUTEAL-PHASE DEFECT - COMPARISON BETWEEN DOPPLER VELOCIMETRY, HISTOLOGICAL AND HORMONAL MARKERS

The aim of this prospective study was to investigate the relationship between the ultrasonographic appearance of the endometrium, histologic al dating by biopsy, hormonal profile and impedance within the segment al uterine and ovarian circulation for assessment of luteal phase func tion. A total of 61 infertile patients undergoing endometrial biopsy w ere studied by transvaginal B-mode and color and pulsed Doppler ultras ound. Uterine, radial, spiral, ovarian and intraovarian artery impedan ce throughout the natural ovarian cycle were related to histological a nd hormonal markers of uterine receptivity. Plasma levels of follicle stimulating hormone, luteinizing hormone (LH) and estradiol were measu red on cycle days 5 and 10 and measurements were continued daily until the detection of the LH surge. Endometrial biopsy was performed 7 day s after ultrasonically and hormonally detected ovulation. Progesterone levels were evaluated on the day of endometrial biopsy and 3 days lat er. After all the data were collected, the patients were divided into two groups, according to the histopathology: 15 patients with normal e ndometrial dating and 43 patients with a delayed endometrial pattern ( i.e. luteal phase defect). One patient with an asynchronous endometriu m and two anovulatory subjects were excluded from further evaluation. A significant difference between patients with a luteal phase defect a nd the control group was obtained for impedance in the uterine (p < 0. 05), radial (p < 0.05), spiral (p < 0.001), ovarian (p < 0.05) and int raovarian arteries (p < 0.001) during the luteal phase. The endometriu m showed secretory transformation when serum levels of progesterone we re higher than 15 ng/ml. Segmental uterine and ovarian artery perfusio n demonstrates a significant correlation with histological and hormona l markers of uterine receptivity. Therefore, blood flow impedance in t he corpus luteum and spiral arteries may aid in assessing luteal phase adequacy.