BLOOD-FLOW CHANGES IN THE OVARIAN AND UTERINE ARTERIES IN WOMEN WITH POLYCYSTIC-OVARY-SYNDROME WHO RESPOND TO CLOMIPHENE CITRATE - CORRELATION WITH SERUM HORMONE CONCENTRATIONS

Objective Our purpose was to study the hemodynamic changes in the uter ine and intraovarian vessels in women with polycystic ovary syndrome ( PCOS) and to relate the vascular changes to hormonal indices. Methods Six women with a history of previous anovulatory cycles and/or oligome norrhea and/or elevated serum luteinizing hormone concentrations In ad dition to polycystic ovaries underwent induction of ovulation with clo miphene citrate. Serial transvaginal ultrasonography was performed on menstrual cycle day 2, daily from the estimated day of ovulation minus 6, 6-hourly from the estimated day of ovulation minus 2 or when the m ean follicular diameter was greater than 16 mm (whichever runs earlier ) until 6 h after follicular rupture, and once 7 days after follicular rapture. At each scan, uterine and intra-ovarian blood flow was asses sed by transvaginal color Doppler ultrasound, and serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), estr adiol and progesterone were assessed by fluoroimmunoassay. Results All six women demonstrated ultrasonographic features of ovulation. Follic ular peak systolic blood flow velocity (V-max) and ovarian stromal V-m ax in the dominant ovary increased during the follicular phase of the menstrual cycle and reached a peak at 36 and 42 h after the onset of t he LH surge of 30.7 +/- 4.6 cm/s and 37.0 +/- 3.9 cm/s, respectively. There was no significant change in the ovarian stromal V-max of the no n-dominant ovary. There was no significant change in the pulsatility i ndex (PI) in either the follicular or the ovarian stromal vessels duri ng the menstrual cycle. The changes in follicular V-max correlated sig nificantly with changes in serum concentrations of FSH, LH and progest erone. Uterine artery time-averaged maximum velocity (TAMX) declined t o its lowest levels at LN surge minus 6 days, and thereafter increased . In contrast, the PI increased during the follicular phase of the cyc le, reaching a peak at LH surge minus 4 days, and thereafter; declined . The changes in uterine artery PI correlated inversely with serum est radiol and serum progesterone concentrations. Conclusions Women with P COS have significant differences in intraovarian and uterine artery he modynamics, both at the baseline ultrasound scan and during the clomip hene-induced menstrual cycle, compared with women with normal ovaries. The intraovarian and uterine artery vascular differences are likely t o be due to a primary disorder within the polycystic ovary and their d ifferent hormonal status. Clomiphene citrate may have an effect on ute rine artery blood flow.