Colour Doppler analysis of peri-implantation utero-ovarian haemodynamics in women with excessively high oestradiol concentrations after ovarian stimulation

BACKGROUND: Gonadotrophins are used in many assisted reproduction units to achieve a better success rate by increasing the number of replaced embryos. However, high oestradiol concentrations are associated with altered physio logical functions and its complications. We investigated whether high oestr adiol concentrations (greater than or equal to 20 000 pmol/l) after ovarian stimulation in infertile women would affect the uterine haemodynamics at t he time of embryo transfer. METHODS: Colour Doppler indices of utero-ovaria n arteries and endometrial colour signals were measured. Fifty-eight women undergoing ovarian stimulation for IVF were classified according to serum o estradiol concentrations on the day of human chorionic gonadotrophin inject ion into moderate responders (oestradiol < 20 000 pmol/l; n = 39) and high responders (oestradiol greater than or equal to 20 000 pmol/l; n = 19). RES ULTS: Haemodynamic parameters were significantly lower in high responders; the uterine arterial pulsatility index (PI) and resistance index (RI) were (median; range) 1.87 (0.84-2.82) and 0.79 (0.57-0.90) respectively; ovarian artery PI was 0.57 (0.40-1.12) and RI was 0.43 (0.33-0.64). In moderate re sponders the uterine PI and RI were 2.63 (1.46-5.92) and 0.88 (0.77-1.10) r espectively. Ovarian PI was 0.81 (0.32-3.72) and RI was 0.55 (0.23-0.97). T he number of women showing endometrial colour signals was significantly low er in high responders (63%) than in moderate responders (92%) (P < 0.05). A further increase in oestradiol (greater than or equal to 25 000 pmol/l; n = 8) showed significantly (P = 0.03) fewer endometrial colour signals [1.5 (0-8)] compared with moderate responders [4 (0-14)]. CONCLUSION: Despite lo w uterine PI and RI, the endometrial blood flow in high responders appears to be impaired. This may contribute to the decline in implantation efficien cy noted in high responders.