Contraception: Ovarian stromal blood flow in women with polycystic ovaries—a possible new marker for diagnosis?

Blood flow changes in the ovarian stroma of women embarking on in-vitro fertilization treatment were assessed on day 2 or 3 of the menstrual cycle using color and pulsed Doppler ultrasound. Women were divided into 3 groups: group 1 63 women with regular ovulatory menstrual cycles and normal ovaries on ultrasound scan; group 2 13 women similar to group 1 but with polycystic ovaries (PCO) on ultrasound scan; and group 3 12 women with biochemical evidence of previous anovulatory cycles and/or oligomenorrhea and/or elevated serum luteinizing hormone concentrations (>10 IU/l) in the early follicular phase together with PCO on ultrasound scan. A subjective assessment of the intensity and quantity of colored areas in the ovarian stroma appeared to be greater in both groups 2 and 3 compared with group 1. Mean (SEM) ovarian stromal peak systolic blood flow velocity (Vmax) was 16.88 (1.79) and 16.89 (2.36) cm/s in groups 2 and 3 respectively. These velocities were significantly greater than the mean (SEM) ovarian stromal Vmax of group 1; 8.74 (0.68) cm/s (p < 0.001). Mean (SEM) ovarian stromal time averaged maximum velocity (TAMX) was 10.55 (0.91) and 10.89 (1.80) cm/s in groups 2 and 3 respectively both significantly greater than mean ovarian stromal TAMX of group 1 (p < 0.001). There was no significant difference in pulsatility index (PI) between the 3 groups. There thus appears to be significantly greater ovarian stromal blood flow velocity in women with polycystic ovaries as detected by color and pulsed Doppler ultrasound. Increased ovarian stromal blood velocity may be a new parameter to assist in the ultrasound diagnosis of PCO. The increase in stromal blood flow velocity may help to explain the excessive response often seen during gonadotropin administration in women with PCO and is consistent with the theory that the PCO may be a primary disorder of the ovary. (authors)