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Objective: To evaluate the impact of the regressing corpus luteum on the hormone secretion during hCG stimulation. The hCG stimulation test in the early follicular phase has been used to assess the capacity of the ovarian theca cells to secrete steroids., Design: A prospective observational study., Setting: University hospital., Patient(s): The study group consisted of 11 women with confirmed ovulation in the past cycle (corpus luteum positive [CL+]) and the control group of 11 women using oral contraceptive pills (OC; no CL)., Intervention(s): An hCG test (5,000 IU IM) was performed 2 to 4 days after menstrual bleeding, and the ovarian response was measured at 0, 48, and 96 hours after injection., Main Outcome Measure(s): Changes in serum concentrations of P, 17-hydroxyprogesterone (17-OHP), androstenedione (A), T, E(2), and vascular endothelial growth factor (VEGF), and in ovarian vasculature and volume (three-dimensional power Doppler ultrasonography) were measured., Result(s): Secretion of P and 17-OHP increased after hCG injection in the CL group, whereas no change was observed in women on OCs (P < or = .001). Concomitant increases were observed in volume and vasculature of the ovary with a CL (P<.05), but not in the contralateral ovary or in women on OCs. The changes in volume and vasculature correlated with levels of P and 17-OHP (P<.05)., Conclusion(s): The regressing corpus luteum from the past menstrual cycle reactivates and secretes steroids in response to hCG stimulation performed during the early follicular phase, which should be taken into account when comparing hormone profiles of ovulatory and anovulatory women.

Objective: To study the predictive value of initial low response (LR) in IVF/intracytoplasmic sperm injection (ICSI)., Design: Retrospective analysis., Setting: Two Finnish fertility centers., Patient(s): A total of 3,846 IVF/ICSI cycles performed from 1994 to 2002., Intervention(s): Consecutive cycles in the same subject were identified. The study groups consisted of subjects who had three treatment cycles and at least one LR cycle (n = 80)., Main Outcome Measure(s): Pregnancy rate (PR), total gonadotropin dose, and embryo quality., Result(s): Only 2.5% (2/80) of subjects had a LR in all three consecutive cycles. In 43 women an initial LR was followed by >/=1 normal response (NR) cycle, and in 35 women an initial NR was followed by >/=1 LR cycle. The PR/cycle was similarly low in women with an initial LR and an initial NR (10.1% vs. 16.2%). An increase in gonadotropin dose resulted in a higher number of oocytes in women with an initial LR (from 2.1 +/- 0.9 to 6.7 +/- 2.7) but the PR/cycle remained low, compared to the overall mean PR (27.2%). In cycles in which top quality embryos were transferred, subjects with an initial LR had a lower PR than women with an initial NR (17.8% vs. 41.2%)., Conclusion(s): An initial LR is a predictor of poor outcome in subsequent cycles, even if ovarian response is improved by increasing the gonadotropin dose or a top quality embryo is replaced.

Objective: The growth of the follicles induced by gonadotropins during IVF treatment is accompanied by physiologic angiogenesis, which is essential for the maturation of the oocytes. We describe the IVF-induced changes in the vascularization and compare normal with polycystic ovaries (PCOs)., Design: Prospective study., Setting: Assisted reproductive unit at a university hospital., Patient(s): Sixty women who underwent IVF cycles., Intervention(s): The ovarian vascularization was measured after pituitary down-regulation, FSH stimulation, and hCG-injection using three-dimensional power Doppler ultrasonography., Main Outcome Measure(s): The total ovarian vascularization was divided by the number of follicles., Result(s): After pituitary suppression, the ovarian vascularization/follicle was lower in polycystic ovary (PCO) patients. During ovarian stimulation, follicles in PCOs required a lesser amount of FSH to acquire the same level of vascularization than the follicles in normal ovaries. In addition, hCG induced an increase in the follicular vascularization in both normal and PCOs. The follicle count correlated with the total vascularized volume in the ovaries throughout the IVF cycle., Conclusion(s): Follicles in PCOs seem to be less vascularized than the follicles in normal ovaries after GnRH treatment but not after gonadotropin stimulation. It is possible that restricted blood supply to the follicles in PCO might be associated with the follicular arrest that is observed. We could confirm that follicles in PCO are more sensitive to gonadotropin stimulation than follicles in normal ovaries.

Objective: To evaluate the changes taking place in the ovaries during pituitary down-regulation., Design: Prospective observational study of women undergoing IVF treatment., Setting: A tertiary referral center for assisted reproduction., Patient(s): Forty women who received the long buserelin acetate treatment protocol. Transvaginal three-dimensional power Doppler ultrasound examinations before and after pituitary down-regulation., Intervention(s): Ovarian volume, number of follicles, vascularization index (VI), flow index (FI), vascularization flow index (VFI), and mean gray value (MG)., Result(s): Before the pituitary down-regulation, the dominant ovary was larger in volume and had a lower MG than the nondominant ovary. After the down-regulation, there was a significant decrease in the volume and number of follicles and an increase in MG. After pituitary down-regulation, the dominant and nondominant ovaries did not differ from each other in any of the parameters. Polycystic ovaries were larger than normal ones before and after the down-regulation, without any differences in MG, VI, FI, or VFI. Right and left ovaries did not differ from each other after the down-regulation., Conclusion(s): The differences observed between dominant and nondominant ovaries seem to disappear after pituitary down-regulation. In addition, polycystic ovaries were always larger than the normal ones, but no differences could be detected in the stromal brightness or vascularity either before or after the administration of GnRH agonist therapy.