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3D power Doppler; a possible new predictor for ovarian hyperstimulation syndrome in PCOS: hormonal correlation*
Mohamed Eid, Samir Abbas,Amany Tayae, Emad Soliman, Amal Shohiab
Abstract
Objective: An attempt for prediction of severe OHSS using 3D power Doppler scan of ovarian stromal blood flow in PCOS patients and correlating the findings with serum estradiol (E2).
Design: Prospective-observational study.
Materials and methods: Twenty- two infertile, PCOS patients were included; all were fulfilling the criteria of PCOS and were under gonadotrophins stimulation for IVF or ICSI. Serum E2 and 3D power Doppler were done for each patient on the day of hCG injection. Serum E2 for patients included was (≥ 3000 pg/ml), as E2 > 7000 pg/ml is the cut-of figure for cancellation in our center. 3D power Doppler scans, using Voluson 530-3D, were done by the same operator who was blind to the serum E2. Reconstructed 3D vascular image for the ovarian stromal blood flow was recorded and resistance index (RI) was also measured.
Results: Two patterns of 3D vascular images were detected; each pattern was mostly confined to certain level of serum E2. "Reassuring pattern"; (Pattern 1), regular branches, minimal coils, mild dilatation and RI (0.55 - 0.61); was detected in 15(71%) patients. Serum E2 associated was 3000 - 5000 pg/ml in 12 (57%) patients. Of interest, 3(14%) patients with E2 9000 - 11000 pg/ml, showed this pattern; one (37 years), second (BMI = 29.5 kg/m2), and third (associated endometriosis). OHSS was not observed with this pattern. "Aggressive pattern" ; (Pattern II), irregular branches, several angles and coils, marked dilatation and RI (0.48 - 0.52); was detected in 7 (29%) patients. Serum E2 associated was > 5000 - 7000 pg/ml. OHSS was developed in 3 (14%) patients, 2 moderate and one severe.
Conclusion: 3D power Doppler scan for ovarian stromal blood flow reflects the degree of neovascularization "angiogenesis ", which stays behind the pathogenesis of OHSS. So, it could be used as a possible new predictor for OHSS in PCOS patients complementary to serum E2. Moreover, it might be used for reassurance against the development OHSS in certain PCOS patients (age > 35, BMI > 27 kg/m2 and associated endometriosis) even with very high serum E2 level, but this observation needs further extended studies.
Keywords
OHSS, PCOS, power Doppler, 3D-US.
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