The Research On The Impact Of Hydrosalpinx To Ovarian And Uterine Endometrial Blood Flow

Objective:In this research,Transvaginal Color Doppler sonography(TV-C DS) can be used to monitor ovarian stromal,the blood flow of uterine e ndometrium and endometrial-subendometrial blood flow of the group of h ydrosalpinx,the group of non-hydrosalpinx and the treated group which for investigating:(1)the impact of every group to the ovarian reactiveness,puls atility index(PI),resistant index(RI) and ovarian stromal artery peak systoli c velocity(PSV) of the ovarian substrate blood flow,(2)the alteration of pa rameters of the ovarian substrate blood flow in the half hydrosalpinx;(3)th e impact of the modalitys to treat hydrosalpinx to ovarian blood flow;(4)t he impact of hydrosalpinx to the blood flow of uterine endometrium and endometrial-subendometrial blood flow;(5)the impact of the blood flow of uterine endometrium and endometrial-subendometrial blood flow to pregn ancy rate.analyze the impact of hydrosalpinx to ovarian stromal and pregn ancy outcome,the modalitys to treat hydrosalpinx;to purpose for improve t he ovarian reactiveness and the pregnancy rate of IVF-ET.Methods:patients of 120 who had first undergo IVF-ET were recruited f rom the Reproductive Centre of the First Affiliated Hospital of Guang Xi Medical University from June to December 2008,which divided into four groups for hydrosalpinx or non- hydrosalpinx and treated,every group ha s 30 patients,which is seted up group1,group2,group3 and group4,and grou p2 is the controlled group.every patient's age is not more than 35 years,t he average age is 29.70±4.19(21～35)year.They had been infertile betwe en 2 and 12 year.The main reasons of infertility are fallopian tube occlu sion.All of them were confirmed by hyesterosalpingography or laparoscope and B-mode sonography.Systemic diseases are excluded in all patients(f or example hypertension,diabetes,hyperthyreosis).endometriosis and ade nomyosis are exclude.Operation on ovary are excluded in all patients.T here are no ovarian cysts or the diameters of cysts are less than lOmm i n the basal state.Controlled ovarian hyperstimulation used in this researc h for all patients.The opportunity to suck hydrosalpinx from vagina is the time of entering IVF,but before COH;and they are observed in the cycl e of COH.The patients of hydrosalpinx who were treated by laparoscope was infertility over half year,and observed non-hydrosalpinx in the cycle of COH.The patients of hydrosalpinx was observed hydrosalpinx not flo wing into cavity of uterus.The patients of non-hydrosalpinx was simple i nfertility of Fallopian tube occlusion,who confirmed by hyesterosalpingogr aphy and B-mode sonography.The typical sign of hyesterosalpingography i s broaden of half or both fallopian tube,but constrast medium not diffusio n to abdominal cavity.And diagnostic criteria of B-mode sonography is an inhomogeneous mass which look likes cycloid or elliptic thing.Because t here has not diagnostic criteria to hydrosalpinx yet,it is a diagnostic criter ia on the basis of the fact in our reproduction centre.Hydrosalpinx degre e is fallopian tube extanting more than 2×3cm in hyesterosalpingography in all over the petients.Index determine:(1)monitor the parameters PI,RI,PSV of the ovarian stromal blood flow of four group at D₁ and D_HCG in the cycle of COH.(2)record the results of Gn dosage,days of Gn and ob tained ovum in four groups.(3)monitor the thickness of uterine endometriu m at D_HCG.(4)monitor the models of the blood flow of uterine endometriu m and endometrial-subendometrial blood flow.A model:There are blood fl ow in endometrial and subendometrial.B model:There are blood flow in Subendometrial but not in endometrial.C model:There are not blood flow in endometrial and subendometrial.Pregnancy criterion:There is gestation sac in palace or abortion,or eccyes is,or pregnancy in more place after four to five weeks for ET,if have th e floss by the pathology examination,The all of them is clinic pregnancy. The clinic pregnancy is the standard of the research.Results:1,the change of ovarian stromal hemodynamics of four groups in the cycle of COH.â‘ comparition of the ovarian stromal blood flow at D ₁.Group1(0.94±0.11,0.57±0.08,8.99±1.14) compare group2(0.85±0.07, 0.49±0.10,10.34±1.56),group3(0.87±0.08,0.52±0.09,9.74±1.03) and group4(0.86±0.09,0.50±0.10,10.09±1.49),ovarian stromal vascular res istance is heighten,corresponding the value of parameters PI,RI stepping up,but the value of PSV descending.The different is significant(P＜0.05). Group2 compare group3,group4,the diffirent of PI,RI,PSV is not sig nificant,the value of P is over 0.05.â‘¡comparition of the ovarian stromal blood flow at D_HCG.Group1(0.91±0.12,0.53±0.09,9.33±1.09) compare group2(0.82±0.08,0.46±0.11,10.52±1.06),group3(0.85±0.12,0.48±0.0 9,10.16±1.08) and group4(0.84±0.11,0.47±0.10,10.40±1.31),the diffi rent of PI,RI,PSV is significant(P＜0.05),Group2 compare group3,group4,the diffirent of PI,RI,PSV is not significant(P＞0.05),â‘¢co mparition of the ovarian stromal blood flow between D₁ and D_HCG.Ovari an stromal vascular resistance stay heighten level,and descend with utilizin g Gn,nevertheless,the diffirent of PI,RI,PSV is not significant between D₁ and D_HCG(P＞0.05).D₁ groupl's PI,RI are 0.94±0.11,0.57±0.08, group2(0.85±0.07,0.49±0.10),group3(0.87±0.08,0.52±0.09),group4(0. 86±0.08,0.50±0.10);D_HCG group1(0.91±0.12,0.53±0.09),group2(0.82 ±0.08,0.46±0.11),group3(0.85±0.12,0.48±0.09),group4(0.84±0.11,0. 47±0.10).2,comparition of the ovarian stromal blood flow in half hydro salpinx.There are only group1 and group3 having half hydrosalpinx.Group 1 has 13,the other has 15.The parameters of PI,RI,PSV in hydrosalpinx (group1/ D₁:1.01±0.06,0.60±0.04,7.88±1.73;group3/D₁:0.93±0.06,0. 56±0.08,8.98±1.26;group1/ D_HCG:0.99±0.06,0.58±0.04,8.71±1.60;gr oup3/ D_HCG:0.91±0.09,0.55±0.08,9.18±1.17) compare the other half(non -hydrosalpinx)(group1/D₁:0.88±0.12,0.53±0.09,11.50±2.53;group3/ D₁:0.83±0.09,0.48±0.10,11.06±1.93;group1/ D_HCG:0.83±0.11,0.48±0. 09,11.92±2.44;group3/ D_HCG:0.81±0.14,0.42±0.10,11.47±2.00),the di ffirent of PI,RI,PSV in the groupl is significant(P＜0.05);while the diffirent of the parameters of the group3 is nonsignificant.3,comparition of the Gn dosage,Gn days and obtained ovum of four group.The diffire nt of the Gn dosage,Gn days and obtained ovum is significant(P＜0.05). Group1(29.97±4.42,11.10±1.69,10.56±2.14),group2(25.63±4.33,9.93±1.28,13.93±3.86),group3(27.23±4.29,10.20±1.49,12.57±2.97),group4(27.00±5.33,10.27±1.41,12.70±3.43).4,compare the distribution of the models of the blood flow of uterine endometrium and sub-endometrial blood flow.Mode lA,modelB and modelC are 8,9,13 each other in group1 at D_HCG;group2(1 8,10,2);group3(15,10,5);group4(16,9,5).ModelA,modelB and modelC are 8, 10,12 each other in group1 at D_ET;group2(20,7,3);group3(16,8,6);group4 (18,8,4).The diffirents are significant D_HCG(X²=14.77,P=0.022),D_ET(X² =13.73,P=0.033).5,comparition of the pregnancy rate and implantation rate in each group.The diffirents of the pregnancy rate and implantation r ate are significant(P＜0.05),and the values of the pregnancy rate and i mplantation rate of group2(56.7%),group3(43.3%) and group4(50.0%) are more than group1(20.0%) two times,the values of the pregnancy rate and implantation rate of group3 and group4 is similar to group2,the diffirent is not significant(P＞0.05).6,comparition of the pregnancy out come of each model of the blood flow of uterine endometrium and sub-e ndometrial blood flow in every group at D_HCG and D_ET.The diffirents of t hem are not significant yet.The pregnancy rate and implantation rate of modelA in group1 at D_HCG are 37.5%,18.7%,modelB 33.3%,16.7%,and modelC 0.The pregnancy rate and implantation rate of modelA in group 2 are 66.7%,47.2%,modelB 40.0%,30.0%,and modelC 50.0%,25.0%. The pregnancy rate and implantation rate of modelA in group3 are 53.3 %,36.7%,modelB 50.0%,35.0%,and modelC 0.The pregnancy rate an d implantation rate of modelA in group4 are 62.5%,43.7%,modelB 33. 3%,22.2%,and modelC 40.0%,20.0%.The pregnancy rate and implantat ion rate of modelA in groupl at D_ET are 37.5%,18.7%,modelB 20.0%,10.0%,and modelC 8.3%,4.17%.The pregnancy rate and implantation rat e of modelA in group2 are 65.0%,45.0%,modelB 42.8%,35.7%,and m odelC 33.3%,16.7%.The pregnancy rate and implantation rate of model A in group3 are 56.2%,37.5%,modelB 37.5%,31.2%,and modelC 16.7 %,8.3%.The pregnancy rate and implantation rate of modelA in group4 are 66.7%,44.4%,modelB 25.0%,18.7%,and modelC 25.0%,12.5%.T he pregnancy rate and implantation rate in the model of the blood flow of uterine endometrium which can observed by B-mode ultrasonic apparat us are heighten than that cannot observed endometrium blood flow.Conelusions:1,hydrosalpinx can impact the ovarian stromal blood flow,th ereby to lower ovarian reactivity.2,operations of the hydrosalpinx by suc ked from vagina and by laparoscope can improve the pregnancy outcome for hydrosalpinx.3,hydrosalpinx alters the uterian endometrial receptivity by changing the blood flow of endometrium and sub-endometrium,thereby to lower the pregnancy rate and implantation rate possibly.