Influence Of Controlled Ovarian Hyperstimulation On Uterine Peristalsis In Infertile Women

OBJECTION:To explore the characteristics of uterine endometrial peristalsis in spontaneous and controlled ovarian hyperstimulation (COH) cycles.METHOD:Sixty infertile women with regular, ovulatory menstrual cycle underwent follicular tracking in spontaneous cycle and GnRH-agonist down-regulation ovarian stimulation protocol in subsequent cycle. Endometrial peristaltic wavelike activity was observed and recorded through transvaginal ultrasound on days of LH surge, ovulation,2days after ovulation (ovulation+2) in spontaneous cycle and HCG+1day, ovum pick up (OPU),2days after OPU (OPU+2) in COH cycle. Blood was drawn on days of LH surge, ovulation+2, HCG+1and OPU+2to measure concentrations of serum estradiol and progesterone.RESULTS:1. Wave frequency of uterine peristalsis was significantly lower on HCG+1day than the day of LH surge(2.44±0.73vs.2.88±0.56), but it was higher on OPU, OPU+2than the days of ovulation and ovulation+2respectively(3.57±0.80vs.2.72±0.68;2.40±0.73vs.2.01±0.94). The wave frequency in COH cycle was1.31times of that in natural cycle (P <0.05).2. Among the five wave types of uterine peristalsis, waves from cervix to fundus (CF wave) dominated at all the observation moments, and took higher percentage in COH cycle than spontaneous cycle. But "no activity" was more frequently observed in spontaneous cycle.3. Wave frequency positively correlated with E2(r=0.30; P=0.01) and negatively correlated with P (r=-0.48; P<0.01) within the physiological range of respective steroids level. No correlation was found between wave frequency and supraphysiological concentrations of E2and P.4. There was no linear regressive correlation between uterine peristaltic wave frequency in COH cycle and the dose of administrated gonadotrophin (Gn), the days of COH as well as the number of retrieved oocytes. However, the unstandardized regressive coefficients of the number of retrieved oocytes were statistically significant at OPU and OPU+2.5. Comparing with those in non-pregnant group, patients in pregnant group were younger and the uterine peristaltic wave frequency was higher on days of HCG+1and OPU+2. However, the baseline demographic and clinical characteristics of the study patients in the two groups were the same. Two days after OPU, the percentage of fundocervical waves was higher in non-pregnant group than the pregnant group (10.16%vs.3.00%), while the percentage of opposite waves was lower in non-pregnant group than the pregnant group (0%vs.4.9%). CONCLUSIONS:1. Controlled ovarian hyperstimulation significantly changed uterine peristaltic pattern. It showed higher wave frequency, greater percentage of cervicofundal wave, and more complicated wave shapes in COH cycle.2. Wave frequency positively correlated with E2and negatively correlated with P within the physiological range of respective steroids level. No correlation was found between wave frequency and supraphysiological concentrations of E2and P.3. There was no correlation between uterine peristaltic wave frequency in COH cycle and the dose of administrated gonadotrophin (Gn) as well as the days of COH. However, the number of retrieved oocytes significantly influenced uterine peristaltic wave frequency at OPU and OPU+2.4. Moderate wave frequency of uterine peristaltic at OPU+2may indicate better pregnant outcome, while the fundocervical waves may have an adverse effect on embryo implantation.