| Among many factors which can impact IVF-ET(in vitro fertilization-embryo transfer) outeome, ovarian response and endometrial receptivity are very important key factors. In the past, age and basal FSH level are used to predict the responsiveness of ovary, but the true age is not always consistent to the age of ovary and the basal FSH levele can not reflect the ovary response exactly. The endometrial thiekness and type were used to assess its receptivity. Howerver, more and more facts showed that they are not considered and it is the blood flow of endometrial and subendometrial spiral arteries that determines the fate of implantation in IVF-ET.Ovarian cystectomy and salpingectomy were ordinary surgeries in the field of gynecology. Many infertile patients prepared to receive IVF-ET who had undergone the two kinds of surgery. From the anatomical observations, The blood vessel and nerves of ovary and oviduct are in close vicinity, salpingectomy may destrory ovarian function. Ovarian cystectomy may destrory normal ovarian tissue so that it may affect ovarian function. Many investigator pay close attention to the problem at the present time, but their conclusions are not identical. More clinical doctors use of GH(growth hormone) to improve the patients that with Low ovarian response and adverse reactions of endometrial. Although some patients after treatment can improve the poor condition of ovarian and endometrial. However, the mechanism is not yet clear. Therefore, the role of GH in the reproductive area and its significance is still controversial. Some scholars have already conduct a preliminary study of this, however mostly were animal studies, Yet there have not seen from the human hemodynamic changes in relevant reports.ObjectivesTherefore, this study used power doppler imaging and pulse wave power doppler technique from ovarian and endometrial tissue perfusion and dynamics change to discussion:(1) The relevance from Bilateral ovarian stromal arteries, uterine endometrium and endometrial spiral artery blood flow parameters to the ovarian response and endometrial receptivity, as well as its impact on clinical pregnancy outcome.(2) If ovarian cystectomy and tubal surgery will reduce the ovarian and endometrial blood supply, thus affecting the ovarian response, endometrial receptivity and clinical pregnancy outcome.(3) After added GH, the ovarian and endometrial changes in hemodynamics, in-depth to understanding the mechanism of action of GH increased the ovary to gonadotropin of the reactivity and to improve the poor endometrium, in order to provide a reliable basis for its application of assisted reproductive technology.MethodsOne thousand and thirty one infertile patients undergoing IVF-ET treatment were recruited from the Reproductive Center of The First Affiliated Hospital of Zhengzhou University from July 2009 to January 2010. Grouping according to age, infertile duration, basal FSH and LH level, endometrial thickness, the number of days and total dose of medication, number of ova retrieved, operation history, ovarian response, PSV, EDV, RI, S/D, whether or not use of GH and Pregnancy referred the result. The main reasons of infertility are Fallopian tube occlusion and male azoospermia. Systemic diseases are excluded in all patients. COH protocols used in this research are long protocol and standard corpus lutein stage protocol.The time-resolved fluoroimmunoassay was used to measure endocrine level of basal state and on the day of OPU administration. PDI and PW ultrasound doppler technique was used to monitor the blood flow of uterus and ovary; The methods of IVF-ET referred the routine ways of our center.Results1. According to age is divided into 3 groups:Y≤30(n=495),300.05); Endometrium and endometrial blood flows PSV, EDV, S/D value, RI there was no significant difference (P>0.05); Patients with unilateral ovarian cysts compared with the contralateral side compared to AFC, the number of oocytes, ovarian stromal artery PSV was significantly lower, with statistical difference (P<0.05);(2) Tubal surgery group (unilateral+bilateral) than in patients without surgery AFC, the number of oocytes,2PN fertilization rate was significantly lower, with statistical difference (P<0.05); The basis of FSH, Gn consumption, excellent embryo, implantation rate and clinical pregnancy rates were no significant differences (P> 0.05); Under the endometrium and endometrial spiral arteries PSV, EDV, S/D value, RI there was no significant difference (P>0.05); Patients with unilateral tubal surgery compared with the contralateral side compared to AFC, the number of oocytes significantly reduced, with statistical difference (P<0.05);3. According to the number of oocytes, patients were divided into low-response group and the normal reaction group.There are significant differences for PSV and EDV between the two group (P<0.05), Low response group of PSV,EDV are significantly lower than the normal response group;4. Endometrial blood flow by Applebaum divided into three groups:no endometrial and endometrial blood flow as the A-type(n=144), only visible under endometrial blood flow as the B-type(n=493), under both endometrial and endometrial blood flow as C-type (n=394).(1) A-type endometrium:a groupb group>c group, three groups were statistically significant (P<0.05);(2) Implantation rate and pregnancy rate A-10IU/ml and (or) AFC<5 were divided into 2 groups:GH group(n=76),control group (n=82).(1) The number of oocytes,endometrial thickness,2PN fertilization rate were significantly higher than control group(P<0.05); Significantly reduce the amount of Gn(P<0.05);(2) The use of GH on ovarian stromal blood flow parameters.The ovarian stromal artery PSV of GH group was significantly higher than control group(P<0.05); EDV,RI,S/D are not significant differences between the two groups(P>0.05);(3) The use of GH on endometrial and subendometrial spiral artery blood flow parameters. There are no significant differences for two groups(P>0.05);Conclusion1. Direct impact on women's age, ovarian stromal blood flow, endometrial and endometrial blood flow parameters under. With age, ovarian and endometrial blood flow gradually decreased, decreased ovarian reserve capacity, clinical pregnancy rate.2. Ovarian stromal blood flow parameters can be used as predictive indicators of ovarian response.3. Endometrial perfusion directly affect clinical pregnancy outcome, may serve as indicators of endometrial receptivity.4. Ovarian cystectomy of ovarian blood supply is reduced, thereby affecting ovarian function, reduce the number of oocytes retrieved and clinical pregnancy rate.5. Tubal surgery does not affect ovarian and endometrial blood supply, but will reduce the AFC and the number of oocytes.6. Patients with low. ovarian response to growth hormone can improve ovarian response and uterine receptivity, and thus improve the clinical pregnancy rate.
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