| Part1 Value of transvaginal three-dimensional ultrasound in the quantitative evaluation of decreased ovarian reserve functionObjectiveTo observe the changes of antral follicle count,ovarian volume and ovarian interstitial blood perfusion in patients with decreased ovarian reserve function by transvaginal three-dimensional ultrosound,and to explore the value of quantitative evaluation of decreased ovarian reserve function by intracavity three-dimensional ultrasound.MethodsFemale patients underwent ultrasound examination in our outpatient clinic from August 2016 to March 2018 were selected,to screen the normal group(100 cases)of ovarian reserve function,the group(100 cases)with decreased ovarian reserve function(DOR)according to the test results of sex hormone.The general conditions such as age,menarche age,menstrual period and menstrual cycle in 200 patients were recorded respectively,and the transvaginal three-dimensional ultrasound examination was carried out at the same time.Three-dimensional ultrasound VOCAL and SonoAVC analysis software were used to quantitatively analyze the ovaries in two groups of subjects,and the following parameters were obtained:antral follicle count(AFC),ovarian volume(OV),ovarian vascular index(VI),blood flow index(FI),vascular blood flow Index(VFI).The parameters of three dimensional ultrasound were compared between the two groups,and the ROC analysis were adopted.Results1.Comparison of general cases.The age between the two groups was compared,and that in DOR group was older than that in the normal group,the difference was significant(P<0.001).The length of menstrual cycle between the two.groups was compared,and that in DOR group was larger than that in the normal group,the difference was significant(P<0.001).The menstrual length between the two groups was compared,there was no statistically significant difference(p>0.05).2.Comparison of three-dimensional ultrasound parameters of ovary.There was no significant difference(P>0.05)between three-dimensional ultrasound parameters of ovary of left and right ovaries in the two groups.Compared between two groups,AFC,OV,FI and VFI in DOR group were all smaller than that in the normal group,and the difference was significant(p<0.001).VI in DOR group was slightly smaller than that in the normal group,and the difference was no statistically significant(P>0.05).In the comparison between normol group and DOR group,The area under curve of AFC was 0.912,and the sensitivity and specificity were 0.93 and 0.79,respectively;The area under curve of OV was 0.906,the sensitivity and specificity were 0.91 and 0.76,respectively;The area under curve of VI was 0.495,and the sensitivity and specificity were 0.47 and 0.6,respectively;The area under curve of FI was 0.847,the sensitivity and specificity were 0.62 and 0.94,respectively;The area under curve of VFI was 0.876,and the sensitivity and specificity were 0.79 and 0.88,respectively.ConclusionThere is important predictive value of the transvaginal three-dimensional ultrasound parameters for assessing ovarian reserve function such as AFC,OV and ovarian blood perfusion,among which AFC is the best predictor,followed by OV,VFI.?FI.NI is not predictor.The parameters of AFC,OV and ovarian blood perfusion,which were measured by intracavitary three-dimensional ultrasound energy Doppler and VOCAL and SonoAVC analysis software,are more accurate and reliable,and it has important clinical value for the evaluation of ovarian reserve functionPart2 Application value of intracavity three-dimensional ultrasound in the treatment detection of infertility patientsObjectiveTo investigate the value of transvaginal three-dimensional ultrasound in the treatment of infertility patients by using vaginal two-dimension and three-dimensional ultrasound in the treatment of patients with decreased ovarian reserve function(DOR).Methods93 patients with the diagnosis of DOR in our outpatient clinic examination and fertility requirements from August 2016 to March 2018 were selected as the study subjects,and DOR patients were treated with dehydroepiandrosterone(DHEA)for 3 consecutive months,vaginal ultrasound monitoring was conducted every 10 days,to record the volume and blood flow changes of ovaries.When detecting of ovulation,transvaginal ultrasound monitoring follicle development was begun to conduct from 8th day to 10th day in the same menstrual cycle,ultrasound monitoring was conducted every 2 days.When mature follicle(dominant follicle diameter>17mm)exist,Human chorionic gonadotropin(hCG)was given with the intramuscular injection dosage of 5000~10000 IU,so as to induce ovulation,the sexual life was guided and the monitoring frequency was changed to be 1 times a day.When the follicle matured up to 20?23 mm in diameter,it was measured 2 times a day if necessary until ovulation.In each monitoring,it received transvaginal three-dimensional ultrasound and two-dimensional ultrasound examination at the same time,to observe the size and morphology of the bilateral ovaries,and to record the maximum follicle volume,menstruation days and so on.In the course of treatment,DOR patients were record and analyzed data in dominant follicles,ovaries,and changes of blood flow.ResultsThe changes of OV and PSV of ovarian in two-dimensional ultrasound and three-dimensional ultrasound were recorded in 10d,20d,30d,40d,50d,60d,70d,80d and 90d in DOR patients accepted DHEA treatment,and the interaction analysis showed that the growth trend of OV and PSV of ovarian detected by three-dimensional ultrasound at different time points was more stable than that of two-dimensional ultrasound,and the difference was statistically significant(p<0.05)2.DOR patients were conducted the follicle monitoring in8d,10d.,12d,13d,14d,15d(am),15d(pm),16d(am),16d(am)of the menstrual cycle.The volume of dominant follicles in two-dimensional ultrasound and three-dimensional ultrasound at various time points was recorded respectively.Under different treatment time,the growth trend of dominant follicle volume measured by three-dimensional ultrasound was more stable than that of two-dimensional ultrasound,and the difference was statistically significant(p<0.05).Two-dimensional ultrasound showed that 15 DOR patients had no ovulation,of which 3 were found to be pregnant,and three-dimensional ultrasound showed that 11 cases had no ovulation and no actual pregnancy.ConclusionTransvaginal ultrasound can be used to detect the treatment process of DOR infertility patients,and the ovarian OV,PSV and follicle OV obtained by transvaginal three-dimensional ultrasound are more accurate and stable,and it have very important clinical significance in the treatment process of infertility patients. |
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