Blutflußveränderungen in den kleinen Beckenarterien im Verlaufe physiologischer Spontanzyklen bei Frauen unterschiedlichen Alters - Untersuchung mittels transvaginaler Farbdopplersonographie

The purpose of the study was to explore the haemodynamic changes in the uterine arteries, the ovarian arteries and the arteries of the follicle/CL by transvaginal Doppler ultrasound during the spontaneous ovulatory menstrual cycle at different ages and to search for differences in blood flow at the end of reproductive age, during which no macroscopic-anatomic changes of the reproductive organs and no changes of the hormone concentrations can be found, but infertility definitively increases. Study design: 24 fertile women at an age of 20-25, 30-35 and 40-45 (premenopausal) years underwent serial transvaginal ultrasonography. The examination of each woman involved taking 9-14 measurements of the mean blood flow velocity (vmean) during each menstrual cycle. The measurements of 17 women were suitable for evaluation, the remaining 5 women had to be excluded due to pathological menstrual cycles. In order to establish the blood flow pattern for each age-related group the series of measurements were standardised according to a synchronisation-system referring to 3 items (ovulation, beginning and end of the cycle). The results showed specific changes in blood flow for every artery and near identical hemodynamic changes in the young-(20-25 years) and middle-aged group (30-35 years). The blood flow changes were very homogenous within the groups. The uterine mean blood flow velocity (vmean) on the side of the dominant follicle showed a maximum at the time of ovulation and rose significantly midluteal. The periovulatory LH peak and the midluteal peak in serum estradiol and progesterone concentrations could be demonstrated at the same time. The non-dominant side showed nearly the same haemodynamic changes with lower blood flow velocity around ovulation and midluteal. The blood flow changes being identical in the dominant ovarian arteries and the arteries of the follicle showed a periovulatory increase and significantly higher velocity in the whole luteal phase compared to the follicle phase. On the non-dominant side, the periovulatory blood flow increase was missing. Changes of blood flow in the dominant ovarian and follicle arteries correlated with changes in hormone levels (estradiol, progesterone and LH). The typical periovulatory blood flow increases in the examined arteries of both younger groups could not be found in the group of the premenopausal women (40-45 years). A gradual but non-significant increase of the midluteal blood flow in the dominant uterine artery could be observed. Only a higher blood flow velocity in the dominant ovarian artery compared to the non-dominant side during the luteal phase could be proved. No correlation was found between vmean and the serum hormone concentrations of LH, estradiol and progesterone despite comparable absolute hormone concentrations in all three groups. Conclusion: The women up to the age of 35 showed an adequate and relatively determinable blood flow in the reproductive organs at the time of ovulation and nidation (midluteal). The results of the premenopausal women made a sufficient blood flow during the ovulation doubtful and could indicate to age-related dysfunctions in the blood flow of the reproductive organs. In the context of reduced oocyte quality caused by intrafollicular hypoxia at the time of ovulation, the results of this study could represent a new aspect in the discussion about age-related infertility.