scholarly journals Effect of nitric oxide donors on uterine and sub-endometrial blood flow in patients with unexplained infertility: a randomized controlled trial

2021 ◽  
Vol 10 (6) ◽  
pp. 2178
Author(s):  
Mohamed A. Abdel Hafeez ◽  
Ashraf M. F. Kortam ◽  
Alaa M. A. Youssef ◽  
Ahmed Reda ◽  
Rehab M. Abdelrahman
Keyword(s):  
Blood Flow ◽  
Uterine Artery ◽  
Endometrial Thickness ◽  
Controlled Trial ◽  
Unexplained Infertility ◽  
Control Group ◽  
Artery Blood Flow ◽  
Randomized Controlled ◽  
Endometrial Blood Flow ◽  
Fertile Women

Background: Impaired sub-endometrial perfusion might reduce endometrial receptivity and possibly contribute to unexplained infertility. A favorable effect on sub-endometrial blood flow has been demonstrated with nitric oxide.Methods: This randomized controlled trial evaluated the effect of nitroglycerine on uterine and sub-endometrial blood flow in women with unexplained infertility. Sixty women were randomized into 2 equal groups. The study group received 5mg nitroglycerine patch daily from day 2 of the cycle till the evaluation day and the control group received no treatment. Independent of the study arms, 30 parous women were included as the fertile group. Six to eight days after detecting luteinizing hormone surge, women were assessed for endometrial thickness, uterine artery blood flow with color Doppler and sub-endometrial blood flow with three-dimensional power Doppler.Results: Compared to fertile women, cases with unexplained infertility (control group) had a significantly thinner endometrium, higher uterine artery Doppler indices and lower sub-endometrial blood flow. Women who received nitroglycerin showed a significant improvement in sub-endometrial blood flow while uterine artery blood flow did not show a significant difference; however, the values were also comparable to fertile women. In addition, no effect on endometrial thickness was found with nitroglycerin treatment. Nitroglycerin treatment side effects were headache, blurring of vision and hypotension. These adverse effects were not significant compared to controls.Conclusions: In women with unexplained infertility, nitroglycerin significantly improved the sub-endometrial blood flow but did not affect the endometrial thickness.

scholarly journals Endometrial Thickness and Subendometrial Vascularity in Anovulatory Polycystic Ovarian Syndrome Patients Treated by Metformin

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
W M Khalaf ◽  
S A Akl ◽  
R R Ramadan ◽  
M A M Kamaleldin
Keyword(s):  
Insulin Resistance ◽  
Blood Flow ◽  
Uterine Artery ◽  
Endometrial Thickness ◽  
Endometrial Receptivity ◽  
Metformin Therapy ◽  
Artery Flow ◽  
Ovarian Syndrome ◽  
Endometrial Blood Flow ◽  
Endometrial Vascularity

Abstract Background PCOS, the commonest endocrinalogical disorder affecting women of age group between 18 and 44 years. PCOS compromises fertility through various pathways as hyperandrogenism, insulin resistance and impedance of the uterine and endometrial blood flow. Metformin improves the blood flow to the endometrium through reducing androgen level and correction of insulin resistance. The commonest parameters used to detect the endometrial receptivity outcome are endometrial vascular indices. Aim of the Work to evaluate the outcome of metformin administration in anovualtory PCO patients and its effect on the endometrium, including its role in ovulation and improvement of pregnancy rates. Patients and Methods this study included 85 patients from Ain Shams University outpatient gynecology and infertility clinic during the period from January 2018 till June 2018. These patients were investigated before treatment with ultrasound on day 14, 21 to evaluate the endometrial receptivity parameters such as endometrial thickness, uterine artery vascularity, endometrial and subendometrial vascularity. The patients received metformin 500mg three times per day for three months. After this duration they were reevaluated by ultrasound at days 14, 21 to detect any improvement. Results metformin therapy resulted in a significant increase of endometrial thickness and had a significant effect on uterine RI and PI. On the endometrial level, the endometrial and subendometrial R.I and P.I were significantly reduced after metformin treatment indicating better blood flow. Conclusion Metformin therapy improves endometrial vascularity, in addition to increasing endometrial thickness and improved impedance observed in uterine artery flow.

scholarly journals Different Bleeding Patterns with the Use of Levonorgestrel Intrauterine System: Are They Associated with Changes in Uterine Artery Blood Flow?

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Carlo Bastianelli ◽  
Manuela Farris ◽  
Stefania Rapiti ◽  
Roberta Bruno Vecchio ◽  
Giuseppe Benagiano
Keyword(s):  
Blood Flow ◽  
Uterine Artery ◽  
Endometrial Thickness ◽  
Power Doppler ◽  
Artery Blood Flow ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Before And After ◽  
Group Ii

Objective. Evaluate if different bleeding patterns associated with the use of the levonorgestrel intrauterine system (LNG-IUS) are associated with different uterine and endometrial vascularization patterns, as evidenced by ultrasound power Doppler analysis.Methodology. A longitudinal study, with each subject acting as its own control was conducted between January 2010 and December 2012. Healthy volunteers with a history of heavy but cyclic and regular menstrual cycles were enrolled in the study. Ultrasonographic examination was performed before and after six months of LNG-IUS placement: uterine volume, endometrial thickness, and subendometrial and myometrial Doppler blood flow patterns have been evaluated.Results. A total of 32 women were enrolled out of 186 initially screened. At six months of follow-up, all subjects showed a reduction in menstrual blood loss; for analysis, they were retrospectively divided into 3 groups: normal cycling women (Group I), amenorrheic women (Group II), and women with prolonged bleedings (Group III). Intergroup analysis documented a statistically significant difference in endometrial thickness among the three groups; in addition, mean pulsatility index (PI) and resistance index (RI) in the spiral arteries were significantly lower in Group I and Group III compared to Group II. This difference persisted also when comparing—within subjects of Group III—mean PI and RI mean values before and after insertion.Conclusions. The LNG-IUS not only altered endometrial thickness, but—in women with prolonged bleedings—also significantly changed uterine artery blood flow. Further studies are needed to confirm these results and enable gynecologists to properly counsel women, improving initial continuation rates.

The role of antioxidants in the complex therapy of patients with endometriosis-associated infertility

2020 ◽  
Vol 19 (6) ◽  
pp. 28-33
Author(s):  
M.G. Khatlamadzhiyan ◽  
◽  
E.V. Kharitonova ◽  
L.N. Shcherbakova ◽  
E.I. Kalenikova ◽  
...  
Keyword(s):  
Blood Flow ◽  
Reproductive Function ◽  
Control Group ◽  
Complex Therapy ◽  
Endometrium Receptivity ◽  
Infertile Patients ◽  
Subendometrial Blood Flow ◽  
Endometrial Blood Flow ◽  
Fertile Women

Objective. To study the role of antioxidants in the complex therapy of patients with endometriosis-associated infertility on the example of evaluating the effectiveness of ubidecarenone. Patients and methods. Forty-three patients with endometriosis-associated infertility and nineteen fertile women with complete reproductive function were examined. In order to improve the receptivity of endometrium and correct the antioxidant status in infertile patients with endometriosis after laparoscopy, therapy with Synergin® was administered at a dosage of 2 capsules per day for 3 months. After therapy, an assessment of endometrium and intrauterine perfusion was made. Results. There was a significant decrease in intrauterine perfusion in patients with endometriosis-associated infertility compared to the control group. However, after therapy with Synergin® within 3 months and correction of endothelial dysfunction in infertile patients with endometriosis, an improvement in intrauterine perfusion was revealed. Thus, prior to therapy, subendometrial blood flow was assessed in 13% of patients as satisfactory, in 77% – it was reduced, in 10% – it was absent; after therapy, 86% of patients showed satisfactory blood flow and 14% had decreased blood flow. Endometrial blood flow was reduced in 32% of patients and in 68% were absent prior to treatment, and after treatment, it was assessed as satisfactory in 45% and was reduced in 55%. Conclusion. Pathogenetic antioxidant therapy is necessary in the complex therapy of infertility in patients with external genital endometriosis after surgical treatment. Key words: α-Tocopherol, infertility, coenzyme Q10, endometrium receptivity, endometriosis

scholarly journals Effect of Hydrotubation in Unexplained Infertility – A Randomized Controlled Trial

2016 ◽  
Vol 22 (3) ◽  
Author(s):  
Shazia Saaqib ◽  
Muhammad Arshad Chohan ◽  
Misbah Ashraf ◽  
Ammara Mumtaz
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Clomiphene Citrate ◽  
Unexplained Infertility ◽  
Control Group ◽  
Fallopian Tubes ◽  
Randomized Controlled ◽  
Tubal Blockage ◽  
Study Participants ◽  
And Control

<p>Unexplained infertility is a major gynecological problem with complex etiolgy. Partial tubal blockage with inflammatory reaction and thick mucus plugs in fallopian tubes and cervix is one of the likely causes in such cases. This study is based on the hypothesis that women having unexplained infertility could be helped by transcervical flushing of fluid through the fallopian tubes which would remove reversible blocking factors and help in achieving pregnancy.</p><p><strong>Objective:</strong><strong>  </strong>To compare the outcome of hydrotubation<br /> in unexplained infertility in clomiphene citrate stimulated cycles with control group (no Hydrotubation).</p><p><strong>Setting:</strong><strong>  </strong>Infertility Centre of a Public Sector Hospital.</p><p><strong>Study Design:</strong><strong>  </strong>A two years Prospective randomized controlled trial from Jan 2014 to Dec 2015.</p><p><strong>Method:</strong><strong>  </strong>128 women participated in the study. Participants were divided into study and control group with 64 members in each group. Ovulation induction was done with clomiphene citrate in all the participants and confirmed by ovulation detection strips and follicular tracking on Ultrasonography. 50 cc cocktail of inject-ion (inj.) kanamycin 1 gm, inj. hydrocortisone and normal saline was injected transcervically in study group for three consecutive days from the next day after end of menstruation. No hydrotubation was done in control group. Main outcome measures were number of conceptions within next 3 cycles and complications of hydrotubation.</p><p><strong>Results:</strong><strong>  </strong>In hydrotubation group, 20 women conceived. Out of these, 14 women conceived in the same cycle in which hydrotubation was done while 6 pregnancies occurred in subsequent cycle. 4 pregnancies occurred in the control group. Complications of hydrotubation were mild abdominal pain (59 women), vomiting (49 women) and Per vaginum bleeding (18 women). There were significantly more pregnancies in women who experienced right shoulder tip pain after the procedure.</p><p><strong>Conclusion:</strong><strong>  </strong>In women with unexplained infertility, tubal hydration can increase conception rate and decrease the time to achieve pregnancy.</p><p> </p>

scholarly journals Role of low-molecular-weight heparin in altering uterine artery blood flow in recurrent spontaneous abortion: a prospective study

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094555
Author(s):  
Kemei Zhang ◽  
Ensheng Wang ◽  
Yang Li ◽  
Haiyan Xu ◽  
Jiaou Zhang ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Blood Flow ◽  
Low Molecular Weight Heparin ◽  
Uterine Artery ◽  
Control Group ◽  
Low Molecular Weight ◽  
Artery Blood Flow ◽  
Uterine Perfusion ◽  
Midluteal Phase

Objective This study aimed to determine the role of uterine artery blood flow (UABF) in recurrent spontaneous abortion (RSA) and to determine a viable option to promote the outcome of pregnancy. Methods A total of 421 women were prospectively recruited for this research. UABF indices, including the systolic/diastolic ratio, pulsatility index and resistance index, during the midluteal phase were compared between patients with RSA and women without RSA (controls). After low-molecular-weight heparin (LMWH) was administered to patients with RSA, indices at 7, 10, and 12 weeks of gestation were compared between the two groups. Results UABF indices during the midluteal phase were significantly higher in the RSA group than in the control group. After LMWH was administered to the RSA group, UABF indices in the first trimester were similar to those in the control group. The rate of spontaneous miscarriage was also similar between the groups after LMWH treatment. Conclusions Our study shows that sufficient uterine perfusion is crucial for a successful pregnancy. LMWH reduces the rate of spontaneous miscarriage in patients with RSA to a similar rate in women without RSA. LMWH might play a role in decreasing UABF resistance and increasing uterine perfusion.

scholarly journals The Proximal and Distal Effects of Blood Flow Restriction Therapy on Upper and Lower Extremity Strengthening: A Randomized Controlled Trial

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0033
Author(s):  
Eric N. Bowman ◽  
Rami El-shaar ◽  
Heather Milligan ◽  
Greg Jue ◽  
Karen Mohr ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Blood Flow ◽  
Lower Extremity ◽  
Controlled Trial ◽  
Lower Extremities ◽  
Blood Flow Restriction ◽  
Control Group ◽  
Flow Restriction ◽  
Low Intensity ◽  
Randomized Controlled

Objectives: Blood flow restriction (BFR) therapy consists of low-intensity exercise performed under reduced venous return due to an inflatable tourniquet. This produces similar physiologic and clinical effects to high-intensity routines with less joint and tissue stress. Postoperative patients may benefit from more efficient rehabilitation. Proximal and distal effects of BFR have been evaluated, however, minimal literature exists on its use in orthopaedic conditions. The purpose of this study was to determine the effects of low-intensity BFR therapy both proximal and distal, in the upper and lower extremities. Methods: This was a prospective, randomized controlled trial of healthy subjects completing a standardized 6-week course of BFR therapy. Subjects were randomized to BFR therapy on one extremity or to a control group. Subjects were excluded for cardiac, pulmonary, or hematologic disease, pregnancy, or previous surgery in the extremity. Data collected at baseline and completion included: limb circumferences, isokinetic, and manual strength testing. Results: Forty subjects completed the protocol. Average age was 27.7 years; 54% were female. For both upper and lower extremity groups, a statistically significant increase was observed in manual and isokinetic strength both proximal and distal to the BFR tourniquet when compared to both the non-tourniquet extremity and the control group (p<0.05). Limb circumference significantly increased in the upper (p<0.01) and lower extremities (p=0.02). A significant increase in manual strength was noted in shoulder abduction and scaption, and hip extension and abduction even in the non-tourniquet BFR extremity compared to the control group (p<0.05). Conclusion: Low-intensity BFR therapy led to greater increases in muscle strength and hypertrophy. Similar strengthening effects were seen in proximal and distal muscle groups. Strength increases in the contralateral BFR extremity may corroborate a systemic effect. This study provides data to further evaluate the efficacy and safety of BFR therapy in operative and non-operative orthopaedic conditions. [Table: see text]

scholarly journals Correlation between Parturients’ Uterine Artery Blood Flow Spectra in the First and Second Trimesters of Pregnancy and Fetal Growth Restriction

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Hongna Yu ◽  
Meiqin Yuan ◽  
Ling Wang ◽  
Xia Li ◽  
Meiping Jiang
Keyword(s):  
Blood Flow ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Uterine Artery ◽  
First Trimester ◽  
Growth Restriction ◽  
Control Group ◽  
Artery Blood Flow ◽  
Second Trimester ◽  
Total Incidence

Objective. To explore the correlation between parturients’ uterine artery blood flow spectra in the first and second trimesters of pregnancy and fetal growth restriction (FGR). Methods. The data of parturients treated in our hospital from February 2018 to February 2020 were retrospectively analyzed, 50 parturients with FGR were selected as the FGR group, and other 50 healthy cases were selected as the control group. In the first trimester (11-12 weeks of gestation) and the second trimester of pregnancy (13–24 weeks of gestation), the parturients of the two groups accepted the color Doppler ultrasonography (CDS), their hemodynamics indicators of uterine artery were recorded, and the correlation between their uterine artery blood flow spectra in the two periods and FGR was analyzed with the Receiver Operating Characteristic (ROC) curve. Results. No statistical differences in the parturients’ general information including age, gestational weeks, gravidity, and parity between the two groups were observed ( P  > 0.05); the newborn’s body weight, Apgar scores, number of preterm infants, and the number of infants transferring to the neonatal intensive care unit (NICU) were significantly different between the two groups ( P  < 0.05); in the first and second trimesters of pregnancy, the uterine artery pulsatility index (UtA-PI), uterine artery resistance index (UtA-RI), maximal systolic flow velocity, and systolic/diastolic (UtA-S/D) ratio were significantly higher in the FGR group than in the control group ( P  < 0.05), and the time-averaged maximal velocity (TAMX) was significantly lower in the FGR group than in the control group ( P  < 0.001); in early pregnancy, the incidence of early diastolic notch at bilateral uterine arteries between the two groups was not significantly different ( P  > 0.05), and the unilateral and total incidence in the first trimester as well as the unilateral, bilateral, and total incidence in the second trimester were significantly higher in the FGR group than in the control group ( P  < 0.05); in the first trimester, the sensitivity of detecting FGR with a uterine artery blood flow spectrum was 0.820, AUC (95% CI) = 0.840 (0.757–0.923), and in the second trimester, it was 0.860, AUC (95% CI) = 0.900 (0.832–0.968). Conclusion. There is a correlation between uterine artery blood flow spectra in the first and second trimesters of pregnancy and FGR, and the sensitivity of spectrum in the first trimester is higher than that in the second trimester, presenting a better clinical application value.

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