“PERIFOLLICULAR BLOOD FLOW IN THE PREOVULATORY PHASE AS A PREDICTOR OF CONCEPTION IN WOMEN UNDERGOING NON-IVF INFERTILITY TREATMENT”
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Keywords
Infertility, Perifollicular Blood Flow, Doppler Ultrasonography, Ovulation Induction, Follicular Vascularity, Conception Rate
Abstract
Background: Infertility remains a major global health concern, affecting approximately 10–15% of couples of reproductive age. While assisted reproductive techniques have improved outcomes, success largely depends on oocyte quality, which is influenced by the follicular microenvironment. Perifollicular blood flow (PFBF), assessed using Doppler ultrasonography, serves as an indirect marker of follicular vascularity and may play a critical role in determining follicular competence and reproductive outcomes.
Objective: To evaluate the role of perifollicular blood flow during the preovulatory phase and its association with conception rates in women undergoing infertility treatment.
Methods: This prospective observational study was conducted over a period of 18 months at a tertiary care center and included 34 women aged 19–40 years with primary or secondary infertility. All participants underwent ovulation induction followed by timed intercourse or intrauterine insemination. Serial transvaginal ultrasonography was performed for follicular monitoring. When the dominant follicle reached 18–20 mm, perifollicular blood flow was assessed using color/power Doppler and graded accordingly. Ovulation was triggered using human chorionic gonadotropin (hCG). The primary outcome measure was conception, confirmed by biochemical and ultrasonographic evaluation.
Results: The mean age of the study population was 29.4 ± 4.8 years, with a mean body mass index of 26.1 ± 3.5 kg/m². The overall conception rate was 35.3%. A statistically significant positive association was observed between PFBF grade and conception rates, with no pregnancies in Grade 1, 20% in Grade 2, 45.4% in Grade 3, and 71.4% in Grade 4 follicles. Women who conceived demonstrated significantly higher mean PFBF grades compared to those who did not conceive (3.4 ± 0.6 vs. 2.1 ± 0.8; p < 0.001). Additionally, higher PFBF grades were significantly associated with larger follicular size at trigger (p = 0.041) and increased endometrial thickness (p = 0.0029). No statistically significant association was found between PFBF grade and polycystic ovary syndrome status.
Conclusion: Perifollicular blood flow is a reliable functional marker of follicular competence and a significant predictor of conception outcomes. Higher grades of vascularity are associated with improved follicular maturity, enhanced endometrial development, and increased pregnancy rates. Incorporation of Doppler-based assessment of perifollicular blood flow into routine infertility evaluation protocols may facilitate individualized treatment strategies and improve clinical outcomes.
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Dr. Pooja Jadhav
Junior Resident of Obstetrics And Gynaecology, Atal Bihari Vajpayee Medical University,
Dr. Bhavana Gupta
Professor and Head of Obstetrics and Gynaecology, Prasad Institute of Medical Sciences,
Dr. Tanusha Das
Assistant Professor Of Obstetrics And Gynaecology, Prasad Institute Of Medical Sciences,
Dr. Maya Yadav
Junior Resident of Obstetrics and Gynaecology, Atal Bihari Vajpayee Medical University,
Dr. Mansi Bhalothia
Junior Resident of Obstetrics and Gynaecology, Atal Bihari Vajpayee Medical University,
