Quantification of Ovarian Power Doppler Signal With Three-Dimensional Ultrasonography to Predict Response During In Vitro Fertilization Ilkka Y. Ja ¨rvela ¨, MD, Povilas Sladkevicius, MD, Simon Kelly, MD, Kamal Ojha, MD, Stuart Campbell, MD, and Geeta Nargund, MD OBJECTIVE: To evaluate whether power Doppler predicts ovarian response to gonadotrophin stimulation during in vitro fertilization (IVF). METHODS: Forty-five women were divided into low-reserve (n  12) and normal-reserve (n  33) ovarian groups, according to antral follicle count. Transvaginal three-di- mensional power Doppler ultrasonographic examinations were performed after pituitary downregulation and after gonadotrophin stimulation. The antral follicle count, ovar- ian volume, vascularization index, flow index, vasculariza- tion flow index, and mean gray value were measured and related to the number of oocytes retrieved and the preg- nancy rate. RESULTS: The number of oocytes retrieved correlated with the antral follicle count (R  .458, P  .004) and ovarian volume (R  .388, P < .016) but not with vascularization index, flow index, vascularization flow index, or mean gray value after pituitary suppression. There was an increase in vascularization index (P < .017), flow index (P < .001), and vascularization flow index (P < .007) during gonadotro- phin stimulation in the normal-ovary group but not in the low-ovarian-reserve group. CONCLUSION: According to our results, quantification of power Doppler signal in the ovaries after pituitary suppres- sion does not provide any additional information to predict the subsequent response to gonadotrophin stimulation dur- ing IVF. The increase in ovarian power Doppler signal during gonadotrophin stimulation is related to the antral follicle count observed after pituitary suppression. (Obstet Gynecol 2003;102:816 –22. © 2003 by The Amer- ican College of Obstetricians and Gynecologists.) The ability of the ovary to respond to exogenous gona- dotrophin stimulation and to produce several mature oocytes simultaneously is essential for successful in vitro fertilization (IVF). Ovarian responsiveness is highly vari- able and therefore difficult to predict. Transvaginal ul- trasonography has proved to be an easy and noninvasive method to provide essential information on the ovarian responsiveness before the initiation of gonadotrophin stimulation. 1–5 Ovarian volume as determined by trans- vaginal ultrasonography seems to correlate with the ovarian reserve. Lass et al 6 observed that small ovaries are associated with poor response to human menopausal gonadotropin and a very high cancellation rate during IVF. Similarly, the number of antral follicles seems to correlate with the response to gonadotrophin stimula- tion. 2–5 A very low number of antral follicles seems to be associated with poor response and a high cancellation rate, 2–5 whereas a high number of antral follicles seems to predict not only good response but also sometimes an increased risk for ovarian hyperstimulation syndrome. 4 It is possible to classify the ovaries according to ultra- sonographic features as inactive or active, even before the initiation of gonadotrophin stimulation. 2 It seems that follicular blood flow plays a major role during the growth and development of the follicle con- taining the oocyte. 7–11 The follicle acquires a vascular sheet of its own at the antral stage. 12 Combining the color Doppler facility in ultrasonography has enabled the detection and measurement of the follicular blood flow. According to two-dimensional color Doppler stud- ies, peak systolic velocity of individual follicles on the day of human chorionic gonadotropin (hCG) injection and egg collection correlates with oocyte recovery, 7,8 development potential of the oocyte, 10 quality of the embryo, 7,9 and even with the pregnancy rate during IVF From the Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland; Diana, Princess of Wales Center for Reproductive Medicine, Academic Department of Obstetrics and Gynecology, St. George’s Hospital Medical School, London, United Kingdom; Department of Obstetrics and Gynecology, Kvinnokliniken, Universitetsjukhuset MAS, Malmo ¨, Sweden; and Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada. This research was supported by a Marie Curie Fellowship of the European Community Program “Quality of Life and Management of Living Resources” (to IYJ) under contract number QLRI-CT-1999-51230. 816 VOL. 102, NO. 4, OCTOBER 2003 0029-7844/03/$30.00 © 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier. doi:10.1016/S0029-7844(03)00693-8