Ovarian size and vascularization as assessed by three-dimensional grayscale and power Doppler ultrasound in asymptomatic women 20–39 years old using combined oral contraceptives

doi:10.1016/j.contraception.2011.12.013

Contraception

Volume 86, Issue 3, September 2012, Pages 257-267

https://doi.org/10.1016/j.contraception.2011.12.013 Get rights and content

Abstract

Background

The aim of this study is to estimate ovarian volume, number and volume of antral follicles, and ovarian power Doppler vascular indices as assessed by three-dimensional (3D) transvaginal grayscale and power Doppler ultrasound in women using combined oral contraceptives (COC).

Study Design

Two hundred thirteen gynecologically asymptomatic women 20–39 years old using COC were examined with transvaginal 3D grayscale and power Doppler ultrasound on cycle day 4–8 (first cycle day is first day of withdrawal bleeding). We used a Voluson E8 ultrasound system with a 6–12-MHz transvaginal transducer. Ovarian volume, number and volume of antral follicles ≥2 mm, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using the virtual organ computer-aided analysis (VOCAL™) and sonography-based automated volume calculation (SonoAVC™) software. Results are described separately for women with follicles 2.0–10.0 mm and for those with at least one follicle >10.0 mm for two age groups: 20–29 years (n=166) and 30–39 years (n=47). Results are also compared between women on monophasic (n=151) and triphasic (n=59) COC, and between women using COC with older (n=110) and newer (n=100) progestins and different doses of estrogen.

Results

One hundred eighty-nine (89%) women had follicles 2.0–10.0 mm, and 24 (11%) had follicle(s) >10.0 mm. The proportion of women with follicle(s) >10.0 mm did not differ between women with different types of COC. In women with follicles 2.0–10.0 mm, the right ovary was larger (mean difference 0.5 cm³ [95% confidence interval 0.22–0.82]) and contained more follicles (mean difference 1.5 [0.52–2.56]) than the left one in the age group 20–29 years. The same differences between the right and left ovary were seen in women 30–39 years old, but they were not statistically significant. In both ovaries, the number of antral follicles 2.0–10.0 mm [median (range)] was significantly higher in women 20–29 than in those 30–39 years old [11 (2–34) vs. 8 (1–26), p=.012 for the right ovary; 9 (0–28) vs. 7 (1–28), p=.035 for the left ovary]. Ovarian volume tended to be smaller in women 20–29 than in those 30–39 years old, but the differences were not statistically significant. Size of the largest follicle, total follicular volume and vascular indices manifested no clear differences between the age groups. For all 378 ovaries with follicles ≤10 mm, ovarian volume ranged from 1 to 16 cm³ (median 5), total follicular volume ranged from 0.03 to 2.7 cm³ (median 0.7), VI ranged from 0.0 % to 13.4% (median 0.97), FI ranged from 0 to 38 (median 25), and VFI ranged from 0.0 to 4.7 (median 0.3).

Conclusions

Our results show estimated ranges of 3D grayscale and power Doppler ultrasound measurements in ovaries of women using COC.

Introduction

Combined oral contraceptives (COC) are used by many women. Remaining ovarian activity and follicle development during COC use have been reported [1]. Ultrasonography is a useful tool for assessing ovarian morphology and vascularization. Three-dimensional (3D) grayscale and power Doppler ultrasound has made it possible to assess volume, number of follicles and ovarian vascularization of the ovary as a whole. To correctly interpret 3D ultrasound images, one must define what constitutes normal findings at 3D ultrasound examination.

The aim of this study is to estimate ovarian volume, number and volume of antral follicles, and ovarian power Doppler vascular indices as assessed by 3D transvaginal grayscale and power Doppler ultrasound in women using COC.

Section snippets

Materials and methods

The study protocol was approved by the Ethics Committee of the Medical Faculty of Lund University, Sweden. Written informed consent was obtained from all participants immediately before the ultrasound examination after the nature of the procedures had been fully explained to them both in writing in an invitation letter and orally by the ultrasound examiner before the ultrasound examination.

Results

Four thousand nine hundred and eighty-two invitation letters were distributed, and 899 (18%) women returned the response form stating that they were willing to participate. Of the 899 women who initially stated that they wanted to participate, 153 finally declined participation and another 512 women did not fulfill our eligibility criteria. The 234 women fulfilling our eligibility criteria were examined with ultrasound as described above. Of the 234 women examined with ultrasound, three (1%)

Discussion

Our results show that there is wide variation in ovarian volume, number of antral follicles, size of the largest follicle, total follicular volume and vascular indices as measured by 3D ultrasound on cycle day 4–8 in gynecologically asymptomatic women using COC. They also show that some 11% (95% CI 7–16) of women using COC for 3 months or more have follicles >10.0 mm in at least one ovary on cycle day 4–8. In addition, we found the right ovary to be larger and to contain a larger number of

Acknowledgments

This study was supported by the Swedish Medical Research Council (grants nos. K2001-72X-11605-06A, K2002-72X-11605-07B, K2004-73X-11605-09A and K2006-73X-11605-11-3), two governmental grants [Landstingsfinansierad regional forskning (Region Skåne and ALF-medel)] and funds administered by Malmö University Hospital.

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^☆: Competing interests: None of the authors have any financial, personal or professional competing interests.

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Original research articleOvarian size and vascularization as assessed by three-dimensional grayscale and power Doppler ultrasound in asymptomatic women 20–39 years old using combined oral contraceptives☆

Abstract

Background

Study Design

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgments

Fertil Steril

Fertil Steril

Fertil Steril

Fertil Steril

Fertil Steril

Am J Obstet Gynecol

Gynecol Oncol

Obstet Gynecol

J Obstet Gynaecol Can

Contraception

Contraception

Contraception

Fertil Steril

Contraception

Fertil Steril

Placenta

Residual ovarian activity during oral steroid contraception

Hum Reprod Update

Progestogens in combined oral contraceptives for contraception

Cochrane Database Syst Rev

Ultrasound of the human corpus luteum

Ultrasound Q

Automated follicle tracking facilitates standardization and may improve work flow

Ultrasound Obstet Gynecol

Characterization of ovarian follicular wave dynamics in women

Biol Reprod

Original research article
Ovarian size and vascularization as assessed by three-dimensional grayscale and power Doppler ultrasound in asymptomatic women 20–39 years old using combined oral contraceptives☆