Ultrasonographic Comparison of Ovarian Stromal Blood Flow between Fertile Women with Normal Ovaries and Infertile Women with Polycystic Ovary Syndrome

Abstract

Background: Polycystic ovary syndrome (PCOS) is characterized by ovulatory dysfunction, hyperandrogenism, and altered ovarian morphology. Doppler ultrasonography may provide additional information regarding ovarian stromal vascular characteristics, although Doppler indices are not established as standalone diagnostic criteria for PCOS. Objective: To compare ovarian stromal blood-flow indices, ovarian morphology, and reproductive hormones between fertile women with normal ovaries and infertile women with PCOS and to examine relationships among vascular, structural, and hormonal markers. Methods: A cross-sectional comparative study included 120 women aged 20–35 years: 60 fertile controls and 60 infertile women with PCOS diagnosed using Rotterdam criteria. Transvaginal Doppler ultrasonography was performed on cycle days 2–4. Pulsatility index (PI), resistance index (RI), systolic-to-diastolic (S/D) ratio, vascularization index (VI), flow index (FI), vascularization-flow index (VFI), antral follicle count (AFC), and ovarian volume were assessed. Results: Participants with PCOS had substantially greater AFC (36.50±5.64 vs 15.43±4.34; mean difference 21.07, 95% CI 19.25–22.89) and ovarian volume (11.99±2.80 vs 6.11±1.30 mL; mean difference 5.88, 95% CI 5.09–6.67), together with higher PI, RI, VI, FI, and VFI; all p<0.001. FSH was lower, whereas LH and testosterone were higher in the PCOS group. VI correlated positively with AFC (r=.667), ovarian volume (r=.596), LH (r=.612), and testosterone (r=.591), whereas FSH was inversely related to VI (r=−.614) and FI (r=−.557); all p<0.001. Conclusion: PCOS was associated with marked structural, hormonal, and stromal vascular differences. Doppler indices may provide complementary physiological information but require standardized prospective validation before use for diagnosis or fertility prediction.