Evaluation of the tear parameters of ovulation induction patients in a short time period with anterior segment optical coherence tomography / Avaliação dos parâmetros lacrimais de pacientes submetidas à indução de ovulação por curto período pela tomografia de coerência óptica do segmento anterior

ABSTRACT Purpose: The effects of sex steroid hormones on tearparameters are known. Theaim of this studywas to examine the effects on tear parameters during exposure to high-dose sex steroids in a short period of time. Methods: Forty patients who were admitted to the infertility clinic of our hospital and planned to undergo ovulation induction with exogenous gonadotropins were included in our study. Prior tothe initiation of ovulation induction, the basal levels of estradiol were measured on day 3 of the menstrual cycle and ophthalmologic examinations were performed by the ophthalmology department of our hospital. The estradiol levels were-measured on the day ofovulation induction usinghuman chorionic gonadotropin and compared with basal estra­diol; eye examinations were also repeated. Result: Forty women with reproductive period and average age of 33.3 ± 4.2 years were included in this study. Basal levels of estradiol were significantly (p<0.001) higher after ovulation induction than before induction. The scores in the break-up timeand after induction were 6.2 ± 2.8 sn and 8.4 ± 1.4 sn, respectively. The values of Schirmer's test were 14.3 ± 7.1 mm and 20.6 ± 6.2 mm before and after induction, respectively. Both values were significantly higher after ovulation induction (p<0.001; p=0.001, respectively). Conclusion: We observed impro­vemet in tear function tests following the use of estradiol even for a limited time.The use of estradiol during menopause may improve dry eye symptoms in patients.

RESUMO Objetivo: Os efeitos dos hormônios esteróides se­xuais nos parâmetros lacrimais são conhecidos. O objetivo deste estudo foi examinar como os efeitos nos parâmetros lacrimais durante a exposição a altas doses de esteróides sexuais em um curto período de tempo. Métodos: Quarenta pacientes que foram admitidas na clínica de infertilidade do nosso hospital e planejavam a indução de ovulação por gonadotropinas exógenas. Antes do início da indução da ovulação, os níveis basais de estradiol foram medidos no terceiro dia do ciclo menstrual e os exames oftalmológicos foram efetuados pelo Departamento de Oftalmologia do nosso hospital. Os níveis de estradiol foram medidos no dia da indução da ovulação usando gonadotrofina coriónica humana e comparados aos estradiol basal; exames oftalmológicos também foram repetidos. Resultado: Quarenta mulheres com período reprodutivo e idade média de 33,3 ± 4,2 anos foram incluídas neste estudo. Os níveis basais de estradiol foram significativamente maiores (p<0,001) após a indução da ovulação do que antes desta. Os resultados dos testes de ruptura do filme lacrimal e após a indução foi de 6,2 ± 2,8 s e 8,4 ± 1,4 s respectivamente. Os valores do teste de Schirmer foram 14,3 ± 7,1 mm e 20,6 ± 6,2 mm, respectivamente antes e depois da indução. Ambos os valores foram significativamente maiores após a indução da ovulação (p<0,001; p=0,001 respectivamente). Conclusão: Observamos uma melhora nos testes de função lacrimal após o uso de estradiol, mesmo por tempo limitado. O uso de estradiol durante a menopausa poderá melhorar os sintomas do olho seco em pacientes.

May myo-inositol and d-chiro-inositol (40:1) treatment be a good option on normal-weighted polycystic ovary syndrome patients without insulin resistance?

AIM: To investigate the effectiveness of myo-inositol and d-chiro-inositol (MI:DCI) (40:1) treatment in normal-weight polycystic ovary syndrome (PCOS) patients without insulin resistance. METHODS: This retrospective case-control study included PCOS patients without insulin resistance who were diagnosed in the gynecology and obstetrics clinic of Baskent University Konya Practice and Research Hospital between January 2016 and October 2019 and received at least 6 months of MI:DCI (40:1) treatment. The patients were divided into two groups according to body mass index (BMI). Twenty-nine anovulatory patients without insulin resistance with a BMI of 18-25 were included in group 1 (normal-weight group), whereas 17 patients without insulin resistance with BMI > 25 were included in group 2 (obese/overweight group). Ovulation status of both groups was compared after MI:DCI treatment. RESULTS: Ovulation was detected in 23 of 29 patients in the normal-weight group, whereas it was detected only in 5 of 17 patients in the obese/overweight group; this difference was statistically significant (P < 0.001) (Table 2, Figure 1). Post-treatment progesterone levels of both groups were compared and in the normal-weight PCOS group was significantly higher than the obese/overweight group (P < 0.001) (Table 2, Figure 2). In addition, spontaneous pregnancy following treatment was observed in six of the seven (85.7%) patients in the normal-weight group who wanted to conceive, whereas it was observed in only two of the six (33.3%) patients in the obese/overweight group who wanted to conceive. CONCLUSION: Our results showed that MI:DCI (40:1) treatment may be a first-line treatment in normal-weight PCOS patients without insulin resistance.

Is placental KISS-1 expression associated with first trimester abortion spontaneous?

OBJECTIVE: Several studies have examined biological markers during the first trimester to predict the maintenance of a healthy pregnancy. One such marker is kisspeptin, which is encoded by the KISS-1 gene. We aimed to determine whether firsttrimester pregnancy losses were associated with levels of placental KISS-1 expression. METHODS: This prospective case control study was conducted at a tertiary center. The study group included 27 and 24 patients who underwent dilation and curettage at <10 weeks of gestation, due to first trimester spontaneous pregnancy loss and for elective termination (control), respectively. Placental and decidual tissues from all patients were sectioned and immunohistochemically analyzed for kisspeptin. RESULTS: Age, gravida status, parity number, gestational week, and number of previous abortions did not significantly differ between the groups. KISS-1 expression levels were significantly lower in the group with spontaneous abortion compared with the group with elective termination. The median staining intensity of KISS-1 expression in the elective and spontaneous termination groups were 3 (strong) and 2 (moderate), respectively (P=0.004). KISS-1 expression levels were significantly lower among patients with previous abortions in the elective termination group (P=0.002). CONCLUSION: KISS-1 expression levels were found to be significantly reduced in patients with spontaneous pregnancy loss; KISS-1 plays an important role in the implantation and continuation of pregnancy.

Serum and placental periostin levels in women with early pregnancy loss.

OBJECTIVES: Periostin is secreted from the placenta in the embryonic period and it is emphasized that it may be involved in endometrial implantation. In this study, we aimed to investigate periostin serum levels and placental tissue expression in first trimester pregnancy losses. STUDY DESIGN: In this prospective case-control study, 30 patients who underwent dilatation and curettage with first trimester spontaneous abortion (<10 weeks of gestation) were included in the study group and 30 patients who had voluntary pregnancy termination (<10 gestational weeks) were included in the control group. Serum samples collected from the study and control groups were analyzed usingenzyme-linkedimmunosorbent assay (ELISA), and trophoblastic and decidual tissues were examined using immunohistochemical staining with streptavidin-biotin-peroxidase techniques. RESULTS: There were no significant differences between the groups in terms of age, gravida status, parity number, gestational week, and number of previous abortions. In the spontaneous abortion group, the serum level of periostin was significantly lower than in the voluntary termination group (6.56 ± 4.16 pg/mLvs. 9.51 ± 4.52 pg/mL, p = 0.03). There was no significant difference between the two groups in terms of periostin expression in decidual and trophoblastic tissue (p = 0.617, p = 0.274, p = 0.497). CONCLUSION: Periostin serum levels were significantly reduced in patients with spontaneous pregnancy loss. Periostin can be used as a predictive marker for the success of endometrial implantation.

Role of mean platelet volume in pregnancy to predict gestational diabetes mellitus in the first trimester.

Objectives: Gestational diabetes mellitus (GDM) is defined as glucose intolerance detected for the first time in pregnancy or identified during pregnancy. Mean platelet volume (MPV) is a marker of activation and function of platelet. Several studies investigated the relation between MPV and GDM. The purpose of the present study is to predict GDM in the first trimester by using MPV value.Materials and methods: Two hundred pregnant women with GDM and 200 normal pregnant women were enrolled in the study. The first trimester MPV values of GDM and control groups were compared to predict GDM in the first trimester.Results: Women with GDM had higher MPV value compared with the control group (p < .001). The area under the receiver-operator curve was 0.70 for MPV. The cutoff value of MPV was 7.38 fl with 70% sensitivity and 60% specificity. According to the ages, MPV value was higher in GDM group in the individuals who were above 28-year-old (p < .001).Conclusion: MPV can be used to predict GDM in the first trimester.

Evaluation of the tear parameters of ovulation induction patients in a short time period with anterior segment optical coherence tomography.

PURPOSE: The effects of sex steroid hormones on tearparameters are known. Theaim of this studywas to examine the effects on tear parameters during exposure to high-dose sex steroids in a short period of time. METHODS: Forty patients who were admitted to the infertility clinic of our hospital and planned to undergo ovulation induction with exogenous gonadotropins were included in our study. Prior tothe initiation of ovulation induction, the basal levels of estradiol were measured on day 3 of the menstrual cycle and ophthalmologic examinations were performed by the ophthalmology department of our hospital. The estradiol levels were-measured on the day ofovulation induction usinghuman chorionic gonadotropin and compared with basal estra-diol; eye examinations were also repeated. RESULT: Forty women with reproductive period and average age of 33.3 ± 4.2 years were included in this study. Basal levels of estradiol were significantly (p<0.001) higher after ovulation induction than before induction. The scores in the break-up timeand after induction were 6.2 ± 2.8 sn and 8.4 ± 1.4 sn, respectively. The values of Schirmer's test were 14.3 ± 7.1 mm and 20.6 ± 6.2 mm before and after induction, respectively. Both values were significantly higher after ovulation induction (p<0.001; p=0.001, respectively). CONCLUSION: We observed impro-vemet in tear function tests following the use of estradiol even for a limited time.The use of estradiol during menopause may improve dry eye symptoms in patients.

Phosphodiesterase 4 inhibitor plus metformin is superior to metformin alone for the treatment of polycystic ovary syndrome: A rat model study.

The role of metformin in the management of polycystic ovary syndrome (PCOS) and PCOS-related obesity remains controversial. Recent research on the treatment of PCOS-related obesity investigated novel therapeutic agents with the potential to work synergistically with metformin. The aim of the present study was to determine the synergistic effect of a phosphodiesterase 4 inhibitor (PDE4i) and metformin on weight and hormonal changes in a rat model of PCOS. A total of 40 female Sprague-Dawley rats were randomly divided into 4 groups (n=10/group): Sham; PCOS control (no medication after PCOS induction with dehydroepiandrosterone); metformin (300 mg/kg/day p.o. after PCOS induction); and metformin + PDE4i (300 mg/kg/day p.o. metformin + 0.5 mg/kg/day p.o. PDE4i after PCOS induction). The body weight was measured every 7 days, from day 1 to day 49. Vaginal smears were performed and examined daily via light microscopy for determination of the stage of each rat's estrous cycle. At the end of 21st day and at the end of the study, blood samples were collected from rats and the testosterone and insulin levels were measured. Immunohistochemical staining was performed to quantify phosphorylated cyclic AMP response element-binding protein expression in all groups. At the end of the study, the median body weight differed significantly among the groups (χ2=30.581, P<0.001), being the highest in the PCOS control group and the lowest in the metformin + PDE4i group. At the end of the study, the median testosterone level differed significantly among the groups (χ2=27.057, P<0.001), being the highest in the PCOS control group and the lowest in the metformin + PDE4i group. The cycle was restored to normal at the end of the study in all the rats in the metformin and metformin + PDE4i groups, whereas an irregular cycle persisted in all the rats in the PCOS control group. In conclusion, PDE4i + metformin was superior to metformin alone in reducing weight gain and decreasing the testosterone levels in a rat model of PCOS.

Vitamin D receptor gene TaqI single nucleotide polymorphism is not associated with lead levels in maternal and umbilical cord blood.

PURPOSE: We aimed to investigate the association of vitamin D receptor (VDR) gene TaqI single nucleotide polymorphism (SNPs) with serum lead (Pb) levels in maternal and umbilical cord blood. MATERIALS AND METHODS: Eighty-one patients who lived in Konya, Turkey for the last 3 years and had delivery at Baskent University Konya Hospital in 2016 were included in this study. Venous blood samples were drawn from each volunteer immediately before giving birth to determine the maternal Pb levels and VDR SNPs. Additionally, umbilical cord blood samples were collected from the umbilical vein into tube with EDTA as an anticoagulant immediately after birth to determine Pb levels of the fetus. RESULTS: The median level of Pb in the maternal blood was 29.00 (Interquartile Range (IQR) = 16.35) µg/L and the median Pb level in the cord blood was 22.50 (IQR = 9.75) µg/L. Blood Pb level of women living in the urban area was significantly higher than in those living in the rural area (Z = 2.118; p = .034). There was a very strong positive correlation between the Pb levels in the maternal blood and in the umbilical cord blood (ρ = 0.825, p < .001, respectively). Regarding VDR SNPs, "TT", "TC", and "CC" VDR TaqI genotypes were observed in 28 (34.6%), 45 (55.5%), and eight samples (9.9%), respectively. Pb levels in maternal and cord blood were higher in women with the "CC" VDR TaqI genotype; however, there was no statistically significant difference (p > .05). CONCLUSIONS: Although women with the "CC" VDR TaqI genotype had higher maternal and cord blood Pb levels, this was statistically insignificant and therefore, VDR TaqI SNPs did not significantly affect maternal and umbilical cord blood Pb levels.

Platelet-to-lymphocyte ratio: A new inflammatory marker for the diagnosis of preterm premature rupture of membranes.

OBJECTIVE: Preterm premature rupture of membranes (PPROM) is closely related with maternal and fetal complications. Therefore, early diagnosis is extremely important to provide maternal and fetal well-being. Many inflammatory markers have been evaluated for their ability to diagnose membrane rupture at early stages. We aimed to investigate the relationship between the platelet-to-lymphocyte ratio (PLR) and preterm premature membrane rupture. MATERIAL AND METHODS: In this study, 121 pregnant women with PPROM and 96 age-matched pregnant women with spontaneous preterm labor who were admitted to our hospital between January 2014 and December 2015 were enrolled. Demographic data, complete blood cell count results, and neonatal outcomes were recorded. RESULTS: The neutrophil and platelet counts were higher in the PPROM group (9948.4±3393.2 vs. 7466.1±1698.5/mm3 and 244.5±60 vs. 210.6±64.8/mm3, respectively, p<0.001). The PLR and neutrophil-to-lymphocyte ratios (NLR) were both significantly higher in the PPROM group (p<0.001). Correlation analysis revealed that the PLR was positively correlated with the NLR (r=0.10, p=0.031). The ability of the PLR to diagnose preterm premature rupture of membranes was evaluated using an ROC curve. The sensitivity and specificity of the PLR was 57.8% and 73.7%, respectively, at a threshold >117.14 (p<0.001). CONCLUSION: The PLR might be a cost effective, easy to use, and practical marker for the early diagnosis of PPROM, which can help to determine the appropriate waiting time for delivery and provide maternal and fetal well-being.

GnRH agonist triggering affects the kinetics of embryo development: a comparative study.

BACKGROUND: To evaluate the effects of an ovulation triggering agent, human chorionic gonadotropin (hCG), versus a gonadotropin-releasing hormone agonist (GnRHa) on early embryo development in vitro using a time-lapse system. METHODS: Retrospective analysis of a prospectively collected database. A total of 739 embryos from 152 infertile couples undergoing intracytoplasmic sperm injection cycles. INTERVENTIONS: Embryo culture in a time-lapse incubator (EmbryoScope, Vitrolife, Göteborg, Sweden). MAIN OUTCOME MEASURES: Embryo morphokinetic parameters. RESULTS: In the 152 women, 252 embryos were derived from GnRHa-triggered cycles compared with 487 embryos derived from hCG-triggered cycles. Time-lapse analysis revealed that embryos from cycles triggered by a GnRHa cleaved faster than embryos derived from hCG-triggered cycles. CONCLUSION: Triggering with a GnRHa in in vitro fertilization cycles affects embryo kinetics.

Absence of luteal phase defect and spontaneous pregnancy in IVF patients despite GnRH-agonist trigger and "freeze all policy" without luteal phase support: a report of four cases.

Human chorionic gonadotropin (hCG) is commonly used for final oocyte maturation in "in vitro fertilization" (IVF)-treatment cycles, however, the main important risk is development of severe ovarian hyperstimulation syndrome (OHSS). OHSS can almost be avoided by using gonadotrophin-releasing-hormone agonist for final oocyte maturation in an antagonist protocol. However, primarily this approach lead to a very poor reproductive outcome, despite the use of a standard luteal phase support. The reason seems to be severe luteolysis. Obviously, luteolysis post-gonadotropin-releasing-hormone-agonist (post-GnRH-a) trigger is individual specific, and not all patients will develop a complete luteolysis, as expected previously. Luteolysis can been reverted by the administration of hCG. Unprotected intercourse around the time of ovulation induction and oocyte retrieval can lead to a spontaneous conception in IVF treatment and, endogenous hCG, produced by the trophoblast, will rescue the corpora lutea. Therefore, one should not rely on complete luteolysis after GnRH-a triggering and, especially patients for egg donation and pre-implantation-genetic diagnosis for single gene disorder, have to be counselled to avoid unprotected intercourse.

Can first-trimester screening program detect women at high risk for gestational diabetes mellitus?

This study was designed to compare first-trimester maternal serum biochemical markers of aneuploidy and fetal nuchal translucency in pregnancies complicated by gestational diabetes mellitus and those of a control group. The study included 60 gestational diabetic and 60 control women who attended the first-trimester combined screening program for Down syndrome between 11 and 14 gestational weeks with complete follow-up data and delivered in our institution. Maternal serum free ß-human chorionic gonadotropin, pregnancy-associated plasma protein-A and fetal nuchal translucency were investigated. The combined risks, double test risks and age risks were calculated by PRISCA software version 4.0. Comparison of the results between the two groups yielded no significant differences in serum levels of free ß-human chorionic gonadotropin and fetal nuchal translucency. However, women who developed gestational diabetes mellitus had significantly lower pregnancy-associated plasma protein-A. And also, the combined risks and double test risks calculated by PRISCA software were statistically higher in gestational diabetic women than normal pregnant women. These results suggest that differences can be seen between diabetic and healthy pregnant women in first-trimester maternal serum biochemical markers of aneuploidy.

The role of gynecological, urological, and psychiatric factors in chronic pelvic pain.

AIM: In this study, the effectiveness of diagnostic laparoscopy, one of the methods used in the diagnosis and treatment of chronic pelvic pain, was investigated by the etiological examination of patients with chronic pelvic pain, who were treated and followed up on our clinic, allowing for gynecological, urological, and psychological factors. MATERIALS AND METHODS: In this study, the importance of diagnostic laparoscopy in chronic pelvic pain was assessed in 44 patients diagnosed with chronic pelvic pain between September 2005 and May 2006. Additionally, the records of 31 patients who did not have pelvic pain and on whom laparoscopy was performed due to tubal ligation at the same time were assessed. FINDINGS: The study group and the control group were compared in terms of laparoscopic findings. There were laparoscopic findings in 38 (86 %) of the 44 patients in the study group and pathological findings in 13 (41 %) of the 31 patients in the control group. Differences between the groups were statistically significant (p < 0.05). RESULT: Chronic pelvic pain is a syndrome in which biological and psychosocial factors play a role. Laparoscopy for chronic pelvic pain is an operation based on the "see and fight" principle.

Phenotypic subgroups of polycystic ovary syndrome have different intra-renal resistance symptoms.

OBJECTIVE: The polycystic ovary syndrome (PCOS) is known to be related with increased metabolic and cardiovascular risks. Various phenotypic subgroups of PCOS have been proven to have metabolic and endocrine disorders with varying degrees of severity However, intra-renal vascular resistance, which is an indirect indication of atherosclerosis, remains unknown in PCOS subgroups. In this study we examined whether PCOS subgroups have different intra-renal resistance symptoms. MATERIAL AND METHODS: 98 PCOS patients (diagnosed according to the Rotterdam criteria) 30 controls were included in the study The diagnosis of PCOS was established in the presence of at least two of the following criteria: 1-oligo and/or amenorrhea (OM); 2-clinic and/or biochemical signs of hyperandrogenism (HA); 3-polycystic ovarian morphology (PCO) detected by transvaginal ultrasonography 37 patients (Group 1) met all three criteria (HA+OM+PCO), 29 patients (Group 2) met two of the criteria including hyperandrogenism (HA+OM or HA+PCO) and the remaining 32 patients (Group 3) had no hyperandrogenism but fulfilled the other two criteria; PCO+OM. Renal Doppler ultrasonography and hormonal/biochemical analyses were carried out. The first outcome measure was designated as the differences in the renal resistive index (RRI) values of the groups, and the second outcome measure was designated as the relation of RRI with the insulin resistance and lipid profile. RESULTS: In Group 1, the RRI and the homeostasis model assessment of insulin resistance (HOMA-IR) values were significantly higher than in Group 3 and controls (P < 0.031, P < 0.001, respectively after adjusting for age and BMI). The RRI and HOMA-IR values in Group 3 were similar to those of the control group. It was determined that RRI has a positive correlation with HOMA-IR (r = 0.784, P < .0001) and BMI (r = 0.645, P < .0001). CONCLUSIONS: In this study we demonstrated that PCOS subgroups have metabolic and endocrine disorders and cardiovascular risks of varying degrees of severity Moreover, we showed that there was no increase of metabolic and cardiovascular risks in PCOS patients without hyperandrogenism.

Effects of delayed umbilical cord clamping on peripheral blood hematopoietic stem cells in premature neonates.

AIM: To investigate the effects of delayed cord clamping (DCC) on peripheral hematopoietic progenitor cells (HPCs) and hematological parameters in premature infants (<32 weeks) during the neonatal period. METHODS: This was a prospective, randomized, and controlled, single-center study. Prior to delivery, 21 infants were randomly assigned to immediate cord clamping (ICC) at 5-10 s and 21 infants to DCC at 30-45 s. One milliliter blood sample was taken in the first 30 min of life. HPCs were measured by three-color flow cytometry using monoclonal antibodies. RESULTS: There were no significant differences between groups in either maternal or neonatal demographics. All HPC counts were higher in the ICC group, but the difference was not significant. CD34+ cell counts were 45.3 ± 36.6/µL in the ICC and 33.2 ± 26.6/µL in the DCC group (P=0.33); multi-potent progenitor cell counts were 43.2 ± 35/µL in the ICC and 31.1 ± 26.6/µL in the DCC group (P=0.28); and hematopoietic stem cell counts were 2.1 ± 2.1/µL in the ICC and 2.1 ± 3.1/µL in the DCC group (P=0.66). CONCLUSION: Contrary to our expectation, all HPC counts were lower in the DCC group.

Effect of controlled ovarian hyperstimulation treatment on cardiac function.

OBJECTIVE: To evaluate the effects of controlled ovarian hyperstimulation (COH) treatment on cardiac functions using tissue Doppler imaging (TDI). STUDY DESIGN: Twenty-one patients aged 22-35 years were enrolled to COH cycles. Each subject underwent a conventional transthoracic echocardiographic examination that included an assessment of cardiac function. Measurements were taken twice--the first on the second day of the cycle and the second on the day when human chorionic gonadotropin was administered. Twenty-one healthy women were chosen for the control group. RESULTS: The COH treatment did not cause favorable cardiac function changes. The parameters showing the left ventricular diastolic function such as early diastolic peak flow velocity (E), late diastolic peak flow velocity (A), mitral E/A ratios, mitral E wave, deceleration time (DT), lateral isovolumic relaxation time (IVRT), and left ventricular myocardial performance index (LVMPI) were not changed. The COH treatment did not affect the right ventricular diastolic functions such as tricuspid valve E wave, DT, right ventricular (RV) IVRT, or right ventricular myocardial performance index (RVMPI). Concurrently, the COH treatment showed no effects on the right and left ventricular systolic functions. CONCLUSION: TDI findings reveal no effects of the COH treatment on cardiac function.

The effect of metformin treatment on ovarian stromal blood flow in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the effects of metformin on the ovarian stromal blood perfusion in the patients with polycystic ovary syndrome (PCOS). METHODS: Twenty-five women with PCOS who underwent a Doppler examination of the ovarian stroma was evaluated; hormonal, anthropometric, and biochemical parameters of patients were determined. After the patients were treated with 850 mg metformin twice a day for 6 months, the same parameters were evaluated in the same patients. RESULTS: After metformin treatment, although pulsatility index (PI) was increased from 1.80 +/- 1.23, 1.84 +/- 1.28 to 2.20 +/- 1.10, 2.19 +/- 0.83 in the right and left ovary, respectively, and resistance index was increased from 0.84 +/- 0.25, 0.83 +/- 0.23 to 1.16 +/- 0.37, 1.10 +/- 0.26 in the right and left ovary respectively (P < 0.05), peak systolic velocity (PSV) was decreased from 12.30 +/- 1.72, 12.34 +/- 1.55 to 10.25 +/- 0.97, 10.53 +/- 1.33 in the right and left ovary respectively (P < 0.05). PI and RI did not show any difference between the homeostatic model assessment insulin resistance index (HOMA-IR) >or= 2.38 and HOMA-IR < 2.38 groups before and after metformin treatment (P > 0.05). However, PSV was decreased significantly from 13.05 +/- 1.35, 12.82 +/- 2.02 to 11.03 +/- 0.71, 10.25 +/- 0.42 in HOMA-IR >or= 2.38 group in the right and left ovary, respectively, and PSV was decreased from 11.50 +/- 2.67, 11.28 +/- 0.26 to 9.10 +/- 0.58, 9.28 +/- 0.25 in HOMA-IR < 2.38 group in the right and left ovary, respectively, before and after metformin treatment (P < 0.05). PSV for both ovaries were positively correlated with HOMA scores before and after metformin treatment [(r = 0.713, P = 0.000; r = 0.617, P = 0.04 and r = 0.635, P= 0.03; r = 0.483, P = 0.031 respectively]. CONCLUSION: Metformin treatment affected ovarian stromal blood flow in PCOS patients.