**5.2 Ovarian volume**

The volume of the ovaries is calculated by imaging and callipering the ovary in three perpendicular planes with using the formula of ellipsoid volume as (L1 × L2 × L3 × π/6). An alternative automatic method is calculation of Ovarian volume through "virtual organ computer-aided analysis" or VOCAL. The predictive performance of ovarian volume toward poor response is clearly inferior compared with that of AFC. Therefore, the AFC may be considered the test of first choice when estimating quantitative ovarian reserve before IVF. Total Basal Ovarian Volume (BOV) is obtained by adding the volumes of both. The ovarian volume is constant till the perimenopausal period and the measurement does not increase the

### **Figure 5.**

*Doppler ovarian stromal vascularity measurements with 2D doppler calculation of pulsatility index and resistivity index.*

**71**

**Author details**

Nidhi Sharma\* and Sudakshina Chakrabarti

provided the original work is properly cited.

Ovarian volume, at a cut-off value 3 mL3

Saveetha Medical college and hospital Chennai, India

\*Address all correspondence to: drbonuramkumar@yahoo.co.in

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

the follicular cohort that has been selected from the follicular pool.

*Ovarian Reserve*

**6. Conclusion**

*DOI: http://dx.doi.org/10.5772/intechopen.89772*

measurement, at a cut off value of 3 cm3

(three studies, 95% CI), respectively [21].

**5.3 Ovarian stromal vascularity**

positive predictive value of AFC. Furthermore, the decrease in the Basal Ovarian Volume is a very late phenomenon women >40 years [25, 26]. Ovarian volume

cancelation and non-pregnancy of 92% (three studies, 95% CI, 89–94) and 93%

The observation of the ovarian stromal Doppler flow during ovarian stimulation has been studied in IVF cycles. Poor ovarian stromal vascularization impairs the access of gonadotropins to the ovarian follicles. Power Doppler US in combination with 3D VOCAL is an appropriate approach for correlating the ovarian vascular network with the ovarian response to ART. The gradual increase in the Doppler flow noted during

Ovarian pathophysiology is complex. Ovarian folliculogenesis follicular rupture and luteal transition should be studied elaborately. Endometrial evaluation should be also done in a nonstimulated cycle. Serum hormone values should be measured in normal non-induced menstrual cycle to study the ovarian reserve and detect any undiagnosed synchronizing defects in embryo invasion and endometrial implantation window. Sonoendocrinology is a new imaging science deciphers the hormonal action on target organs. Antral follicle count, at a cut off value of less than four, had high specificity for the prediction of cycle cancelation in assisted reproduction.

non-pregnancy and cycle cancelation in assisted reproduction. Doppler studies of ovarian stromal blood flow are promising, but more research is needed. AFC and ovarian volume provide direct measurements of ovarian response, while AMH, Inhibin B and estradiol are released from the growing follicles and so they reflect

stimulation may provide additional information to AFC (**Figure 5**) [27–36].

, showed specificity for prediction of cycle

, had high specificity for the prediction of

### *Ovarian Reserve DOI: http://dx.doi.org/10.5772/intechopen.89772*

positive predictive value of AFC. Furthermore, the decrease in the Basal Ovarian Volume is a very late phenomenon women >40 years [25, 26]. Ovarian volume measurement, at a cut off value of 3 cm3 , showed specificity for prediction of cycle cancelation and non-pregnancy of 92% (three studies, 95% CI, 89–94) and 93% (three studies, 95% CI), respectively [21].
