To the content
1 . 2021

Adenomyosis, uterine fibroids and intrauterine septum: IVF program results depending on endometrial receptivity

Abstract

Background. The results of the IVF program depend on many factors, the most significant of which are the quality of the oocytes and embryos obtained for fertilization, as well as the readiness of the endometrium for implantation of the blastocyst. At the same time, the quality of the embryos is most affected by the patient's age and genetic factors, while the endometrial condition is significantly affected by gynecological pathology.

The aim of this work is to evaluate the receptivity of the endometrium in patients with adenomyosis, uterine fibroids and intrauterine septum and infertility in relation to the results of the in vitro fertilization program.

Material and methods. Examination and surgical treatment of 862 patients with benign uterine diseases and infertility (tubal-peritoneal) before the IVF program was performed: 200 patients with nodular adenomyosis, 510 patients with uterine myoma, 152 patients with uterine septum. Histological and immunohistochemical (IHC) studies of endometrial biopsies were performed during the "implantation window" in cycles before surgical treatment and before IVF in 30 patients of the main groups and in 10 patients with tubal-peritoneal infertility factor without endometrial and myometrial pathology. A comparative assessment of the expression of endometrial receptivity markers relative to the results of the IVF program was performed.

Results. We found statistically significant differences in the expression of endometrial receptivity markers (estrogen (ER) and progester (PgR) receptors, leukemia-inhibiting factor (LIF), integrin αV/β3, claudin (CLDN-5), and the НОХ gene family (HOXA-10, HOXA-11) in patients with adenomyosis, myoma, and uterine septum between groups with a successful and unsuccessful IVF program after surgical treatment.

Conclusion. Successful implantation in ART programs in patients with benign uterine diseases after treatment was associated with better endometrial receptivity - higher levels of progesterone receptor expression, low levels of estrogen receptors, normal levels of stromal progesterone-estrogen index (SPEI), high levels of LIF and LIFR, high levels of integrin, mainly low claudine expression, higher levels of HOXA-10 and HOXA-11 expression - compared to endometrial receptivity in unsuccessful programs Art.

Keywords:adenomyosis, uterine fibroids, intrauterine septum, infertility, IVF, surgical treatment, endometrial receptivity

Funding. The authors received no financial support.

Conflict of interests. The authors declare no conflict of interests.

For citation: Kozachenko I.F., Fayzullina N.M., Smolnikova V.Yu., Adamyan L.V. Adenomyosis, uterine fibroids and intrauterine septum: IVF program results depending on endometrial receptivity Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2021; 9 (1): 6-14. DOI: https://doi.org/10.33029/2303-9698-2021-9-1-6-14 (in Russian)

References

1. Abubakirov A.N., Adamyan L.V., Andreeva E.N., Anshina M.B., Veyukova M.A., Gavisova A.A., et al. Female infertility (modern approaches to diagnosis and treatment). Clinical recommendations (treatment protocol). Moscow, 2019. (in Russian)

2. Korsak V.S., Smirnova A.A., Shurygina O.V. Art Register of the Russian Association of Human Reproduction. Report for 2017. Problemy reproduktsii [Problems of Reproduction]. 2019; 25 (6): 8-21. (in Russian)

3. Infertile marriage. Current approaches to diagnosis and treatment: guidance. In: G.T. Sukh, T.A. Nazarenko (eds). Moscow: GEOTAR-Media, 2010: 518 p. (in Russian)

4. Krylova Yu.S., Kvetnoy I.M., Aylamazyan E.K. Endometrial receptivity: molecular mechanisms of implantation regulation. Zhurnal akusherstva i zhenskikh bolezney [Journal of Obstetrics and Women's Diseases]. 2013; 62 (2): 63-74. (in Russian)

5. Krstich E.V., Krasnopol'skaya K.V., Kabanova D.I. New approaches to improving the effectiveness of IVF in women of older reproductive age. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2010; (2): 48-53. (in Russian)

6. Kozachenko I.F., Fayzullina N.M., Shchegolev A.I., Adamyan L.V. Endometrial receptivity in patients with benign uterine diseases in combination with infertility before and after surgical treatment. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2020; (11): 147-58. DOI: https://doi.org/10.18565/aig.2020.11.147-158 (in Russian)

7. Nikitina L.A., Demidova E.M., Radzinsky V.E., et al. Molecular basis of implantation and placentation regulation. Voprosy ginekologii, akusherstva i perinatologii [Problems of Gynecology, Obstetrics and Perinatology]. 2007; 6 (3): 43-8. (in Russian)

8. Hasegawa E., Ito H., Hasegawa F., Hatano K., Kazuka M., Usuda S., et al. Expression of leukemia inhibitory factor in the endometrium in abnormal uterine cavities during the implantation window. Fertil Steril. 2012; 97 (4): 953-8.

9. Kogan E.A., Askolskaya S.I., Burykina P.N., Demura T.A., Fayzulina N.M., Karavaev Yu.E., et al. Morphofunctional state of the endometrium in patients with uterine myoma of reproductive age. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2013; (8): 46-51. (in Russian)

10. Poteryaeva O. N. Matrix metalloproteinases: structure, regulation, role in the development of pathological conditions (literature review). Meditsina i obrazovanie v Sibiri [Medicine and Education in Siberia]. 2010; (5): 7-17. (in Russian)

11. Dyuzheva E.V., Kogan E.A., Kalinina E.A., Kuzmichev L.N. Principles of individual hormonal preparation of the endometrium in patients with ineffective IVF attempts. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2011; 7 (2): 39-45 (in Russian)

12. Vercellini P., Consonni D., Dridi D., Bracco B., Frattaruolo M.P., Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014; 29: 964-77.

13. Martynova A.E., Smol'nikova V.Yu., Demura T.A., Kogan E.A. The effectiveness of the IVF program in women with uterine myoma depending on the morphofunctional state of the endometrium. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2013; (2): 57-61. (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITORS
CHIEF EDITOR
Sukhikh Gennadii Tikhonovich
Academician of the Russian Academy of Medical Sciences, V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Moscow
CHIEF EDITOR
Kurtser Mark Arkadievich
Academician of the Russian Academy of Sciences, MD, Professor, Head of the Obstetrics and Gynecology Subdepartment of the Pediatric Department, N.I. Pirogov Russian National Scientific Research Medical University, Ministry of Health of the Russian Federation
CHIEF EDITOR
Radzinsky Viktor Evseevich
Corresponding Member of the Russian Academy of Sciences, MD, Professor, Head of the Subdepartment of Obstetrics and Gynecology with a Course of Perinatology of the Medical Department in the Russian People?s Friendship University

Journals of «GEOTAR-Media»