Endometrial state in women with uterine factor of infertility at the stage of preconceptional care according to sonography and doplerometry data

Authors

DOI:

https://doi.org/10.26641/2307-0404.2020.4.221395

Keywords:

infertility, uterine factor, echostructure of the endometrium, chronic endometritis, preconceptional diagnosis

Abstract

In recent years, the number of cases of uterine factors infertility is constantly growing. Unfortunately, the analysis of scientific works is characterized by the lack of data on the improvement of the diagnostic algorithm and the expediency of accentuating the significance of the preconceptional stage. The purpose of this study was to develop sonographic criteria for endometrial readiness for implantation at the stage of preconceptional care in women with uterine factor infertility. The first group included 80 women with uterine factor infertility, the second group (40 women) consisted of patients who entered the IVF program for the first time. The control group consisted of 30 women with normal fertility. Studies of the structure of the endometrium, myometrium and ovarian tissue were performed on a Voluson 760, on the 4th-6th days of the menstrual cycle (according to the International Endometrial Tumor Analysis (IETA) – consensus of ultrasound description of endometrial changes) and on the 20th-24th days of the cycle. To assess the indirect signs of chronic endometritis the echographic criteria developed by V.N. Demidov et al. were used. The sonographic diagnosis was verified during morphological and immunohistochemical examination. The most common menstrual disorders in women with uterine factor infertility were algodysmenorrhea – 33.3%, algohypomenorrhea –22.2%, hypoopsomenorrhea – 64.4%. Thinning of the endometrium was significantly more often observed in the group with uterine factor of reproductive disorders; one third of patients (33.8%) had dyschronosis of the endometrial echotexture; heterogeneity of M-echo with a predominance of hyperechoic areas was diagnosed in 41.3% of cases. Hyperechogenic inclusions in the basal layer, multiple structures of a linear nature and increased echogenicity were revealed in every fifth patients and hypoechoic uterine contour – in 47.5% of cases. The most significant odds ratio associated with IVF failures and early reproductive loss was found in patients with endometriosis (OR – 5.85; 95% CI: 1.32-13.32), synechiae (OR – 2.27; 95% CI: 0.96-10.16) and polyps (OR – 2.48; 95% CI: 0.84-11.36). It was possible to distinguish the following criteria of functional readiness of the endometrium for implantation: endometrial thickness was more than 8 mm, compliance with the echostructure phase of the menstrual cycle, homogeneity of M-echo, absence of hyper-and hypoechoic inclusions, and full hemodynamics in the vascular pool of the pelvis.

References

Borys EN, Suslykova LV, Kaminskyi VV. [Opti­mization of preparation of morphofunctional endometrial structure in assisted reproductive technology programs]. Reproduktivnaia endokrinologiia. 2015;1:60-63. Ukrainian. doi: https://doi.org/10.18370/2309-4117.2015.21.60-63

Volkova EYu, Korneeva IE, Silant'eva ES. [The role of uterine hemodynamics in assessing of endometrial receptivity]. Problemy reproduktsii. 2012;2:57-62. Russian. Available from: https://www.mediasphera.ru/issues/problemy-repro­duktsii/2012/2/downloads/ru/031025-72172012213

Demidov VN, Gus AI. [Pathology of the uterus cavity and endometrium]. VMK: prakticheskoe posobie; 2001. Russian. Available from:

http://med-vvolske.ru/docs/2018_04_06/­R8BsDQTR36K6saGAZHKK9iaFe.pdf

Serova OF, Tamazyan GV, Sovaev NI, Trifono­va IA, Eliseev EN. [The clinical significance of the morphological and functional state of the endometrium in reproductive disorders]. Voprosy ginekologii, akusherstva i perinatologii. 2010;4:43-48. Russian. Available from: http://www.phdynasty.ru/katalog/zhurnaly/voprosy-ginekologii-akusherstva-i-perinatologii/2010/tom-9-nomer-4/10195

Korobko OM. [The role of a comprehensive study of the uterine cavity in improving the effectiveness of female infertility treatment after unsuccessful attempts at assisted reproductive technologies]. Zdorove zhen­sh­chiny. 2011;9:163-4. Ukrainian.

https://med-expert.com.ua/ua/publishing-activity-uk/zdorove-zhenshchiny-publishing-activity-uk/

Kotsabyn NV, Makarchuk OM. [Role of the en­dometrium functional state as a leading factor in the successful implantation of a fertilized egg]. Arkhiv klinichnoi medytsyny. 2014;2:8-10. Ukrainian. Available from: https://issuu.com/glvisnyk.if.ua/docs/akm____2_2014

Leviashvili MM, Demura TA, Mishieva NG, Fay­zullina NM, Nazarenko TA, Kogan EA. [Endometrial receptivity assessment in patients with unsuccessful in vitro fertilization programs]. Akusherstvo i ginekologiya. 2012;4:65-69. Russian. Available from: https://aig-journal.ru/articles/Ocenka-receptivnosti-endometriya-u-pacientok-s-bezuspeshnymi-programmami-ekstrakorporalnogo-oplodotvoreniya-v-anamneze.html

Pyrohova VI, Kozlovskyi IV. [Rehabilitation of reproductive function in women with chronic endo­metritis]. Zdorove zhenshchiny. 2015;2:94-96. Ukrainian. doi: https://doi.org/10.15574/hw.2015.98.94

Rudakova EB, Davydov PV, Davydov VV. [In­trauterine pathology in women who underwent the first attempt at in vitro fertilization and embryo transfer]. Lechashchiy vrach. 2012;11:6-11. Russian. Available from: https://www.lvrach.ru/foreign_articles/

Alieva KU, Smolnikova VYu, Dyuzheva EV, Ipatova MV, Kalinina EA. [Modern approaches to the comprehensive assessment and preparation of the endometrium in patients with IVF]. Ginekologiya. 2012;14(3):16-18. Russian. Available from: http://www.fesmu.ru/elib/Article.aspx?id=264017

Tabolova VK. [The profile of local gene expres­sion of growth factors and cytokines in the endometrium of the “implantation window” period in chronic endometritis]. Akusherstvo i ginekologiya. 2014;12:74-78. Russian. Available from: https://aig-journal.ru/articles/Profil-lokalnoi-ekspressii-genov-rostovyh-faktorov-i-citokinov-v-endometrii-perioda-implantacionnogo-okna-pri-hroniches­kom-endometrite.html

Titchenko YuP, Zarochentseva NV, Arsha­kyan AK, Men'shikova NS. [The use of ultrasound re­search methods in assessing the status of the endometrium in patients with chronic endometritis and miscarriage]. Rossiyskiy vestnik akushera-ginekologa. 2014;1:55-58. Russian. Available from: https://www.mediasphera.ru/issues/rossijskij-vestnik-akushera-ginekologa/2014/1/031726-6122201419

Burlev VA, Kuz'michev LN, Onishchenko AS, Ilyasova NA, Shchetinina NS. [Influence of endometrial functional activity on IVF results and embryo transfer: molecular mechanisms of fertility regulation]. Problemy reproduktsii. 2010;16(2):41-52. Russian. Available from: http://www.fesmu.ru/elib/Article.aspx?id=221027

Lédée-Bataille N, Olivennes F, Kadoch J, Duban­chet S, Frydman N, Chaouat G, Frydman R. Detectable levels of interleukin-18 in uterine luminal secretions at oocyte retrieval predict failure of the embryo transfer. Human Reproduction. 2004;19(9):1968-73. doi: https://doi.org/10.1093/humrep/deh356

Jacqueline F Donoghue, C Jay McGavigan, Fiona L Lederman, Leonie M Cann, Lulu Fu, Eva Dimitriadis, Jane E Girling, Peter A W Rogers. Dilated Thin-Walled Blood and Lymphatic Vessels in Human Endometrium: A Potential Role for VEGF-D in Proges­tin-Induced Break-Through Bleeding. PLoS One. 2012;7(2):e30916. doi: https://doi.org/10.1371/journal.pone.0030916

Maryam Eftekhar, Mozhgan Sayadi, Farideh Ara­bjahvani. Transvaginal perfusion of G-CSF for infertile women with thin endometrium in frozen ET program: A non-randomized clinical trial. Iran Journal of Reproductive Medicine. 2014;12(10):661-6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248151/

Downloads

Published

2020-12-28

How to Cite

1.
Makarchuk O, Ostrovska O, Gibson OO, Orishchak I, Cheredarchuk A. Endometrial state in women with uterine factor of infertility at the stage of preconceptional care according to sonography and doplerometry data. Med. perspekt. [Internet]. 2020Dec.28 [cited 2024Mar.28];25(4):114-21. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/221395

Issue

Section

CLINICAL MEDICINE