Endometrial blood flow evaluation in women with uterine fibroids during in vitro fertilization treatment

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Abstract

BACKGROUND: Sufficient endometrial blood supply in the mid-secretory phase of the menstrual cycle is a key to a successful pregnancy achievement, and a decreased spiral artery blood flow resistance determined by the Doppler is known to be positively associated with successful in vitro fertilization outcome. Particular aspects of endometrial blood flow in women with uterine fibroids might affect the efficiency of in vitro fertilization and intra cytoplasmic sperm injection cycles.

AIM: The aim of this study was Doppler-based determination of the uterine and spiral artery blood flow resistance in women with uterine fibroids throughout controlled ovarian stimulation in in vitro fertilization cycles, depending on the clinical pregnancy rate.

MATERIALS AND METHODS: Doppler ultrasound spiral artery blood flow evaluation was performed in 83 women throughout the in vitro fertilization cycle. Intramural uterine fibroids were detected in 44 women, and 39 women with no uterine fibroids comprised the comparison group. All women underwent a Doppler study of spiral artery blood flow on the second or third day of the menstrual cycle (at the start of the in vitro fertilization protocol) and on the day of embryo transfer. The in vitro fertilization efficiency was determined by the onset of clinical pregnancy after visualizing the gestational sac in the uterine cavity during ultrasound examination on the 20–25th day after embryo transfer.

RESULTS: The values of the uterine and spiral artery blood flow resistance in the uterine fibroids group were determined to be significantly lower than those in the comparison group. Considering the identified influence of decreased spiral artery blood flow resistance on the results of in vitro fertilization cycles in the comparison group, we have analyzed the dependence of the efficiency of the cycles based on the rate of the spiral artery blood flow resistance decline. Thus, a significantly more reliable decline in the pulsatility index was revealed in pregnant women from the comparison group throughout the in vitro fertilization cycle compared to women with negative results. In women with uterine fibroids, the pulsatility index decline did not differ depending on the onset of pregnancy, and the decline rate differed significantly from that in the comparison group.

CONCLUSIONS: Uterine fibroids are associated with a stable decline in the uterine and spiral artery blood flow resistance. This leads in turn to increased endometrial vascularization throughout the stimulation cycle in in vitro fertilization programs and negatively affects the blastocyst implantation ability.

About the authors

Lyailya Kh. Dzhemlikhanova

Saint Petersburg State University; The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Author for correspondence.
Email: dzhemlikhanova_l@mail.ru
ORCID iD: 0000-0001-6842-4430
SPIN-code: 1691-6559
Scopus Author ID: 56896086100
ResearcherId: J-3441-2013

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Inna O. Krikheli

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: ikrikhely@gmail.com
ORCID iD: 0000-0002-5439-1727
SPIN-code: 7356-6189
Scopus Author ID: 57200795744
ResearcherId: J-8653-2018

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Aleksandr V. Potapov

ITMO University

Email: aleksandr.potapov.2000@mail.ru
Russian Federation, Saint Petersburg

Ksenia V. Ob'edkova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: iagmail@ott.ru
ORCID iD: 0000-0002-2056-7907
SPIN-code: 2709-2890
Scopus Author ID: 57201161145
ResearcherId: A-7258-2019

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Galina Kh. Safarian

Saint Petersburg State University; The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: galasaf07@gmail.com
ORCID iD: 0000-0001-5988-323X
SPIN-code: 7096-3838
Scopus Author ID: 57215531925
Russian Federation, Saint Petersburg; Saint Petersburg

Dariko A. Niauri

Saint Petersburg State University; The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: d.niauri@mail.ru
ORCID iD: 0000-0003-1556-248X
SPIN-code: 4384-9785
Scopus Author ID: 12806465200
ResearcherId: G-8224-2015

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Alexander M. Gzgzyan

Saint Petersburg State University; The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: ovrt@ott.ru
ORCID iD: 0000-0003-3917-9493
SPIN-code: 6412-4801
ResearcherId: G-7814-2015

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

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2. Figure. ROC curves for assessing the dependence of the in vitro fertilization and intra cytoplasmic sperm injection outcome on the Doppler blood flow data in the uterine and spiral arteries throughout the cycle

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