Endometrial blood flow evaluation in women with uterine fibroids during in vitro fertilization treatment
- Authors: Dzhemlikhanova L.K.1,2, Krikheli I.O.2, Potapov A.V.3, Ob'edkova K.V.2, Safarian G.K.1,2, Niauri D.A.1,2, Gzgzyan A.M.1,2
-
Affiliations:
- Saint Petersburg State University
- The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott
- ITMO University
- Issue: Vol 72, No 4 (2023)
- Pages: 47-57
- Section: Original Research
- URL: https://journals.rcsi.science/jowd/article/view/253856
- DOI: https://doi.org/10.17816/JOWD466995
- ID: 253856
Cite item
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.
Full Text
##article.viewOnOriginalSite##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 PetersburgInna 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 PetersburgAleksandr 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 PetersburgGalina 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 PetersburgAlexander 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 PetersburgReferences
- Somigliana E, Vercellini P, Daguati R, et al. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update. 2007;13(5):465–476. doi: 10.1093/humupd/dmm013
- Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91(4):1215–1223. doi: 10.1016/j.fertnstert.2008.01.051
- Wang X, Chen L, Wang H, et al. The Impact of noncavity-distorting intramural fibroids on the efficacy of in vitro fertilization-embryo transfer: an updated meta-analysis. Biomed Res Int. 2018;2018. doi: 10.1155/2018/8924703
- Yan L, Yu Q, Zhang YN, et al. Effect of type 3 intramural fibroids on in vitro fertilization-intracytoplasmic sperm injection outcomes: a retrospective cohort study. Fertil Steril. 2018;109(5):817–822.e2. doi: 10.1016/j.fertnstert.2018.01.007
- Bai X, Lin Y, Chen Y, Ma C. The impact of FIGO type 3 fibroids on in-vitro fertilization outcomes: A nested retrospective case-control study. Eur J Obstet Gynecol Reprod Biol. 2020;247:176–180. doi: 10.1016/j.ejogrb.2019.12.018
- Somigliana E, De Benedictis S, Vercellini P, et al. Fibroids not encroaching the endometrial cavity and IVF success rate: a prospective study. Hum Reprod. 2011;26(4):834–839. doi: 10.1093/humrep/der015
- Bulletti C, DE Ziegler D, Levi Setti P, et al. Myomas, pregnancy outcome, and in vitro fertilization. Ann N Y Acad Sci. 2004;1034:84–92. doi: 10.1196/annals.1335.010
- Oliveira FG, Abdelmassih VG, Diamond MP, et al. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril. 2004;81(3):582–587. doi: 10.1016/j.fertnstert.2003.08.034
- Ikhena DE, Bulun SE. Literature review on the role of uterine fibroids in endometrial function. Reprod Sci. 2018;25(5):635–643. doi: 10.1177/1933719117725827
- Horcajadas JA, Goyri E, Higón MA, et al. Endometrial receptivity and implantation are not affected by the presence of uterine intramural leiomyomas: a clinical and functional genomics analysis. J Clin Endocrinol Metab. 2008;93(9):3490–3498. doi: 10.1210/jc.2008-0565
- Arslan AA, Gold LI, Mittal K, et al. Gene expression studies provide clues to the pathogenesis of uterine leiomyoma: new evidence and a systematic review. Hum Reprod. 2005;20(4):852–863. doi: 10.1093/humrep/deh698
- Hague S, Zhang L, Oehler MK, et al. Expression of the hypoxically regulated angiogenic factor adrenomedullin correlates with uterine leiomyoma vascular density. Clin Cancer Res. 2000;6(7):2808–2814.
- Xu J, Luo X, Chegini N. Differential expression, regulation, and induction of Smads, transforming growth factor-beta signal transduction pathway in leiomyoma, and myometrial smooth muscle cells and alteration by gonadotropin-releasing hormone analog. J Clin Endocrinol Metab. 2003;88(3):1350–1361. doi: 10.1210/jc.2002-021325
- Ozerskaja IA, Shheglova EA, Sirotinkina EV, et al. Fiziologicheskie izmenenija gemodinamiki matki u zhenshhin reproduktivnogo, peri- i postmenopauzal’nogo periodov. SonoAce Ultrasound. 2010;(21):40–56. (In Russ.)
- Koo HS, Park CW, Cha SH, et al. Serial evaluation of endometrial blood flow for prediction of pregnancy outcomes in patients who underwent controlled ovarian hyperstimulation and in vitro fertilization and embryo transfer. J Ultrasound Med. 2018;37(4):851–857. doi: 10.1002/jum.14418
- Gzgzyan AM, Niauri DA, Kogan IY, et al. Doppler indices of uterine vessels in assessing the ability of endometrial implantation during in vitro fertilization (IVF) cycles. Journal of Obstetrics and Women’s Diseases. 2013;62(4):29–36. (In Russ.) doi: 10.17816/JOWD62429-36
- Wang J, Xia F, Zhou Y, et al. Association between endometrial/subendometrial vasculature and embryo transfer outcome: a meta-analysis and subgroup analysis. J Ultrasound Med. 2018;37(1):149–163. doi: 10.1002/jum.14319
- Buyanova SN, Shchukina NA, Chechneva MA, et al. Ultrasound diagnosis in the planning of organ-sparing surgery for uterine myoma. Russian bulletin of the obstetrician-gynecologist. 2018;18(6):83–87. (In Russ.) doi: 10.17116/rosakush20181806183
- Kamel A, El-Mazny A, Ramadan W, et al. Effect of intramural fibroid on uterine and endometrial vascularity in infertile women scheduled for in-vitro fertilization. Arch Gynecol Obstet. 2018;297(2):539–545. doi: 10.1007/s00404-017-4607-2
- Ng EH, Chan CC, Tang OS, et al. Endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound in patients with small intramural uterine fibroids during IVF treatment. Hum Reprod. 2005;20(2):501–506. doi: 10.1093/humrep/deh594
- Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393–408. doi: 10.1002/ijgo.12666
- Sinclair DC, Mastroyannis A, Taylor HS. Leiomyoma simultaneously impair endometrial BMP-2-mediated decidualization and anticoagulant expression through secretion of TGF-β3. J Clin Endocrinol Metab. 2011;96(2):412–421. doi: 10.1210/jc.2010-1450
- Galliano D, Bellver J, Díaz-García C, et al. ART and uterine pathology: how relevant is the maternal side for implantation? Hum Reprod Update. 2015;21(1):13–38. doi: 10.1093/humupd/dmu047
- Taylor HS. Fibroids: when should they be removed to improve in vitro fertilization success? Fertil Steril. 2018;109(5):784–785. doi: 10.1016/j.fertnstert.2018.03.003
- Lédée N, Chaouat G, Serazin V, et al. Endometrial vascularity by three-dimensional power Doppler ultrasound and cytokines: a complementary approach to assess uterine receptivity. J Reprod Immunol. 2008;77(1):57–62. doi: 10.1016/j.jri.2007.07.006
- Wulff C, Weigand M, Kreienberg R, et al. Angiogenesis during primate placentation in health and disease. Reproduction. 2003;126(5):569–577. doi: 10.1530/rep.0.1260569
- Kitaya K, Yamaguchi T, Honjo H. Central role of interleukin-15 in postovulatory recruitment of peripheral blood CD16(-) natural killer cells into human endometrium. J Clin Endocrinol Metab. 2005;90(5):2932–2940. doi: 10.1210/jc.2004-2447
- Makker A, Singh MM. Endometrial receptivity: clinical assessment in relation to fertility, infertility, and antifertility. Med Res Rev. 2006;26(6):699–746. doi: 10.1002/med.20061
- Makker A, Goel MM. Uterine leiomyomas: effects on architectural, cellular, and molecular determinants of endometrial receptivity. Reprod Sci. 2013;20(6):631–638. doi: 10.1177/1933719112459221
- Lu N, Wang Y, Su YC, et al. Effects of the distance between small intramural uterine fibroids and the endometrium on the pregnancy outcomes of in vitro fertilization-embryo transfer. Gynecol Obstet Invest. 2015;79(1):62–68. doi: 10.1159/000363236