EFFICIENCY OF IVF PROGRAM IN WOMEN WITH UTERINE MYOMA IN RELATION TO ENDOMETRIAL MORPHOFUNCTIONAL STATE

Subjects and methods. Endometrial morphological and immunohistochemical features were studied in 52 patients with intramural uterine myoma (or concurrent with subserous myoma) up to 4 cm in diameter with no deformity of the uterine cavity, 53 patients after laparoscopic myomectomy (for intramural uterine myoma) without opening the uterine cavity, and 53 women with tuboperitoneal factor infertility with no myometrial pathology. Results. Conception rates were 23.1% in Group 1, 30.2% in Group 2, and 41.5% in the control group, the decrease in the conception rate being statistically significant in the uterine myoma group as compared with the control. Implantation rates were 11.9, 16.2, and 23.9%, respectively, those being significantly higher in the control group than in the uterine myoma and postmyomectomy groups. Patients with a successful IVF attempt showed a higher level of mature pinopodia-containing cells, higher expression of progesterone receptors in the endometrial stroma, and less pronounced expression of estrogen receptors in the surface epithelium and glands. Conclusion. In the patients who had undergone laparoscopic myomectomy prior to the IVF program, the conception rate was comparable with that in the patients without uterine myoma, which supports the need for myomectomy if intramural nodules are 4 cm or more in diameter. It is necessary to conduct an in-depth investigation involving the determination of a wider range of markers to study the mechanisms of action of uterine myoma on endometrial receptivity.

uterine myoma, myomectomy, in vitro fertilization, conception rate, pinopodia, estrogen receptors, progesterone receptors