EFFICIENCY OF AN IVF PROGRAM IN WOMEN WITH UTERINE MYOMA IN RELATION TO THE ENDOMETRIAL RECEPTIVITY MARKERS PINOPODIA, LEUKEMIA INHIBITORY FACTOR, VASCULAR ENDOTHELIAL GROWTH FACTOR-A, CLAUDIN-5
- Authors: MARTYNOVA A.E1, SMOLNIKOVA V.Y.1, DEMURA T.A1, KOGAN E.A1
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Affiliations:
- Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
- Issue: No 8 (2013)
- Pages: 40-45
- Section: Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/247006
- ID: 247006
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Abstract
Objective. To study the effectiveness of an in vitro fertilization (IVF) program in women with uterine myoma and in those who underwent myomectomy in relation to the current endometrial receptivity markers pinopodia, leukemia inhibitory factor (LIF), vascular endothelial growth factor-A (VEGF-A), claudin-5 (CLDN-5). Subject and methods. The morphological and immunohistochemical features of the endometrium and the outcomes of the IVF program 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 (Group 1), 53 patients after laparoscopic myomectomy (for intramural uterine myoma) without opening the uterine cavity, which had been done at least 6 months before inclusion into the IVF program (Group 2), and 53 women with tuboperitoneal factor infertility with no myometrial pathology (a control group). 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. The implantation rates were 11.9, 16.2, and 23.9%, respectively; those being significantly higher than in the group of patients with uterine myoma and post-myomectomy. The endometrium of patients with a successful attempt of IVF and embryo transfer showed a higher level of mature pinopodia-containing cells, higher expression of LIF and VEGF-A in the stroma and epithelial layer. The vascular endometrial epithelium was characterized by a higher level of VEGF-A and a lower concentration of CLDN-5. Conclusion. In the patients who have undergone laparoscopic myomectomy prior to the IVF program, the conception rate is 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.
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About the authors
A. E MARTYNOVA
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: Anaabrossimova@yandex.ru
V. Yu SMOLNIKOVA
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: v_smolnikova@oparina4.ru
T. A DEMURA
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: t_demura@oparina4.ru
E. A KOGAN
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: e_kogan@oparina4.ru
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