Abstract
Objective. To study the impact of the energy of focused ultrasonic waves during focused ultrasound ablation of uterine fibroids guided by magnetic resonance imaging (MRI-FUS) on the parameters of endometrial receptivity. Patients and methods. A prospective cohort study of 67 reproductive-age women suffering from uterine fibroids. The treatment group comprised 32 patients, who underwent treatment for a uterine fibroid by MRI-FUS ablation. The comparison group consisted of 35 women, who underwent laparoscopic myomectomy. The control group included 28 fertile healthy women. The endometrial tissue obtained with the use of pipelle biopsy pipelle biopsia on the 20–22th day of the cycle was examined by the method of light and scanning electron microscopy before and three months after treatment. Results. The ultrastructural parameters of endometrial receptivity in patients with uterine fibroids were characterised by a phase delay in the pinopode development rates (88.57 vs. 21.42% in control; р < 0.05), a high incidence of tight junctions (34.29 vs. 7.14% in control; р = 0.021) and atypical cells of the microenvironment (54.29 vs. 7.14%; р = 0.005). No significant changes in the pinopode development rates were noted after myomectomy, the incidence of their asynchronous development significantly decreased (54,29 vs. 20.00%; р = 0.011). No significant changes in the pinopode development rates were noted after MRI-FUS ablation of uterine fibroids either, conversely, a significant increase of their asynchronous development was established (50.00 vs. 14.28%; р = 0.021) as well as a higher number of heteromorphic secretory cells (53.33 vs. 5.88%; р = 0.002) in the endometrium. Conclusion. The use of non-invasive methods of treatment of uterine fibroids in patients who are planning a pregnancy should be well grounded and take into consideration the character and causes of previous reproductive failures. Key words: magnetic resonance imaging, uterine fibroids, myomectomy, pinopodes, focussed ultrasound ablation, endometrium
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