How noninvasive treatment of uterine fibroids affects endometrial receptivity: a prospective cohort study

Abstract

Objective To investigate the effect of the ultrasonic energy during MRI-guided high-intensity focused ultrasound ablation (HIFU) of uterine fibroids on molecular and tissue markers of endometrial receptivity in women of reproductive age. Material and methods A prospective cohort study of 60 women of reproductive age was conducted. The main group consisted of 32 patients suffering from the symptomatic course of uterine fibroids who received treatment with HIFU ablation of uterine fibroids. The control group consisted of 28 healthy fertile women examined voluntarily. The endometrium obtained with pipelle biopsy on days 20–22 of the cycle was examined by scanning electron microscopy and immunohistochemistry before and three months after the treatment. The results were processed by the method of variation statistics using the SPSS 22.0. Results The focused ultrasound rays passing through the endometrium did not cause any change in the maturation rate or the state of intercellular contacts. At the same time, a significant increase in the frequency of asynchronous maturation of pinopodia was found to be 14.28% before HIFU versus 50.00% after HIFU; p = .021 and the number of heteromorphic secretory cells 5.88% before HIFU versus 53.33% after HIFU; p = .002 in implantation endometrium. A significant decrease in the stromal expression of CD95+bright in the endometrium to the level comparable with control values was observed after HIFU (from 70.22 ± 9.77 c/s to 48.81 ± 5.47 c/s; p < .001; the control level − 47.80 ± 2.13 c/s). The ratio and expression of steroid receptors, proliferation markers, p53-dependent apoptosis and its blockers, regulators and markers of angiogenesis, LIF and LIF-R signaling molecules in the stroma and endometrial glands did not change significantly after treatment. Conclusion This study did not reveal any significant negative effects of HIFU ablation of uterine fibroids on endometrial receptivity in women of reproductive age.