Role of vascular growth factors as a regulator of angiogenesis processes at the stage of implantation potential formation in women with uterine factor infertility

Abstract

Despite the broad discussion of clinical significance, the features of the etiopathogenesis of impaired implantation potential in women with uterine sinechias are described in individual works, there is no unanimous opinion on this issue among researchers. The objective: to find out the diagnostic value of a number of markers of the functional state of the endothelium and the level of individual induction angiogenesis in the formation of implantation potential in women with uterine infertility. Materials and methods. The evaluation of the endometrium was performed in 36 women with uterine senechias (first group) and 30 patients with long-term infertility and reproductive loss in history (second group). The control group included 20 healthy patients. This stage of scientific research was conducted taking into account the complex of instrumental methods – ultrasound, histological examination of endometrial biopsies obtained by hysteroscopy intervention, and/or fractional scissors in the dynamics of the menstrual cycle. The design of the study envisaged the study and evaluation of the level of individual factors of angiogenesis, in particular: vascular endothelial growth factor (VEGF-1), as well as antiangiogenic growth factor sFlt-1 and their fluctuations in the preconception phase in serum and cervical mucus. Results. The conducted researches allow to assert, that practically in all patients with uterine sinechia in the complex examination the predominance of the morphological picture of chronic endometritis, hyperplasia and endometrial polyposis, as well as inferior secretory transformation of the endometrium is established. The evaluation of the results of the histological study made it possible to diagnose the presence of hyperplastic processes in 36.1%, the so-called thin endometrium was verified at 19.4%, and the endometrium atrophy was found in 13.9% of the histological findings. The results obtained were demonstrated at the preconception stage in the reduction of VEGF-1 and the high anti-angiogenic growth factor sFlt-1: the level of said transmitter in the group of women with uterine senechias was 63% higher in controls than controls (2.8-fold) (p<0,05). Thus, in the case of deep pathomorphological lesions of the endometrium, at the stage of preconception preparation, there is a marked shift in the balance of vascular growth factors towards the increase in the concentration of antiangiogenic markers – sFlt-1, which is evidence of more severe impingement potential impairment in this category of patients. Conclusions. The level of vascular-endothelial growth factor in serum and cervical secretion as well as the estimation of the angiogenic factor may be early prognostic markers that characterize the initial signs of trophoblast invasion, occurring long before implantation impairment and clinical manifestation of non-compliance. It provides an opportunity to predict damage to the endometrium and its vascular network and can be used to control the effectiveness of preventive measures and the effectiveness of preconception training in women at risk for the implementation of possible underdeveloped pregnancy. Key words: uterine senechia, chronic endometritis, growth factors, angiogenic coefficient.