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Amooee, S., Akbarzadeh-Jahromi, M., Motavas, M., & Zarei, F. (2020). Comparing endometrial hysteroscopic and histological findings of infertile women with polycystic ovary syndrome and unexplained infertility: A cross-sectional study. International Journal of Reproductive BioMedicine (IJRM), 18(1), 33-40. https://doi.org/10.18502/ijrm.v18i1.6195
https://doi.org/10.18502/ijrm.v18i1.6195
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- Cited by 3 articles
authors
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Sedigheh Amooee
Sedigheh Amooee
Department of Obstetrics and Gynecology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Mojgan Akbarzadeh-Jahromi
Mojgan Akbarzadeh-Jahromi
Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Maternal-fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Maedeh Motavas
Maedeh Motavas
Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Fatemeh Zarei
Fatemeh Zarei
Department of Obstetrics and Gynecology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
Published Date
- Jan 26, 2020
Comparing endometrial hysteroscopic and histological findings of infertile women with polycystic ovary syndrome and unexplained infertility: A cross-sectional study
Abstract
Background: Infertility is a critical condition in women with polycystic ovary syndrome (PCOS), caused not only by anovulation but also by endometrial abnormality.
Objective: This study aimed to evaluate and compare the hysteroscopic and histological findings of endometrial biopsies in infertile women with PCOS and normal endometrial thickness and women with unexplained infertility (UI).
Materials and Methods: This cross-sectional study compared the initial hysteroscopy and endometrial histological findings of 70 infertile women with PCOS and normal endometrial thickness with those of 35 women with UI. The relationship between endometrial histology and clinical parameters such as including luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, testosterone, prolactin, fasting blood sugar, body mass index (BMI), and infertility duration was analyzed.
Results: The mean age of women with PCOS was significantly lower than that of women with UI (27.5 ± 4.1 vs. 30 ± 4.5 years, respectively) (p < 0.001). The mean BMI was higher in women with PCOS than in women with UI (28.7 ± 4.4 vs. 25.1 ± 3 kg/m2) (p < 0.001). The hysteroscopic findings of all women with PCOS were normal, whereas 91.4% of women with UI had normal hysteroscopic findings, 2.9% had a polyp, and 5.7% had endometrial thickening. The histological findings of women with PCOS revealed proliferative endometrium in 54.3%, disordered proliferative endometrium in 17.1%, secretory endometrium in 8.6%, and endometrial polyp in 17.1%, whereas these percentages in women with UI were 28.6%, 0%, 54.3%, and 20%, respectively.
Conclusion: The hysteroscopic evaluation alone of infertile women might not detect all probable endometrial pathologies in women with PCOS.
Key words: Polycystic ovary, Hysteroscopy, Histology, Endometrium, Infertility.
References
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[15] Bhalerao NM. Hysteroscopy and Fertility. Manual of Fertility Enhancing Hysteroscopy 2018: 45–59.
[16] Di Spiezio Sardo A, Di Carlo C, Minozzi S, Spinelli M, Pistotti V, Alviggi C, et al. Efficacy of hysteroscopy in improving reproductive outcomes of infertile couples: a systematic review and meta-analysis. Hum Reprod Update 2016; 22: 479–496.
[17] Cholkeri-Singh A, Sasaki KJ. Hysteroscopy for infertile women: a review. J Minim Invasive Gynecol 2015; 22: 353–362.
[18] Kuribayashi Y, Nakagawa K, Sugiyama R, Motoyama H, Sugiyama R. Frequency of endometrial cancer and atypical hyperplasia in infertile women undergoing hysteroscopic polypectomy. J Obstet Gynaecol Res 2017; 43: 1465–1471.
[19] Ramezanali F, Khalili G, Arabipoor A, Bagheri Lankarani N, Moini A. Relationships between Serum Luteinizing Hormone Level, Endometrial Thickness and Body Mass Index in Polycystic Ovary Syndrome Patients with and without Endometrial Hyperplasia. Int J Fertil Steril. 2016; 10: 36–41.
[20] Hardiman P, Pillay OC, Atiomo W. Polycystic ovary syndrome and endometrial carcinoma. Lancet 2003; 361: 1810–1812.
[21] Haoula Z, Salman M, Atiomo W. Evaluating the association between endometrial cancer and polycystic ovary syndrome. Hum Reprod 2012; 27: 1327–1331.
[22] Indhavivadhana S, Rattanachaiyanont M, Wongwananuruk T, Techatraisak K, Rayasawath N, Dangrat C Endometrial neoplasia in reproductive-aged Thai women with polycystic ovary syndrome. Int J Gynaecol Obstet. 2018; 142: 170–175.
[23] Garuti G, Sambruni I, Colonnelli M, Luerti M. Accuracy of hysteroscopy in predicting histopathology of endometrium in 1500 women. J Am Assoc Gynecol Laparosc 2001; 8: 207–213.
[24] Cicinelli E, Resta L, Nicoletti R, Zappimbulso V, Tartagni M, Saliani N. Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod 2005; 20: 1386–1389.
[25] Kitaya K, Tada Y, Taguchi S, Funabiki M, Hayashi T, Nakamura Y. Local mononuclear cell infiltrates in infertile patients with endometrial macropolyps versus micropolyps. Hum Reprod 2012; 27: 3474–3480.
[26] Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T, et al. Chronic endometritis: potential cause of infertility and obstetric and neonatal complications. Am J Reprod Immunol 2016; 75: 13–22.
[27] Cicinelli E, Tinelli R, Lepera A, Pinto V, Fucci M, Resta L. Correspondence between hysteroscopic and histologic findings in women with chronic endometritis. Acta Obstet Gynecol Scand 2010; 89: 1061–1065.
[28] Kitaya K, Yasuo T. Immunohistochemistrical and clinicopathological characterization of chronic endometritis. Am J Reprod Immunol 2011; 66: 410–415.
[29] Kosei N, Zakharenko N, Herman D. Endometrial polyps in women of reproductive age: clinical and pathogene-tic variations. Georgian Med News 2017; 273: 16–22.
[30] Lasmar BP, Lasmar RB. Endometrial polyp size and polyp hyperplasia. Int J Gynaecol Obstet 2013; 123: 236–239.
[31] Mouhayar Y, Yin O, Mumford SL, Segars JH. Hysteroscopic polypectomy prior to infertility treatment: A cost analysis and systematic review. Eur J Obstet Gynecol Reprod Biol 2017; 213: 107–115.
[32] Ghaffari F, Arabipoor A, Bagheri Lankarani N, Hosseini F, Bahmanabadi A. Hysteroscopic polypectomy without cycle cancellation in IVF/ICSI cycles: a cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2016; 205: 37–42.
[33] Clark TJ, Voit D, Gupta JK, Hyde C, Song F, Khan KS. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA 2002; 288: 1610–1621.
[34] Radwan P1, Radwan M, Polać I, Wilczyński JR. Detection of intracavitary lesions in 820 infertile women: comparison of outpatient hysteroscopy with histopathological examination. Ginekol Pol. 2013; 84: 857–861.
[35] Vitner D, Filmer S, Goldstein I, Khatib N, Weiner Z. A comparison between ultrasonography and hysteroscopy in the diagnosis of uterine pathology. Eur J Obstet Gynecol Reprod Biol 2013; 171: 143–145.
[2] Park JC, Lim SY, Jang TK, Bae JG, Kim JI, Rhee JH. Endometrial histology and predictable clinical factors for endometrial disease in women with polycystic ovary syndrome. Clin Exp Reprod Med 2011; 38: 42–46.
[3] Shang K, Jia X, Qiao J, Kang J, Guan Y. Endometrial abnormality in women with polycystic ovary syndrome. Reprod Sci 2012; 19: 674–683.
[4] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndome. Fertil Steril 2004; 81: 19–25.
[5] Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development 22:687–708.
[6] Ferreira SR, Motta AB. Uterine function: from normal to polycystic ovarian syndrome alterations. Curr Med Chem 2018; 25: 1792–1804.
[7] Lopes IM, Baracat MC, Simões Mde J, Simões RS, Baracat EC, Soares JM Jr. Endometrium in women with polycystic ovary syndrome during the window of implantation. Rev Assoc Med Bras 2011; 57: 702–709.
[8] Amjadi F, Mehdizadeh M, Ashrafi M, Nasrabadi D, Taleahmad S, Mirzaei M, et al. Distinct changes in the proteome profile of endometrial tissues in polycystic ovary syndrome compared with healthy fertile women. Reprod Biomed Online 2018; 37: 184–200.
[9] Indhavivadhana S, Rattanachaiyanont M, Wongwananuruk T, Techatraisak K, Tanmahasamut P, Dangrat C. Hyperandrogenemia is associated with thin endometrium in reproductive-aged Thai women with polycystic ovary syndrome. Asian Biomedicine 2013; 7: 545–551.
[10] Ndefo UA, Eaton A, Green MR. Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P T. 2013; 38: 336–355.
[11] Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol 2011; 7: 219–231.
[12] Strowitzki T, Germeyer A, Popovici R, Von Wolff M. The human endometrium as a fertility-determining factor. Hum Reprod Update 2006; 12: 617–630.
[13] Al Chami A, Saridogan E. Endometrial polyps and subfertility. J Obstet Gynaecol India 2017; 67: 9–14.
[14] Indraccolo U, Greco P, Scutiero G, Marrocchella S, Sorrentino F, Mastricci L, et al. The role of hysteroscopy in the diagnostic work-up of infertile asymptomatic patients. Clin Exp Obstet Gynecol 2014; 41: 124–127.
[15] Bhalerao NM. Hysteroscopy and Fertility. Manual of Fertility Enhancing Hysteroscopy 2018: 45–59.
[16] Di Spiezio Sardo A, Di Carlo C, Minozzi S, Spinelli M, Pistotti V, Alviggi C, et al. Efficacy of hysteroscopy in improving reproductive outcomes of infertile couples: a systematic review and meta-analysis. Hum Reprod Update 2016; 22: 479–496.
[17] Cholkeri-Singh A, Sasaki KJ. Hysteroscopy for infertile women: a review. J Minim Invasive Gynecol 2015; 22: 353–362.
[18] Kuribayashi Y, Nakagawa K, Sugiyama R, Motoyama H, Sugiyama R. Frequency of endometrial cancer and atypical hyperplasia in infertile women undergoing hysteroscopic polypectomy. J Obstet Gynaecol Res 2017; 43: 1465–1471.
[19] Ramezanali F, Khalili G, Arabipoor A, Bagheri Lankarani N, Moini A. Relationships between Serum Luteinizing Hormone Level, Endometrial Thickness and Body Mass Index in Polycystic Ovary Syndrome Patients with and without Endometrial Hyperplasia. Int J Fertil Steril. 2016; 10: 36–41.
[20] Hardiman P, Pillay OC, Atiomo W. Polycystic ovary syndrome and endometrial carcinoma. Lancet 2003; 361: 1810–1812.
[21] Haoula Z, Salman M, Atiomo W. Evaluating the association between endometrial cancer and polycystic ovary syndrome. Hum Reprod 2012; 27: 1327–1331.
[22] Indhavivadhana S, Rattanachaiyanont M, Wongwananuruk T, Techatraisak K, Rayasawath N, Dangrat C Endometrial neoplasia in reproductive-aged Thai women with polycystic ovary syndrome. Int J Gynaecol Obstet. 2018; 142: 170–175.
[23] Garuti G, Sambruni I, Colonnelli M, Luerti M. Accuracy of hysteroscopy in predicting histopathology of endometrium in 1500 women. J Am Assoc Gynecol Laparosc 2001; 8: 207–213.
[24] Cicinelli E, Resta L, Nicoletti R, Zappimbulso V, Tartagni M, Saliani N. Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod 2005; 20: 1386–1389.
[25] Kitaya K, Tada Y, Taguchi S, Funabiki M, Hayashi T, Nakamura Y. Local mononuclear cell infiltrates in infertile patients with endometrial macropolyps versus micropolyps. Hum Reprod 2012; 27: 3474–3480.
[26] Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T, et al. Chronic endometritis: potential cause of infertility and obstetric and neonatal complications. Am J Reprod Immunol 2016; 75: 13–22.
[27] Cicinelli E, Tinelli R, Lepera A, Pinto V, Fucci M, Resta L. Correspondence between hysteroscopic and histologic findings in women with chronic endometritis. Acta Obstet Gynecol Scand 2010; 89: 1061–1065.
[28] Kitaya K, Yasuo T. Immunohistochemistrical and clinicopathological characterization of chronic endometritis. Am J Reprod Immunol 2011; 66: 410–415.
[29] Kosei N, Zakharenko N, Herman D. Endometrial polyps in women of reproductive age: clinical and pathogene-tic variations. Georgian Med News 2017; 273: 16–22.
[30] Lasmar BP, Lasmar RB. Endometrial polyp size and polyp hyperplasia. Int J Gynaecol Obstet 2013; 123: 236–239.
[31] Mouhayar Y, Yin O, Mumford SL, Segars JH. Hysteroscopic polypectomy prior to infertility treatment: A cost analysis and systematic review. Eur J Obstet Gynecol Reprod Biol 2017; 213: 107–115.
[32] Ghaffari F, Arabipoor A, Bagheri Lankarani N, Hosseini F, Bahmanabadi A. Hysteroscopic polypectomy without cycle cancellation in IVF/ICSI cycles: a cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2016; 205: 37–42.
[33] Clark TJ, Voit D, Gupta JK, Hyde C, Song F, Khan KS. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA 2002; 288: 1610–1621.
[34] Radwan P1, Radwan M, Polać I, Wilczyński JR. Detection of intracavitary lesions in 820 infertile women: comparison of outpatient hysteroscopy with histopathological examination. Ginekol Pol. 2013; 84: 857–861.
[35] Vitner D, Filmer S, Goldstein I, Khatib N, Weiner Z. A comparison between ultrasonography and hysteroscopy in the diagnosis of uterine pathology. Eur J Obstet Gynecol Reprod Biol 2013; 171: 143–145.