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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Reproduction
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1489839
This article is part of the Research Topic Lifestyle and Environmental Factors and Human Fertility View all 4 articles

The impact of intrauterine adhesions on endometrial receptivity in patients undergoing in vitro fertilization-embryo transfer

Provisionally accepted
Yan Ouyang Yan Ouyang Yangqin Peng Yangqin Peng Mingxiang Zheng Mingxiang Zheng Yuyao Mao Yuyao Mao Fei Gong Fei Gong Yuan Li Yuan Li Hui Chen Hui Chen Xihong Li Xihong Li *
  • Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China

The final, formatted version of the article will be published soon.

    Objective To clarify whether intrauterine adhesions (IUAs) affect endometrial receptivity (ER) on the day of ovulation and to compare patients with mild and moderate-severe adhesions.Methods This prospective cohort study included 592 infertile women with IUAs who underwent frozen-thawed embryo transfer (FET). Patients were divided into groups with or without IUAs; and pregnant and nonpregnant populations based on whether a clinical pregnancy was achieved. The ultrasound ER parameters on the ovulation day were compared. Patients with IUAs were then divided into mild or moderate-severe IUA subgroups according to IUA degree.The proportions of patients with Type B plus Type C endometrial morphology (94% vs. 75%, P<0.001), an endometrial thickness ≥ 8mm (97% vs. 81%, P<0.001), an endometrial volume ≥ 2ml (94% vs. 67%, P<0.001), a frequency of endometrial peristalsis≥2 times/min (84% vs. 53%, P<0.001), low subendometrial volume (11.54 ± 2.94 vs. 9.57 ± 2.35, P<0.001) and subendometrial vascularization flow index (VFI) values (2.70 ± 3.10 vs. 2.23 ± 2.23, P=0.033) and a low live birth rate (65% vs. 56%, P=0.039) were significantly higher in the group without IUAs than in the group with IUAs. The group with moderate-severe IUAs had lower proportion of patients with an endometrial thickness≥8mm (73% vs. 89%, P=0.008) and an endometrial volume ≥ 2ml (58% vs. 78%, P=0.005), a lower frequency of endometrial peristalsis ≥ 2 times/min (42% vs. 65%, P=0.003), and low subendometrial volume (9.22 ± 2.29 vs. 9.97 ± 2.36, P=0.023) and subendometrial flow index (FI) (31.48 ± 3.64 vs. 33.43 ± 4.17, P=0.002) values than the group with mild IUAs; a high antral follicle count (AFC), basal follicle-stimulating hormone (FSH), and anti-Müllerian hormone (AMH) levels and an endometrial thickness ≥ 8mm were independent predictors of clinical pregnancy.IUAs can affect ER on the ovulation day and the live birth rate during natural cycles.Moderate-severe IUAs have a greater impact on ER than mild adhesions do; however, if these adhesions are treated properly, they do not have adverse effects on the clinical pregnancy rate. A high AFC, basal FSH and AMH levels and an endometrial thickness ≥8 mm were found to be independent predictors of clinical pregnancy.

    Keywords: Endometrial receptivity, Intrauterine adhesion, Frozen-thawed embryo transfer, Natural cycle, ovulation day, Transvaginal sonography

    Received: 02 Sep 2024; Accepted: 27 Dec 2024.

    Copyright: © 2024 Ouyang, Peng, Zheng, Mao, Gong, Li, Chen and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Xihong Li, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China

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