Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity

Abstract

Endometrial polyps, adenomyosis, and leiomyomas are commonly encountered abnormalities frequently found in both fertile women and those with infertility. The clinician is frequently challenged to determine which of these entities, when found, is likely to impair fertility, and which are ''innocent bystanders'' unrelated to the problem at hand. Although removing an endometrial polyp may be seen as a relatively benign and safe intervention, myomectomy, and in particular adenomyomectomy, can be substantive surgical procedures, associated with their own potential for disrupting fertility. One of the mechanisms thought to be involved when these entities are contributing to infertility is an adverse impact on endometrial receptivity. Indeed polyps, adenomyosis, and leiomyomas have all been associated with an increased likelihood of abnormal endometrial molecular expressions thought to impair implantation and early embryo development. This review is designed to examine the relationship of these common entities to endometrial receptivity and to identify evidence gaps that should be considered when strategizing research initiatives. It is apparent that we have the tools necessary to fill these gaps, but it will be necessary to approach the issue in a strategic and coordinated fashion. It is likely that we will have to recognize the limitations of imaging alone and look to the evidence-based addition of molecular analysis to provide the individualized phenotyping of disease necessary for patient-specific treatment decisions. (Fertil Steril Ò 2019;111:629-40. Ó2019 by American Society for Reproductive Medicine.

The effect of hysteroscopic polypectomy on the concentrations of tumour necrosis factor-α in uterine flushings and serum in infertile women

“…It is important to point out that in the stromal component of endometrial polyps there is a lower number of hormone receptors. Therefore, the glands and stroma of polyps do not respond to progesterone stimulation, which may be the cause of abnormal secretion of progesterone in the endometrium [27,28,29]. A study that measured TNF-α concentration in uterine flushings of 12 patients before and after hysteroscopic polypectomy showed an increase in TNF-α concentrations after polyp removal with TNF-α values reaching the peak in the midluteal menstrual cycle phase [25].…”

Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches

“…Although adenomyosis has been considered a typical uterine condition identified in multiparous women over the age of 40, recent studies and modern diagnostic imaging methods have demonstrated the presence of this disease in young women as well. Regarding the association with infertility and reproductive failure the evidence suggests that the percentage of adenomyosis prevalence is variable between 20% and 40% in cases of recurrent pregnancy loss, and about 35% was reported in previous ART failure [ 101 , 102 , 103 , 104 , 105 ].…”

Melatonin Promotes Uterine and Placental Health: Potential Molecular Mechanisms

“…For endometrial preparation, the orchestrated control of estradiol (E2) and progesterone (P4) produced by the ovaries induces proliferative changes and development of a secretory phase, both required for 2 of 21 embryo-endometrial synchronicity [1]. Upon P4 stimulation, the process of decidualization begins with a complex and coordinated set of molecular events that result in endometrial receptivity [2]. During decidualization, P4 influences the secretion of bone morphogenetic protein (BMP)-2 by the endometrial stromal cells to proliferate and differentiate into epithelioid decidual cells that are critical to the establishment of fetal-maternal interface [3].…”

“…Regulation of uterine peristalsis (UP) is also a relevant factor for conception and embryo implantation since UP disorders are associated with low fertility rate and may contribute to the pathogenesis of adenomyosis and endometriosis in addition to failure in sperm and embryo transport [2,12]; these UP-associated pathologies are observed in normal and infertile women and influence pregnancy in both natural and artificial cycles.…”