Association of Endometrial Polyps with Membranous Adhesions in Uterine Cavity

  • Lee, Yoon-Jung (Dept. of Obstetrics and Gynecology, CHA University School of Medicine, Gangnam CHA Medical Center) ;
  • Cha, Dong-Hyun (Dept. of Obstetrics and Gynecology, CHA University School of Medicine, Gangnam CHA Medical Center) ;
  • Kim, Ji-Young (Dept. of Pathology, CHA University School of Medicine, Gangnam CHA Medical Center) ;
  • Cho, Jung-Hyun (Dept. of Obstetrics and Gynecology, CHA University School of Medicine, Gangnam CHA Medical Center) ;
  • Lee, Gun-Ho (Dept. of Obstetrics and Gynecoloty, Kumi CHA Medical Center)
  • 투고 : 2011.08.30
  • 심사 : 2011.09.29
  • 발행 : 2011.12.31

초록

The membranous adhesions could induce implantation failure despite transplantation of high quality of embryo. Clinically, of the patients who have membranous filmy adhesions, endometrial polyps have been found in not infrequently. Thus this study was tried to evaluate the features of endometrial polyps and the effect of endometrial polyps on formation and extents of membranous adhesions in uterine cavity of infertile patients under hysteroscopy. A retrospective study was conducted on 34 infertile patients who were diagnosed as endometrial polyps with membranous adhesions during hysteroscopy from July 2008 to July 2011. Number, size, location and morophologic type of endometrial polyps were investigated. If needed, methylene blue solution was instillated to endometrial cavity to identify membranous adhesions. Then, associations between membranous adhesions with features of endometrial polyps were evaluated. Mean size of endometrial polyp was $1.6{\pm}0.6$ cm, the bigger of endometrial polyps was, the larger of extents of membranous adhesions. (p<0.05). Endometrial polyps were locate evenly in endometrial cavity as follows: anterior uterine wall, 39.1%; posterior uterine wall, 34.8%; lateral uterine wall, 26.1%; upper: 29.4%, middle: 32.4%, lower segment, 35.3%. Mean number of endometrial polyps was $2.26{\pm}1.3$. The pedunculated type was 37.7% and sessile type was 32.4%. There was no statistically significant association of location, number and morphologic type of endometrial polyps with membranous adhesions. In conclusion, hysteroscopy before in vitro fertilization on infertile patients was worthy because of removing of endometrial polyps and membranous adhesions.

키워드

참고문헌

  1. Allahbadia GN, Sheth SS (1996) Hysteroscopic surgery in infertility. Indian J Gynaecol Endosc 1:25-32.
  2. Bingol B, Gunenc Z, Gedikbasi A, Guner H, Tasdemir S, Tiras B (2011) Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy. J Obstet Gynaecol 31:54-58. https://doi.org/10.3109/01443615.2010.532246
  3. Bradley LD, Pasuqaloto EB, Price LL (2000) Hysteroscopic management of endometrial polyps. Obstet Gynecol 95:S23.
  4. Fernandez-Parra J, Rodriquez Oliver A, Lopez Criado S, Parrilla Fernandez F, Montoya Ventoso F (2006) Hysteroscopic evaluation of endometrial polyps. Int J Gynaecol Obstet 95:144-148. https://doi.org/10.1016/j.ijgo.2006.07.007
  5. Golan A, Sagiv R, Berar M, Ginath S, Glezerman M (2001) Bipolar electrical energy in physiologic solutionda revolution in operative hysteroscopy. J Am Assoc Gynecol Laparosc 8:252-258. https://doi.org/10.1016/S1074-3804(05)60586-5
  6. Ioannis Stamatellos, Aristotelis Apostolides, Panagiotis Stamatopoulos, John Bontis (2008) Pregnancy rates after hysteroscopic polypectomy depending on the size or number of the polyps. Arch Gynecol Obstet 277:395-399 https://doi.org/10.1007/s00404-007-0460-z
  7. Isikoglu M, Berkkanoglu M, Senturk Z, Coetzee K, Ozgur K (2006) Endometrial polyps smaller than 1.5 cm do not affect ICSI outcome. Reprod Biomed Online 12:199-204. https://doi.org/10.1016/S1472-6483(10)60861-9
  8. Ji eun Shin (2010) Effects on pregnancy outcomes after removal of membranous filmy adhesion in the uterine cavity in case of repeated implantation failure [dissertation]. Department of Medicine, the Graduate School, Cha University.
  9. Lass A, Williams G, Abusheikha N, Brinsden P (1999) The effect of endometrial polyps on outcomes of in vitro fertilization (IVF) cycles. J Assist Reprod Genet 16:410-415. https://doi.org/10.1023/A:1020513423948
  10. Licong Shen, Qiushi Wang, Wei Huang (2011) High prevalence of endometrial polyps in endometriosis-associated infertility. Fertil Steril 95:2722-2724. https://doi.org/10.1016/j.fertnstert.2011.04.067
  11. Lieng M, Qvigstad E, Sandvik L, Jorgensen H, Langebrekke A, Istre O (2007) Hysteroscopic resection of symptomatic and asymptomatic endometrial polyps. J Minim Invasive Gynecol 14:189-194. https://doi.org/10.1016/j.jmig.2006.09.018
  12. Makrakis E, Hassiakos D, Stathis D, Vaxevanoglou T, Orfanoudaki E, Pantos K (2009) Hysteroscopy in women with implantation failures after in vitro fertilization: findings and effect on subsequent pregnancy rates. J Minim Invasive Gynecol. 16:181-187. https://doi.org/10.1016/j.jmig.2008.12.016
  13. Norwitz ER, Schust DJ, Fisher SJ (2001) Implantation and the survival of early pregnancy. N Engl J Med 345:1400-1408. https://doi.org/10.1056/NEJMra000763
  14. Peterson WF, Novak ER (1956) Endometrial polyps. Obstet Gynecol 8:40-49.
  15. Perez-Medina T, Bajo-Arenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P (2005) Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod 20:1632-1635. https://doi.org/10.1093/humrep/deh822
  16. Savelli L, De Iaco P, Santini D (2004) Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol 188:927-931.
  17. Sherman ME, Mazure MT, Kurman RJ (2002) Benign disease of the endometrium: Kurman RJ, ed. Blaunstein's Pathology of the Female Genital Tract. 3rd ed. Springer, New York, pp 421-466.
  18. Shokeir TA, Shalan HM, El-Shafei MM (2004) Significance of endometrial polyps detected hysteroscopically in eumenorrheic infertile women. J Obstet Gynaecol Res 30:84-89. https://doi.org/10.1111/j.1447-0756.2003.00163.x
  19. Taylor P, Pattinson H, Kredenster J (1992) Diagnostic hysteroscopy. In: Hunt R (ed.), Atlas of Female Infertility. Mosby-Year Book, Boston, pp 200.
  20. Valle RF (1980) Hysteroscopy in the evaluation of female infertility. Am J Obstet Gynecol 137:425-431. https://doi.org/10.1016/0002-9378(80)91122-9
  21. Varasteh NN, Neurith RS, Levin B, Keltz MD (1999) Pregnancy rates after hysteroscopic polypectomy and myomectomy in infertile women. Obstet Gynecol 94:168-171. https://doi.org/10.1016/S0029-7844(99)00278-1
  22. Wu HH, Schuetz MJ 3rd, Cramer H (2001) Significance of benign endometrial cells in Pap smears from postmenopausal women. J Reprod Med 46:795-798.
  23. Yanaihara A, Yorimitsu T, Motoyama H, Iwasaki S, Kawamura T (2008) Location of endometrial polyp and pregnancy rate in infertility patients. Fertil Steril 90:180-182. https://doi.org/10.1016/j.fertnstert.2007.05.072