Characterizing the endometrium in unexplained and tubal factor infertility: a multiparametric investigation.
OBJECTIVE
To characterize endometrial development in unexplained and tubal factor infertility.


METHODS
Prospective study of 20 women with unexplained infertility, 22 with tubal factor infertility, and 21 fertile controls in the midproliferative, periovulatory, and midluteal phases of the menstrual cycle.


METHODS
Reproductive Medicine Department of St. Mary's Hospital, Manchester, United Kingdom.


METHODS
Women awaiting assisted conception.


METHODS
Serum hormone assays, transvaginal ultrasound, Doppler, and midluteal endometrial biopsies.


METHODS
Serum levels of E2, P, and LH, endometrial ultrasound morphometry, uterine and subendometrial artery Doppler, and endometrial histology and biochemistry.


RESULTS
Women with unexplained infertility demonstrated significantly reduced uterine artery flow velocity in all phases, significantly elevated uterine and subendometrial artery impedance in the periovulatory and midluteal phases, and significantly reduced endometrial texture in the midproliferative phase. Women with tubal factor infertility demonstrated significantly reduced uterine artery flow velocity, without a concomitant increase in impedance, and significantly greater expression of endometrial glandular and luminal keratan sulphate.


CONCLUSIONS
Unexplained infertility is associated with a profound impairment of endometrial perfusion that might be amenable to treatment by perfusion enhancers. Tubal factor infertility is associated with endometrial developmental defects that might be corrected by salpingectomy. Endometrial ultrasound and Doppler studies are likely to become a vital tool in the investigation of infertility.
Edi-Osagie
Edmond C O
EC
Department of Obstetrics and Gynecology, St. Mary's Hospital, Manchester, United Kingdom. edmond.edi-osagie@cmmc.nhs.uk
Seif
Mourad W
MW
Aplin
John D
JD
Jones
Carolyn J P
CJ
Wilson
Godfrey
G
Lieberman
Brian A
BA
D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D001706:Biopsy; D001783:Blood Flow Velocity; D004717:Endometrium / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000473:pathology; D005184:Fallopian Tube Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000473:pathology; D005260:Female; D005498:Follicular Phase; D006801:Humans; D007150:Immunohistochemistry; D007247:Infertility, Female / Q000000981:diagnostic imaging* / Q000209:etiology / Q000378:metabolism*; D007632:Keratan Sulfate / Q000378:metabolism; D037102:Lectins / Q000378:metabolism; D008183:Luteal Phase; D010060:Ovulation; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D014599:Uterus / Q000098:blood supply; D014655:Vascular Resistance
D037102:Lectins; D007632:Keratan Sulfate