Influence Of Endometrial Minimally Invasive Surgery By Hysteroscopy On Biochemical Indicators Of The Receptivity Of Endometrium

Objective: To study the expression of endometrial related factors ofpreoperative and postoperative by hysteroscopy endometrial minimally invasivesurgery, to analyze the influence of hysteroscopy endometrial minimallyinvasive surgery on the receptivity of endometrium from the point of view ofmolecular biology, to discuss its improving the clinical value of embryoimplantation rate and pregnancy rate, to explore a new method of treatment forthe repeated embryo transplantation failure patients.Methods: To choose20patients with the failed pregnancies ofimplementation of three consecutive cycles of IVF treatment quality embryos ormore, in Reproductive Centre of the First Affiliated Hospital of GuangxiMedical University from November,2011to September,2012. The blood serum E2and P levels were measured, the specimens of endometrial were collectedand the hysteroscopy endometrial minimally invasive surgery was implementedin the window period of implantation. In the first and second month after theoperation, the hysteroscopy endometrial minimally invasive surgery wasimplemented once more. To collect specimens of peripheral blood andendometrium of the patients in the third month after the operation. Comparingpreoperative and postoperative changes of serum sex hormones, endometrialsecretion were observed under optical microscope by HE staining. Theendometrial ER, PR, LIF, VEGF of each group was detected byimmuneohistochemistry (Streptomyces avidin peroxidase connection). To usepathological image analyzer and the enclosed software to measure the averageoptical density value of various factors (MOD). Postoperative patients again inIVF-ET treatment,were followed up for6months，track their pregnancies. Theexperimental data was described by mean standard deviation (x±s) or rate (%),and was analyzed by SPSS16.0software package. The measurement data wasanalyzed by t-test (α=0.05), the enumeration data was analyzed by chi-squaretest (α=0.05).Results:20patients with the endometrial factor infertility underhysteroscopy endometrial minimally invasive surgery, the preoperative bloodserum E2and P levels and those of3month after the operation wererespectively574.70±184.35VS618.91±217.85, P＞0.05and38.59±11.46VS 43.60±8.85, P＞0.05, there was no statistically significant difference.Comparing the normal endometrial secretion and inadequate secretion, thepreoperative and those of3months after the operation were respectively10％VS75%and90%VS25%, P＜0.01, the difference was statistically significant.The comparison of preoperative receptivity of endometrial related factor andthat of3months after the operation: the expression of ER on the endometrialglandular epithelial was0.165±0.007VS0.232±0.037, P＜0.01, and interstitialwas0.085±0.020VS0.124±0.020, P＜0.01; the expression of PR onendometrial glandular epithelial was0.030±0.009VS0.079±0.018, P＜0.01,and interstitial was0.037±0.013VS0.087±0.018, P＜0.01; the expression ofLIF was0.204±0.015VS0.236±0.027, P＜0.01, the expression of VEGF was0.155±0.025VS0.295±0.023, P＜0.01, the difference had statisticalsignificance. Postoperative patients selected for embryo transfer again werefollowed up for6months，the implantation rate was33.3%, and the pregnancyrate was27.8%.Conclusion:1. The minimally invasive surgery under hysteroscopy can promote theexpression of endometrial ER, PR, improve the sensitivity ofendometrial response to ovarian hormones, increase the endometrialthickness and enhance the endometrial secrete reaction.2. The minimally invasive surgery under hysteroscopy can enhance theexpression of LIF and VEFG, stimulate the spiral of tiny blood vessels,rich endometrial blood flow, make the endometrium to adhesive state transitions.3. The minimally invasive surgery under hysteroscopy can improveendometrial factor infertility patients with endometrial receptive, toincrease IVF embryo implantation rate and clinical pregnancy rate haveimportant value.