Effects Of Interventional Scleotherapy On Endometrial Receptivity Of The Patients With Hydrosalpinx And Its Mechanism

PartⅠThe Constituent Changes of Hydrosalpinx after Interventional Ultrasound ScleotherapyObjective To detect the constituent changes of hydrosalpinx after interventional ultrasound scleotherapy.Methods Hydrosalpinx samples before and after interventional ultrasound sclerotherapy were collected from randomizedly selected 16 cases of hydrosalpinx and assigned into group A and group B,then the measurement of pH,concentrations of K⁺,Na⁺,Cl^-,Ca²⁺,Mg²⁺,protein,glucose,TNF-α,LIF,VEGF,IGF-1,NO,ET-1,PGI₂,TXA₂,and culture of bacteria,mycoplasma,chlamydia and gonococcus were carried out and compared between Group A and group B.Results The pH values in hydrosalpinx were comparable before and after the sclerotherapy（8.46±0.82 vs.8.23±0.77）.The concentrations of K⁺,Ca²⁺,protein and glucose in hydrosalpinx after treatment were significantly higher than pretreatment（P<0.05）,while the level of TNF-αdecreased significantly after treatment.The positive rates of mycoplasma and chlamydia after treatment（25.00%,12.5%）,were lower than pretreatment（31.25%,18.75%）,but the difference did not reach statistical significence.No bacterial and gonococcus growth were cultured in all hydrosalpinx samples.Conclusions Increased concentrations of K⁺,Ca²⁺,protein and glucose in hydrosalpinx after treatment may be beneficial for embryo development,and lower level of TNF-αmay improve the endometrial receptivity.Part II The Effects of the Interventional Ultrasound Sclerotherapy on Endometrial Ultrastructure and the Cytokines in the Window of Implantation of Patients with HydrosalpinxObjective To investigate the changes of endometrial receptivity in patients with hydrosalpinx after interventional ultrasound sclerotherapy.Methods The endometrial specimens in the window of implantation from randomly selected 10 cases with hydrosalpinx before and after sclerotherapy treatment were collected,and endometrial pinopodes were observed with scanning electron microscope.Random samples of 10 patients of tubal infertility without hydrosalpinx were designed as control.Meanwhile,the endometrial specimens of implanting window phase from 17 hydrosalpinx patients without sclerotherapy（group A）,16 cases received treatment of sclerotherapy（group B）,and 20 cases with tube infertility patients without hydrosalpinx（group C）were collected to detect the expressions of VEGF,IGF-1,integrin αVβ3 and HOXA10 through immunohistochemisty.Results The development and richness of endometrial pinopodes in group B were similar to group C,which were significantly higher than that in group A.The expression levels of VEGF,integrin αVβ3 and HOXA10 in group B increased significantly compared with that in group A（P<0.05）.The expression of IGF-1 in group A decreased than that in group C（P<0.05）,whereas,which in group B showed no statistical significance with group A and group C（P>0.05）.Conclusion The endometrial pinopodes of development and richness and the levels of VEGF,IGF-1,integrin αVβ3,HOXA10,as the markers of endometrial receptivity,increased significantly after sclerotherapy,suggesting sclerotherapy could significantly improve the endometrial receptivity for the patients with hydrosalpinx.Part III The Gene Expression Profiles of Implanting Window Phase Endometrium in the Patients with Hydrosalpinx after Interventional Ultrasound SclerotherapyObjective To detect the endometrial gene expression changes of the patients with hydrosalpinx after interventional ultrasound sclerotherapy.Methods The endometrial specimens of implanting windows were collected and grouped.4 specimens from the patients with hydrosalpinx before treatment and the patients with hydrosalpinx after sclerotherapy treatment were as assigned as group A.and group B,while the 4 specimens from the patinents with tuble infertility without hydrosalpinx were served as control（group C）.The gene expression levels of the endometrial specimens were detected with Human Gene Expression 4x44 K v2 Microarray and Expression Spectrum Chips（Agilent）and the Me V analysis software was used for hierarchical clustering.Gene ontological analysis and KEGG analysis were also used.Real-time quantitative PCR was performed to verify the different expression genes.Results There were large amount of genes expressed differently between group A and group C,group B and group A.Hierarchical clustering analysis of differential expression genes showed that four samples in group A,group B and group C were classified into one group,respectively.There were great differences in gene expression between group A and group B,group A and group C.Whereas,the genes expression profiles of group B were closer to group C.The genes such as ITGA3,MEGF6 and KRT79 were in the same group with VEGF.They might have similar functions with VEGF and were closely related to endometrium receptivity.The result of RT-PCR was consistent with the results of chips.Conlusions The poor endometrial receptivity in the patients with hydrosalpinx might attribute to the genes expression of endometrium up-regulated or down-regulated expressed during the implanting window phase,which might be altered after sclerotherapy.This might be the important mechanism that IVF outcomes of hydrosalpinx patients could be improved after interventional ultrasound scleotherapy.