Adenomı̇yozı̇sı̇n eşlı̇k ettı̇ğı̇ endometrı̇ozı̇s tanılı ı̇nfertı̇l hastalarda serum HE4 (Human Epididymis Protein-4) sevı̇yelerı̇nı̇n embrı̇yo transferı̇ sı̇kluslarında ı̇mplantasyon başarısına etkı̇sı̇nı̇n değerlendı̇rı̇lmesı̇
Date
2024
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Amaç: Adenomiyozis, endometriumun ektopik olarak miyometriumda yerleşmesi olarak tanımlanır. Reprodüktif çağdaki kadınlarda infertilite ile prezente olmaktadır. İnfertilite patogenezi, implantasyonu olumsuz etkilenmesi olarak bilinmektedir. Günümüzde ultrasonografi ile belirlenmiş kriterlerle tanı konabilmektedir. Human Epididymis Protein 4 (HE4) belirteci, jinekolojide malignite potansiyelinin, miyometrial invazyon derecesinin belirlenmesinde yardımcı olan bir invazyon biyomarkerı olarak öne çıkmaktadır. Çalışmadaki amacımız merkezimize infertilite ile başvuran adenomiyozis tanılı hastaların, adenomiyozisin ultrasonografik bulgularının ve embriyo transferi uygulananların implantasyon başarısının değerlendirilmesinde HE4 belirtecinin etkisini araştırmaktır. Gereç ve Yöntem: Çalışmamıza 1 Aralık 2022 – 31 Ağustos 2023 tarihleri arasında Bursa Uludağ Üniversitesi Kadın Hastalıkları ve Doğum (BUÜTF-KHD) İnfertilite Polikliniği ve Üremeye Yardımcı Tedaviler (ÜYTE) Merkezine infertilite ile başvuran, ultrasonografide adenomiyozisi olan toplam 82 hasta dahil edilmiştir. Hastalarla ilgili veriler prospektif olarak toplanmıştır. Ultrasonografi kriterleri Uluslararası Morfolojik Uterus Sonografik Değerlendirme (MUSA) konsensüsünde belirlenen bulgulara göre değerlendirilmiş ve foliküler fazda hastalardan alınan serumdan HE4 testi çalışılmıştır. Embriyo transferi uygulananların implantasyon ve gebelik sonuçları değerlendirilmiştir. Bulgular: Ultrasonografi bulgularından subendometrial lineer çizgi oluşumunda HE4 ile korelasyon saptanmış, ROC analizinde 37.4 pmol/L cut-off değer bulunmuştur. MUSA konsensüsünde belirtilen diğer ultrasonografi bulguları ile HE4’ün korelasyonu saptanmamıştır. Embriyo transferi yapılan hastaların transfer sonuçlarına bakıldığında implantasyon başarısı ile HE4 ilişkilendirilememiştir. Bu hastaların gebelik sonuçlarında abortus yaşayan hastalarda HE4 anlamlı olarak daha yüksek bulunmuştur (p=0,038). Sonuç: HE4’ün invazyon markerı olması dolayısıyla bu hipotez kurulmuştur. Çalışmamızda endo-miyometrial invazyonun göstergelerinden biri olan subendometrial lineer çizgilenmede HE4 ile istatistiksel olarak anlamlı ilişki saptanmıştır. Diğer belirteçler ve embriyo transferlerinde implantasyon ilişkisi için daha geniş örneklem büyüklüğüne sahip prospektif çalışmaların yapılması faydalı olacaktır.
Aim: Adenomyosis is defined as the ectopic location of the endometrium in the myometrium. It presents with infertility in women of reproductive age. It is known to negatively affect implantation in the pathogenesis of infertility. Today, its diagnosis can be made with criteria determined by ultrasonography. The Human Epididymis Protein 4 (HE4) marker stands out as an invasion biomarker that helps determine the degree of myometrial invasion and the potential for malignancy in gynecology. Our aim in our study is to investigate the effect of the HE4 marker in the evaluation of ultrasonographic findings of adenomyosis and to evaluate the implantation success of patients who underwent embryo transfer with the HE4 marker. Materials and Methods: 82 patients who applied to Bursa Uludağ University Obstetrics and Gynecology Infertility Clinic and the Assisted Reproductive Technology (ART) Center between 01/12/2022 – 31/08/202 with infertility and had adenomyosis on ultrasonography were included in our study. Data on patients were collected prospectively. Ultrasonography criteria were evaluated according to the findings determined in the Morphological Uterus Sonographic Assessment (MUSA) consensus, and the HE4 test was studied from serum taken from patients in the follicular phase. The implantation and pregnancy results of those who underwent embryo transfer were evaluated. Results: Among the ultrasonography findings, a correlation with HE4 was detected in the formation of subendometrial linear lines, and a cut-off value of 37.4 pmol/L was found in the ROC analysis. No correlation of HE4 with other ultrasound findings specified in the MUSA consensus was found. When the transfer results of patients who underwent embryo transfer were examined, HE4 could not be associated with implantation success. In the pregnancy outcomes of these patients, HE4 was found to be significantly higher in patients who experienced abortion (p=0.038). Conclusion: This hypothesis was established because HE4 is an invasion marker. In our study, a statistically significant relationship was found with HE4 in subendometrial linear lineation, which is one of the indicators of endo-myometrial invasion. It would be useful to conduct prospective studies with larger sample sizes for the relationship between other markers and implantation in embryo transfers.
Aim: Adenomyosis is defined as the ectopic location of the endometrium in the myometrium. It presents with infertility in women of reproductive age. It is known to negatively affect implantation in the pathogenesis of infertility. Today, its diagnosis can be made with criteria determined by ultrasonography. The Human Epididymis Protein 4 (HE4) marker stands out as an invasion biomarker that helps determine the degree of myometrial invasion and the potential for malignancy in gynecology. Our aim in our study is to investigate the effect of the HE4 marker in the evaluation of ultrasonographic findings of adenomyosis and to evaluate the implantation success of patients who underwent embryo transfer with the HE4 marker. Materials and Methods: 82 patients who applied to Bursa Uludağ University Obstetrics and Gynecology Infertility Clinic and the Assisted Reproductive Technology (ART) Center between 01/12/2022 – 31/08/202 with infertility and had adenomyosis on ultrasonography were included in our study. Data on patients were collected prospectively. Ultrasonography criteria were evaluated according to the findings determined in the Morphological Uterus Sonographic Assessment (MUSA) consensus, and the HE4 test was studied from serum taken from patients in the follicular phase. The implantation and pregnancy results of those who underwent embryo transfer were evaluated. Results: Among the ultrasonography findings, a correlation with HE4 was detected in the formation of subendometrial linear lines, and a cut-off value of 37.4 pmol/L was found in the ROC analysis. No correlation of HE4 with other ultrasound findings specified in the MUSA consensus was found. When the transfer results of patients who underwent embryo transfer were examined, HE4 could not be associated with implantation success. In the pregnancy outcomes of these patients, HE4 was found to be significantly higher in patients who experienced abortion (p=0.038). Conclusion: This hypothesis was established because HE4 is an invasion marker. In our study, a statistically significant relationship was found with HE4 in subendometrial linear lineation, which is one of the indicators of endo-myometrial invasion. It would be useful to conduct prospective studies with larger sample sizes for the relationship between other markers and implantation in embryo transfers.
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Keywords
Adenomiyozis, İnfertilite, İnvazyon, Human Epididymis Protein 4, Ultrasonografi, Adenomyosis, Infertility, Invasion, Ultrasonography