OBJECTIVE

To study the effect of the energy of focused ultrasonic waves during FUS-MRI ablation of uterine fibroids on molecular markers of endometrial receptivity in women of reproductive age.

MATERIAL AND METHODS

A prospective comparative controlled study of 60 women of reproductive age was conducted. The main group consisted of 32 patients suffering from the symptomatic course of uterine fibroids who received treatment with FUS-MRI ablation of uterine fibroids. Depending on the localization of the treated node, the patients were divided into two subgroups: 17 women with localization of the node on the front wall of the uterus and the reflected action of ultrasonic waves on the endometrium and 15 women with localization of the node on the posterior wall of the uterus and direct penetrating effect of the waves. The control group consisted of 28 healthy fertile women. The endometrium obtained with pipelle biopsia on days 20—22 of the cycle was examined by immunohistochemistry before and three months after the treatment.

RESULTS

After FUS-MRI ablation of uterine fibroids in the endometrium, a statistically significant decrease in the stromal expression of natural uterine killers CD95^{+ bright} was observed to a level comparable to control values (from 70.22±9.77 to 48.81±5.47 c/s; in the control — 47.80±2.13 c/s; p<0.001). The ratio and expression level of steroid receptors, proliferation markers, p53-dependent apoptosis and its blockers, regulators and markers of angiogenesis, LIF and LIF-R signaling molecules in the stroma and endometrial glands did not change significantly after treatment (p>0.05 in treatment dynamics). It was found that focused ultrasound rays passing through the endometrium cause an increase in the level of expression of estradiol alpha recipes in the endometrial glands (118.07±14.01 points to 153.33±11.43 points; p=0.02) and a decrease in stromal p53 expression (30.80±21.61% to 14.66±3.74%; p=0.007). No dependence of the level of decrease in stromal expression of NK-cells of CD56^{+ bright} on the localization of the treated node was revealed. With the passage of ultrasonic waves through the endometrium, a significant increase in the expression of CD34⁺ in the stroma of the endometrium was noted to a level statistically comparable with control values (26.00±1.63 to 32.47±2.03 c/s; p=0.011, in the control 37.99±1.23 c/s).

CONCLUSIONS

The study did not reveal any significant negative effects of focused ultrasonic waves during FUS-MRI ablation of uterine fibroids on endometrial receptivity in women of reproductive age.