Cover
Vol. 10 No. 1 (2020)

Published: December 31, 2020

Pages: 20-34

Research Article

Effect of Letrozole on Hyaluronic Acid Concentration of the Endometrial Wash

Sarab Khalaf Hammood AlJuboory 1 Mufeda Ali Jwad 2 Nadia Al-Hilli 3
1High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al Nahrain University, Baghdad, Iraq.; Ministry of Health, Health Directorate, Kirkuk, Iraq.
2High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al Nahrain University, Baghdad, Iraq.
3Department of Obstetrics & Gynecology, College of Medicine, University of Babylon, Babylon, Iraq .
History
  • Received: July 31, 2020
  • Accepted: August 21, 2020
  • Available Online: December 14, 2020
DOI

https://doi.org/10.28969/IJEIR.v10.i1.r2

Abstract

Hyaluronic acid (HA) is an anionic, non-sulfated glycosaminoglycan distributed widely throughout connective, epithelial, and neural tissues. The study included 40 infertile females. A full history taking, complete general examination, complete gynecological examination, and infertility workup including basal hormonal analysis, and uterine cavity assessment by ultrasound and tubal patency evaluation by hysterosalpingogram was done in addition to husband’s seminal fluid analysis. The control group did not receive any ovarian stimulation drugs, while the 2 nd group was treated with letrozole + gonadotropin. The ovarian stimulation protocol was chosen for each patient according to her age, history, and hormonal assay. Evaluation of thickness and pattern of the endometrium, size, and the number of mature follicles was performed by transvaginal ultrasonography on the 2 nd day of the menstrual cycle and cycle day 11-14 before hCG injection. The study showed no correlation between HA and LH at triggering day in women who received letrozole plus Gonadotropin but a positive correlation was documented between HA concentration and E 2 in addition to a positive correlation with progesterone, the number of follicles, and endometrial thickness at the day of triggering of ovulation. The study revealed that mean hyaluronic acid concentration was elevated significantly (P<0.05) in pregnant women after stimulation protocol compared with nonpregnant (164.2 vs. 152.1 pg/ml). HA was significantly higher in women who undergo ovarian stimulation with letrozole which was a good protocol in the treatment of women with ovulatory problems.

Keywords

References

  1. Bergqvist AS, Yokoo M, Heldin P. Hyaluronan and its binding proteins in the epithelium and intraluminal fluid of the bovine oviduct. Zygote, 2005; 13(3): 207-218. [Online Article Link]
  2. Campbell S. Ultrasound Evaluation in Female Infertility: Part 1, the Ovary and the Follicle. Obstetrics and Gynecology Clinics. 2019; 46(4): 683- 696. [Online Article Link]
  3. Chun S, Seo J, Rim Y. Efficacy of hyaluronan-rich transfer medium on implantation and pregnancy rates in fresh and frozen-thawed blastocyst transfers in Korean women with previous implantation failure. Obstetrics & gynecology science. 2016; 59(3): 201-207. [Online Article Link]
  4. Al-Hussaini TK, Shaaban OM. Aspiration of endometrial cavity fluid at the time of egg collection. Middle East Fertility Society Journal. 2018 Dec 1;23(4):354-6 . [Online Article Link]
  5. Oats JJ, Abraham S. Llewellyn-Jones Fundamentals of Obstetrics and Gynaecology E-Book. Elsevier Health Sciences; 2015 Nov 13. [Online Article Link]
  6. Elsedeek M, Elmaghraby H. Predictors and characteristics of letrozole induced ovulation in comparison with clomiphene induced ovulation in anovulatory PCOS women. Middle East Fertility Society Journal. 2011; 6(2): 125-130. [Online Article Link]
  7. Ahmeid M. Correlation between follicular fluid leptin and the pregnancy rate in women who underwent ICSI. Tikrit Med J. 2017; 22: 248-53. [Online Article Link]
  8. Hameed B, Ahmeid M. Serum follistatin and its role in intracytoplasmic sperm injection outcomes. Medical Journal of Babylon. 2019; 16(4): 302-306. [Online Article Link]
  9. González-Ramos R, Van Langendonckt A, Defrère S, Lousse JC, Colette S, Devoto L, Donnez J. Involvement of the nuclear factor-κB pathway in the pathogenesis of endometriosis. Fertility and sterility. 2010 Nov 1;94(6):1985-94. [Online Article Link]
  10. Simões SR, Carbonel AA, Borges FT, Baracat MC, da Silva Sasso GR, Simões MJ, Serafini PC, Soares JM, Nader HB, Baracat EC. Analysis of hyaluronic acid in the endometrium of women with polycystic ovary syndrome. Gynecological Endocrinology. 2019 Feb 1;35(2):133- 7. [Online Article Link]
  11. Nagyova E. The biological role of hyaluronan-rich oocyte-cumulus extracellular matrix in female reproduction. International Journal of Molecular Sciences. 2018 Jan;19(1):283. [Online Article Link]
  12. Gomes RC, Verna C, Nader HB, dos Santos Simões R, Dreyfuss JL, Martins JR, Baracat EC, de Jesus Simões M, Soares Jr JM. Concentration and distribution of hyaluronic acid in mouse uterus throughout the estrous cycle. Fertility and sterility. 2009 Aug 1;92(2):785- 92. [Online Article Link]
  13. Mohey-Elsaeed O, Marei WF, Fouladi-Nashta AA, El-Saba AA. Histochemical structure and immunolocalisation of the hyaluronan system in the dromedary oviduct. Reproduction, Fertility and Development. 2016 Jun 8;28(7):936- 47. [Online Article Link]
  14. Lane M, Maybach JM, Hooper K, Hasler JF, Gardner DK. Cryo‐survival and development of bovine blastocysts are enhanced by culture with recombinant albumin and hyaluronan. Molecular Reproduction and Development: Incorporating Gamete Research. 2003 Jan;64(1):70-78 . [Online Article Link]
  15. Simon A, Safran A, Revel A, Aizenman E, Reubinoff B, Porat-Katz A, Lewin A, Laufer N. Hyaluronic acid can successfully replace albumin as the sole macromolecule in a human embryo transfer medium. Fertility and sterility. 2003 Jun 1;79(6):1434-8 . [Online Article Link]
  16. Stojkovic M, Krebs O, Kölle S, Prelle K, Assmann V, Zakhartchenko V, Sinowatz F, Wolf E. Developmental regulation of hyaluronan-binding protein (RHAMM/IHABP) expression in early bovine embryos. Biology of reproduction. 2003 Jan 1;68(1):60-66 . [Online Article Link]
  17. Fouladi-Nashta AA, Raheem KA, Marei WF, Ghafari F, Hartshorne G. Regulation and roles of the hyaluronan system in mammalian reproduction. Reproduction. 2017 Feb 1;153(2): R43-R58. [Online Article Link]
  18. Afify AM, Craig S, Paulino AF. Temporal variation in the distribution of hyaluronic acid, CD44s, and CD44v6 in the human endometrium across the menstrual cycle. Applied Immunohistochemistry & Molecular Morphology. 2006 Sep 1;14(3):328- 33. [Online Article Link]