Photodynamic therapy for thin endometrium in patients with infertility

«Radiation and Risk», 2023, vol. 32, No. 2, pp.56-65

DOI: 10.21870/0131-3878-2023-32-2-56-65

Authors

Arutyunyan N.A. – Obstetrician-Gynecologist, C. Sc., Med. Contacts: 1A, Lithuanian Boulevard, Moscow, 117593, Russia. Tel.: +7 968 728 68 86; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Katsalap S.N. – Sen. Researcher, C. Sc., Med.
Akatieva A.S. – Head of Dep., C. Sc., Med.
Khmelevskaya V.F. – Obstetrician-Gynecologist
Alekhin A.I. – Deputy Director, MD, Prof. Central Hospital of the RAS.
Central Clinical Hospital of the Russian Academy of Sciences, Moscow

Abstract

There is now evidence of certain structural and functional changes in the endometrium that may be etiological factors affecting the reproductive system health. Endometrial hypoplasia and alterations in uterine hemodynamics may cause implantation failure. Because thin endometrium is associated with infertility, early miscarriage and difficulty of treating, further search and use of new therapeutic methods designed on the basis of domestic state-of-the-art technologies is relevant. Effectiveness of intracavitary photodynamic therapy (PDT) for patients with thin endometrium was investigated. Fifty patients at the age of 35.4+-3.3 years with established diagnoses of thin endometrium and infertility were included in the study. All patients were given PDT. Before the treatment the photosensitiser “Photoditazine” was injected intracavitary in the II phase of the menstrual cycle. For irradiation of the uterine cavity the medical apparatus “LAMI” providing laser radiation with wavelength of 660 nm, was used. To distribute evenly the light in the uterine cavity, intrauterine cylinder optical fiber diffuser (OFD «KOVB-660») was used. The average laser power density was 0.05+-0.02 W/cm², energy density 36.7+-5.9 J/cm², laser exposure time 11.7+-2.25 min. We found that the use of intracavitary PDT for thin endometrium allows to correct the menstrual cycle, to achieve long-lasting clinical effect, to regenerate the thickness and 3-layer structure of the endometrium, to increase the percentage of recognised pregnancies and to reduce the risk of pregnancy complications.

Key words
photodynamic therapy, endometrial hypoplasia, thin endometrium, infertility, photosen-sitizer, chronic endometritis, miscarriage, hypomenstrual syndrome, pregnancy, laser radiation.

References

1. Obstetrics and gynecology. Clinical guidelines. Eds.: G.M. Savelieva, G.T. Sukhikh, V.N. Serov. Moscow, GEOTAR-Media, 2016. 1024 p. (In Russian).

2. Ermolenko K.S., Radzinsky V.E., Rapoport S.I. The current state of the problem of the implementation of the fertile function in women of late reproductive age. Klinicheskaya meditsina – Clinical Medicine, 2016, no. 1, pp. 10-15. (In Russian).

3. The European health report 2015. Targets and beyond – reaching new frontiers in evidence. Copenhagen, WHO Regional Office for Europe, 2015. 234 p.

4. Radzinsky V.E. Non-developing pregnancy: a guide. Moscow, GEOTAR-Media, 2017. 176 p. (In Russian).

5. Krutova V.A. Ways to overcome female infertility. Dr. med. sci. diss. abstr. Moscow, 2016. 51 p. (In Russian).

6. Check J.H., Cohen R. Live fetus following embryo transfer in a woman with diminished egg reserve whose maximal endometrial thickness was less than 4 mm. Clin. Exp. Obstet. Gynecol., 2011, vol. 38, no. 4, pp. 330-332.

7. Gyulmamedova I.D., Mezhova O.K. Problems of implantation in the IVF program (literature review). Novosti meditsiny i farmatsii – News of Medicine and Pharmacy, 2010, no. 253, pp. 17-27. (In Russian).

8. Mityurina E.V., Perminova S.G., Demura T.A., Galliamova E.M. Morphofunctional state of the endometrium in stimulated cycles of the in vitro fertilization program. Akusherstvo i ginekologiya – Obstetrics and Gynecology, 2014, no. 11, pp. 80-87. (In Russian).

9. Edwards R.G. Human implantation: the last barrier in assisted reproduction technologies? Reprod. Biomed. Online, 2006, vol. 13, no. 6, pp. 887-904.

10. Basir G.S., O W.-S., So W.W., Ng E.H., Ho P.C. Evaluation of cycle-to-cycle variation of endometrial responsiveness using transvaginalsonography in women undergoing assisted reproduction. Ultrasound. Obstet. Gynecol., 2012, vol. 19, no. 5, pp. 484-489.

11. Boiarskii K.Yu., Gaidukov S.N., Palchenko N.A. Modern look on endometrial receptivity and thin endome-trium in art cycles (a review). Problemy` reproduktsii – Russian Journal of Human Reproduction, 2013, no. 4, pp. 51-60. (In Russian).

12. Sher G., Fisch J.D. Effect of vaginal sildenafil on the outcome of in vitro fertilization (IVF) after multiple IVF failures attributed to poor endometrial development. Fertil. Steril., 2002, vol. 78, no. 5, pp. 1073-1076.

13. Kasius J.C., Fatemi H.M., Bourgain C., Sie-Go D.M., Eijkemans R.J., Fauser B.C., Devroey P., Broekmans F.J. The impact of chronic endometritis on reproductive outcome. Fertil. Steril., 2011, vol. 96, no. 6, pp. 1451-1456.

14. Fiçicioğlu C., Tasdemir S., Arioglu P.F., Unlu R., Yorganci C. The use of transvaginal ultrasonography in the evaluation of luteal phase endometrium. Acta Eur. Fertil., 1995, vol. 26, no. 1, pp. 35-40.

15. Mezhevitinova E.A. Transdermal estrogen in women of reproductive age (for the practitioner's aid). Ginekologiya – Gynecology, 2016, vol. 18, no. 2, pp. 103-106. (In Russian).

16. Serebrennikova K.G., Alekhin A.I., Tverdikova M.A., Gevondyan N.M., Vanke E.S., Arutyunyan N.A. The effectiveness of photodynamic therapy in the treatment of endometrial hyperplastic processes in older patients. Rossijskij vestnik akushera-ginekologa – Russian Bulletin of an Obstetrician-Gynecologist, 2018, vol. 18, no. 4, pp. 68-74. (In Russian).

17. Serebrennikova K.G., Babichenko I.I., Arutyunyan N.A., Katsalap S.N., Akat’eva A.S. New in the diagnosis and treatment of chronic endometritis in infertility. Ginekologiya – Gynecology, 2019, vol. 21, no. 1, pp. 14-18. (In Russian).

18. Serebrennikova K.G., Katsalap S.N., Babichenko I.I., Alekhin A.I., Arutyunyan N.A. Photodynamic therapy of chronic endometritis in infertility. The 27th World Congress on Controversies in Obstetrics, Gyne-cology and Infertility (COGI). November 21-23, Paris, France, 2019. 163 p.

19. Serebrennikova K.G., Arutyunyan N.A., Katsalap S.N., Alekhin A.I. Photodynamic therapy in infertile patients with chronic endometritis. Rossijskij vestnik akushera-ginekologa – Russian Bulletin of an Obstetri-cian-Gynecologist, 2020, vol. 20, no. 3, pp. 56-61. (In Russian).

20. Katsalap S.N., Serebrennikova K.G., Arutyunyan N.A., Alekhin A.I. Photodynamic reparative regeneration of the endometrium in infertility caused by chronic endometritis. Radiatsiya i risk – Radiation and Risk, 2020, vol. 29, no. 1, pp.154-161. (In Russian).

21. Health care in Russia: statistical collection. Moscow, Rosstat, 2015. 174 p. (In Russian).

22. Pregravid preparation: clinical protocol. Ed.: V.E. Radzinsky. Moscow, Status Praesens, 2016. 80 p. (In Russian).

23. Radzinsky V.E. Early pregnancy. Moscow, Status Praesens, 2009. 480 p. (In Russian).

24. Bentin-Ley U., Sjögren A., Nilsson L., Hamberger L., Larsen J.F., Horn T. Presence of uterine pinopodes at the embryo-endometrial interface during human implantation in vitro. Hum. Reprod., 2009, vol. 14, no. 2, pp. 515-520.

Full-text article (in Russian)