Abstract
Background and aim: Thin endometrium is a highly relevant issue in reproductive medicine. We aimed at determining the effect of the intrauterine exposure with non-ablative erbium YAG laser on the endometrium and the pregnancy rate in infertile women.
Methods: This was an open pilot study in which sixty-one infertile women with a history of implantation failures using assisted reproductive technology underwent a single procedure of intrauterine and endocervical exposure with a non-ablative laser on the 6th - 10th day of the menstrual cycle. Before and 1-2 months after the laser treatment we performed evaluation of the endometrium (histological and immunohistochemical examinations and sonographic thickness measurement), and a cervical PAP smear.
Results: High glandular proliferation in the endometrium in the middle of the proliferative phase of the menstrual cycle before the laser treatment was detected only in 24.2% of specimens rate that increased to 60.6% after the laser treatment (p=0.002). Sclerosis in the spiral arteries and/or stroma decreased from 54.6% to 30.3% of the specimens (p=0.046). Expression of VEGF, progesterone receptors (PR) and estrogen receptors (ER) significantly improved. There was no histological hyperplasia, malignancy, destruction or necrosis in the endometrium or adverse changes in the PAP smears after treatment. The average sonographic thickness of the endometrium in the middle of the menstrual cycle was 5.9 0.87 mm before and 7.9 2.65 mm after the laser treatment (р<0.001). A 71.1% women achieved clinical pregnancy after the frozen-thawed embryo transfer in 1-4 months after the laser treatment. Conclusions: The intrauterine exposure with non-ablative erbium YAG laser clearly demonstrated the improvement and synchronization with a phase of menstrual cycle of proliferative activity of the endometrium, reduction in the prevalence of sclerosis, restoration of PR and ER nuclei expression, increase in the sonographic thickness of the endometrium and fertility rate.
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