Rani Kanchan, Durga Mounika Kante, Singhal Shivangi
Obstetrics and Gynaecology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, IND.
Obstetrics and Gynaecology, Teerthanker Mahaveer Medical college and Research Centre, Moradabad, IND.
Cureus. 2024 Apr 5;16(4):e57666. doi: 10.7759/cureus.57666. eCollection 2024 Apr.
Introduction There have been numerous studies on the anovulatory factor, leading to infertility in women with polycystic ovary syndrome (PCOS); however, studies on the endometrium factor causing infertility in PCOS women are scarce. While hysteroscopy can accurately diagnose endometrial disorders such as endometrial polyps, it may be ineffective in detecting probable endometrial pathologies due to different hormonal habitats in these patients. Materials and methods Sixty patients with PCOS-related infertility were included in the study. All participants underwent hysteroscopic examination followed by endometrial biopsy and histopathological examination. The clinical and hormonal profiles of two main subgroups, that is, (a) normal endometrium (N), which included proliferative endometrium and secretory endometrium on histology, and (b) disordered endometrium (D), which included disordered endometrium on histology, were compared. Results There was no correlation between hysteroscopic and histopathological findings of PCOS infertile women. In the subgroup analysis of the two main histological types, that is, normal (proliferative and secretory) and disordered (disordered endometrium), age (28.70±4.66 vs. 32.9±5.61, p=0.012) and duration of amenorrhea (5.49±2.43 vs. 7.82±2.93, p=0.008) were significantly higher in the disordered group. There was a statistically nonsignificant higher BMI in the patients of the disordered endometrium group. Conclusion These findings suggest that endometrial biopsy and histopathological evaluation along with hysteroscopy should be desired in women with PCOS-related infertility, especially if they are in the late reproductive age group and have a longer duration of amenorrhea, regardless of endometrial thickening. This approach is essential to diagnose and treat endometrial disorder, which can be an additional cause of infertility, recurrent implantation failure, and recurrent pregnancy loss, in addition to ovulatory dysfunction.
引言 关于导致多囊卵巢综合征（PCOS）女性不孕的无排卵因素已有大量研究；然而，关于导致PCOS女性不孕的子宫内膜因素的研究却很少。虽然宫腔镜检查可以准确诊断子宫内膜疾病，如子宫内膜息肉，但由于这些患者存在不同的激素环境，在检测可能的子宫内膜病变时可能无效。
材料与方法 本研究纳入了60例PCOS相关不孕患者。所有参与者均接受了宫腔镜检查，随后进行了子宫内膜活检和组织病理学检查。比较了两个主要亚组的临床和激素特征，即（a）正常子宫内膜（N），组织学上包括增殖期子宫内膜和分泌期子宫内膜，以及（b）紊乱子宫内膜（D），组织学上包括紊乱子宫内膜。
结果 PCOS不孕女性的宫腔镜检查结果与组织病理学检查结果之间无相关性。在两种主要组织学类型的亚组分析中，即正常（增殖期和分泌期）和紊乱（紊乱子宫内膜），紊乱组的年龄（28.70±4.66 vs. 32.9±5.61，p = 0.012）和闭经持续时间（5.49±2.43 vs. 7.82±2.93，p = 0.008）显著更高。紊乱子宫内膜组患者的BMI略高，但无统计学意义。
结论 这些发现表明，对于PCOS相关不孕的女性，尤其是处于晚育年龄组且闭经持续时间较长的女性，无论子宫内膜是否增厚，都应进行子宫内膜活检和组织病理学评估以及宫腔镜检查。这种方法对于诊断和治疗子宫内膜紊乱至关重要，子宫内膜紊乱除了排卵功能障碍外，还可能是不孕、反复种植失败和反复流产的额外原因。
