Characterization of the uterine junctional zone prior to IVF/ICSI: an observational study.

PURPOSE: The uterine junctional zone as documented by magnetic resonance imaging (MRI) has shown to be of significance with respect to the early process of human reproduction. In this study, MRI findings were related to the outcome of an IVF/ICSI program. MATERIALS AND METHODS: In 113 infertile women, the diameter of the anterior and posterior junctional zone (JZ) myometrium was documented by MRI prior to the use of ART. Each group of women was also subdivided according to the presence (MI/GV>0%) or absence (MI/GV=0%) of metaphase I(MI) and germinal vesicle (GV) oocytes. The MRI measurements were related to these and further parameters like expansion of the cumulus oophorus, pronuclei stages, embryo morphology and pregnancy rates. RESULTS: In all women with MI/GV=0%, the JZ myometrium was significantly enlarged (p<0.004) and the clinical pregnancy rate was significantly lower (p<0.025) when compared to the women with MI/GV>0%. The baby take home rates tended to the same results, but were not significantly different. No direct influence of the JZ on all other parameters could be observed. CONCLUSIONS: The JZ, as documented by MRI, might interfere with follicular function.

Uterine peristaltic activity and the development of endometriosis.

Peristaltic activity of the nonpregnant uterus serves fundamental functions in the early process of reproduction, such as directed transport of spermatozoa into the tube ipsilateral to the dominant follicle, high fundal implantation of the embryo, and, possibly, retrograde menstruation. Hyperperistalsis of the uterus is significantly associated with the development of endometriosis and adenomyosis. In women with hyperperistalsis, fragments of basal endometrium are detached during menstruation and transported into the peritoneal cavity. Fragments of basal endometrium have, because of their equipment with estrogen and progesterone receptors and because of their ability to produce estrogen, an increased potential of implantation and proliferation, resulting in pelvic endometriosis. In addition, hyperperistalsis induces the proliferation of basal endometrium into myometrial dehiscencies. This results in endometriosis-associated adenomyosis with a prevalence of approximately 90%. Adenomyosis results in impaired directed sperm transport and thus constitutes an important cause of sterility in women with endometriosis. Our own date and that from the literature strongly suggest that the principal mechanism of endometriosis/adenomyosis is the paracrine interference of endometrial estrogen with the cyclical endocrine control of archimyometrial peristalsis exerted by the ovary, thus resulting in hyperperistalsis.