Fibroids and Infertility - a Study of the Significance of Removal of Fibroids With Regard to Endometrial Receptivity
- Conditions
- Leiomyoma, Uterine
- Interventions
- Procedure: Myomectomy per laparoscopy or laparotomyProcedure: Transcervical resection of fibroids
- Registration Number
- NCT04426760
- Lead Sponsor
- Oslo University Hospital
- Brief Summary
We aim to explore some of the molecular factors that reduce fertility for women with leiomyomas, taking into account leiomyoma location, size, number and vascularity. Tissue samples from the endometrium and leiomyomas will be obtained during the mid secretory phase before and 3-6 months after surgical excision for a comprehensive search for key molecular derangements.
- Detailed Description
Baseline medical information and standard questionnaire to record symptoms are collected from all participants and a gynaecological examination and a 2D and 3D vaginal ultrasonography including saline infusion sonography (SIS), if indicated, are performed. Blood samples for the biobank for extraction of germ line DNA and for identification of possible biomarkers are taken.
The women with submucosal leiomyomas will undergo hysteroscopic myomectomy and the women with intramural leiomyomas will undergo myomectomy per laparoscopy or laparotomy.
For the participants with intramural leiomyomas and the fertile/infertile controls, endometrial samples are taken with an endometrial suction curette in an outpatient setting at day 19-23 of the menstrual cycle. The endometrial sampling in the group of women with submucosal leiomyomas is being done during the hysteroscopic removal of the leiomyoma, also at day 19-23 of the menstrual cycle.
3-6 months after surgery, cycle day 19-23, endometrial samples will be taken from the women who have undergone myomectomy and ultrasound examination is being performed. The women with submucosal leiomyomas will undergo a second look hysteroscopy
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- Female
- Target Recruitment
- 80
- Age: 18 to 40 years
- Presence of leiomyoma(s)
- Regular menstrual cycle (28 +/- 7 days)
- Having had at least 2 normal menstrual cycles after ending the treatment if previously treated with GnRH analogue
- Signed informed consent
- No treatment indication (no symptoms and/or no desire for fertility)
- Contraindication for surgery
- Known endometriosis
- Known PCOS
- Untreated hydrosalpinx
- Malignancy; gynaecological or other location
- Pre-malignant or malignant pap smear or endometrial biopsy
- Hormonal treatment including ulipristal acetat and levonorgestrel intrauterine device last three months before inclusion in the study
- Ongoing treatment with GnRH analogue
- Pregnancy last 3 months
- Ongoing lactation
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Women with intramural leiomyomas Myomectomy per laparoscopy or laparotomy Women with intramural leiomyomas undergoing myomectomy Women with submucosal leiomyoma(s) Transcervical resection of fibroids Women with submucosal leimyomas undergoing hysteroscopical removal of the leiomyoma
- Primary Outcome Measures
Name Time Method HOXA 10 expression 3-6 months Fold change of HOXA 10 Expression 3-6 months after myomectomy compared to pre-surgery Levels
- Secondary Outcome Measures
Name Time Method Expression of other molecular markers 3-6 months Fold change of other molecular markers than HOXA 10 of endometrial receptivity 3-6 months after myomectomy and compared to fertile/infertile controls
Vascular characteristics of leiomyomas 3-6 months Vascular characteristics of leiomyomas associated with endometrial changes
Genomic characteristics 3-6 months Genomic characteristics of leiomyomas associated with endometrial changes
Endometrial vascular pattern 3-6 months VI and FI of the endometrium and subendometrial myometrium of women with leimyomas 3-6 months after myomectomy and compared to fertile/infertile controls
Leiomyoma location 3-6 months Leiomyoma location associated with endometrial changes
Scar formation 3-6 months Scar/fibrosis/adhesion formation after myomectomy; macroscopically and histologically
Pregnancy 2 years Pregnancy and deliveries within 2 years after myomectomy.
Expression of molecular markers adjacent to the leiomyoma versus remote from the leiomyoma 3-6 months Difference in expression of molecular markers in endometrium adjacent to the leiomyoma compared to endometrium remote from the leiomyoma.
HOXA10 in endometrium of women with leiomyomas compared to fertile/infertile controls 3-6 months Difference in HOXA 10 expression in endometrium of women with leiomyomas compared to fertile/infertile controls
Leiomyoma size 3-6 months Leiomyomas size in centimeters associated with endometrial changes
Partially resected leiomyomas 3-6 months Alterations in molecular markers of endometrial receptivity after partially resected submucosal leiomyomas.
Submucosal leiomyomas versus intramural leiomyomas 3-6 months Difference in expression of molecular markers in endometrium of women with submucosal leiomyomas compared with endometrium in women with intramural leiomyomas.
Biomarkers in blood 1 year Biomarkers in blood related to leiomyomas and a possible correlation between certain biomarkers and reduced endometrial receptivity.
Trial Locations
- Locations (1)
Oslo University Hospital
🇳🇴Oslo, Norway