Relation of Endometrial Hyaluronic Acid with Female Infertility in Women Undergoing Ovarian Stimulation Protocol

Abstract

A comparative prospective study was conducted in the High Institute of Infertility Diagnosis and Assisted

Reproductive Technologies, Al-Nahrain University, from September 2019 to March 2020. The aim of the

study was to evaluate the level of hyaluronic acid (HA) in endometrial fluid at day of trigger in infertile women

whom undergoing ovarian stimulation protocol. The study included a total of 60 women who were selected

from those attended the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies. All

couples subjected to a full history taking, complete general examination, complete gynecologic examination

and infertility workup including: husband’s semen analysis, hormonal analysis, uterine cavity and tubal

patency was performed. Different ovulation induction programs were used evaluation of endometrial

thickness, pattern, size and number of mature follicles was performed by transvaginal sonography in the

2nd of menstrual cycle and cycle day 11-14 before HCG injection. In this study basal hormonal analysis

were performed to the female in the 2nd or 3rd day of the menstrual cycle and study included aspiration of

endometrial fluid for determination of hyaluronic acid level by ELISA technique. The study showed that

mean of hyaluronic acid was elevated significantly in women received letrozole plus FSH (158.7±19.7 pg/

1. ml) followed by women received Clomid plus FSH (160.8±13.5 pg/ml) and the lowest mean was recorded

in the control group (146.1±26.2 pg/ml). The study showedpositive correlation betweenhyaluronic acid and

LH at day of triggering of ovulation in women received Clomid plus FSH (group B). The study showed

positive correlation betweenhyaluronic acid and progesterone at day of triggering of ovulation in women

received letrozole plus FSH. The study showed positive correlation betweenhyaluronic acid and number

of follicles in women after receiving letrozole plus FSH. The study revealed that HA mean was elevated

significantly (P< 0.05) in women who became pregnant after stimulation protocol compared with women

who failed to be pregnant (164.2 vs. 152.1 pg/ml) as shown in Figure 4). The study also revealed that

HA was significantly elevated in women who became pregnant after receiving letrozole + FSH (164.2 pg/

1. ml) as compared with non pregnant women (152.1 pg/ml) while HA level was non significantly related

with pregnancy occurrence after administration of Clomid+FSH. It was concluded that, hyaluronic acid

was elevated significantly in women received ovulation simulation drugs and letrozolewas superior to

clomiphene as a treatment foranovulatory infertility in women