gynecology and obstetrics medical project, gynecology journal, obstetrics, gynecologic oncology, reproductive medicine, gynecological endoscopy, ultrasonography, gynecology articles

Ginekologia i Poloznictwo
ISSN 1896-3315 e-ISSN 1898-0759

Glycodelin A concentration in blood serum and uterine cavity flushings in women with hyper androgenemia diagnoses due to marital infertility



Introduction. Glycodelin A (GdA) is a glycoprotein widely spread in the world of animals, plantsand bacteria. Protein backbone is made of 180 amino acids, and a glycosylation of some aminoacids ensures GdA unique biological properties. In case of women, the main source of GdA is an endometrium and a decidua. GdA has contraceptive and immunosuppressive properties,and is the recognized marker of endometrial receptivity. Screening of endometrial receptivityis included in the diagnostic procedure of infertility.Aim. The aim of this study is the evaluation of GdA usefulness as an endometrial receptivitymarker, on the basis of the analysis of GdA concentration changes in a serum and endometrialflushings, in case of women diagnosed in accordance with an infertility.Material and methods. It was assumed that the research should include all patients diagnosedbecause of the marital infertility, defined as the ineffectiveness of regular maternal efforts withinthe period of one year without using any contraception methods, independently from the veryfirst diagnosed cause. It was planned to conduct a multiple determination of GdA in a serumduring a menstruation period and a single one in endometrial flushings in the middle of apremenstrual phase. It was agreed that due to research protocol, including invasive elements,healthy women will not take part in the research. It was also agreed that received results ofGdA determination will be referred to the activity of ovaries, determined on the basis of modifiedHoogland’s scale. 69 patients with diagnosed infertility took part in the research, they weredivided in 3 groups according to a hormonal ovarian activity based on the modified Hoogland’sscale: ovulatory (“o”), corpus luteum insufficiency (“ncz”), hyperandrogenemia (“ha”).Results.The lowest concentrations of GdA in serum and endometrial flushings were noted incase of hyperandrogenemic patients (“ha”). Average GdA concentrations in serum in a pre-menstrual phase and average GdA concentration in endometrial flushings positively correlatedwith an average 17-â-estradiol concentration in a periovulatory phaseand a progesteroneconcentration in a premenstrual phase, and a negative correlation with an average concentra-tion of a total testosterone in blood. Concentration of GdA in endometrial flushings was referredto the concentration of a total protein and was presented as the GdA/TP coefficient. It’s valuegreater then 0,0625 gives the sensitivity of 53%, whereas the value greater then 0,03125 givesthe specificity of 87,5%. Effectiveness of the test for both values of coefficients amounts to60,87%. For GdA concentrations in blood on the third day of a cycle and in a premenstrualphase, the effectiveness of the test respectively amounts to 58,62% and 57,31%.Conclusions. Determination of GdA in serum and endometrial flushings is a good marker ofendometrial receptivity in case of women examined because of their infertility. Evaluation ofthe concentrations of GdA in endometrial flushings has a better diagnostic effectiveness of thetest then a measurement in blood. The activity of ovaries significantly influences the secretionof GdA, and ipso facto, an endometrial receptivity. Hyperandrogenamia and insulin resistanceinfluence a GdA secretion in multifactor manner and reduce endometrial receptivity.