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.

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.

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%. 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.

The JZ, as documented by MRI, might interfere with follicular function. Similar content being viewed by others

Brosens JJ, de Souza NM, Barker FG (1995) Uterine junctional zone: function and disease. Lancet 346:558–560 Reinhold C, Tafazoli F, Wang L (1998) Imaging features of adenomyosis. Hum Reprod Update 4:337–349 Tamai K, Koyama T, Umeoka S, Saga T, Fujii S, Togashi K (2006) Spectrum of MR features in adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:583–602 Hricak H, Alpers C, Crooks LE, Sheldon PE (1983) Magnetic resonance imaging of the female pelvis: Initial experience. Am J Radiol 141:119–128 Ascher SM, Arnold LL, Patt RH, Schruefer JJ, Bagley AS, Semelka RC et al (1994) Adenomyosis: prospective comparison of MR imaging and transvaginal sonography. Radiology 190:803–806 Reinhold F, McCarthy S, Bret PM, Mehio A, Atri M, Zakarian R et al (1996) Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology 199:151–158 Brosens JJ, Barker FG, de Souza NM (1998) Myometrial zonal differentiation and uterine junctional zone hyperplasia in the non pregnant uterus. Hum Reprod Update 4:496–502 Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Ntoine JM et al (2001) Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod 16:2427–2433 Dueholm M, Lundorf E, Hansen ES, Sorensen JS, Ledertoug S, Olesen F (2001) Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis. Fertil Steril 76:588–594 Kunz G, Beil D, Huppert P, Leyendecker G (2000) Structural abnormalities of the uterine wall in women with endometriosis and infertility visualized by vaginal sonography and magnetic resonance imaging. Hum Reprod 15:76–82 Kunz G, Beil D, Huppert P, Noe M, Kissler G, Leyendecker G (2005) Adenomyosis in endometriosis—prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 20:2309–2316 Kissler S, Zangos S, Kohl J, Wiegratz I, Rody A, Gätje R et al (2008) Duration of dysmenorrhea and extent of adenomyosis visualised by magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 137:204–209 Leyendecker G, Kunz G, Noe M, Herbertz M, Mall G (1998) Endometriosis: a dysfunction and disease of the archimetra. Hum Reprod Update 4:752–762 Noe M, Kunz G, Herbertz M, Mall G, Leyendecker G (1999) The cyclic pattern of the immunocytochemical expression of oestrogen and progesterone receptors in human myometrial and endometrial layers: characterization of the endometrial-subendometrial unit. Hum Reprod 14:101–110 Fusi L, Cloke B, Brosens JJ (2006) The uterine junctional zone. Best Pract Res Clin Obstet Gynaecol 20:479–491 Navarro J, Garrido N, Remohi J, Pellicer A (2003) How does endometriosis affect infertility? Obstet Gynecol Clin North Am 30:181–192 Zaloudek C, Norris HJ (1987) Mesenchymal tumors of the uterus. In: Kurman RJ (ed) Blaustein′s pathology of the female genital tract, 3rd edn. Springer, New York, pp 374–528 Kang S, Turner DA, Foster GS, Rapoport MI, Spencer SA, Wang JZ (1996) Adenomyosis: specificity of 5 mm as the maximum normal uterine junctional zone thickness in MR images. Am J Roentgenol 166:1145–1150 Kunz G, Herbertz M, Beil D, Huppert P, Leyendecker G (2007) Adenomyosis as a disorder of the early and late human reproductive period. Reprod Biomed Online 6:681–685 Vercellini P, Vigano P, Somigliana E, Daguati R, Abbiati R, Fedele L (2006) Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol 20:465–477 Zacharia TT, O’Neill MJ (2006) Prevalence and distribution of adnexal findings suggesting endometriosis in patients with MR diagnosis of adenomyosis. Brit J Radiol 79:303–307 Kissler S, Zangos S, Wiegratz I, Kohl J, Rody A, Gaetje R et al (2007) Utero-tubal sperm transport and its impairment in endometriosis and adenomyosis. Ann NY Acad Sci 1101:38–48 Einer-Jensen N (1988) Countercurrent transfer in the ovarian pedicle and its physiological implications. Oxf Rev Reprod Biol 10:348–381 Einer-Jensen N, McCracken JA, Schram W, Bendz A (1989) Counter current transfer in the female adnex. Acta Physiol Pol 40:3–11 Kunz G, Herbertz M, Noe M, Leyendecker G (1998) Sonographic evidence of a direct impact of the ovarian dominant structure on uterine function during the menstrual cycle. Hum Reprod Update 4:667–672 Zervomanolakis I, Ott HW, Mueller J, Seeber BE, Friess SC, Mattle V et al (2009) Uterine mechanisms of ipsilateral directed spermatozoa transport: Evidence for a contribution of the utero-ovarian countercurrent system. Eur J Obstet Gynecol Reprod 144(Suppl 1):S45–S49 Kunz G, Beil D, Deininger H, Wildt L, Leyendecker G (1996) The dynamics of rapid sperm transport through the female genital tract. Evidence from vaginal sonography of uterine peristalsis (VSUP) and hysterosalpingoscintigraphy (HSSG). Hum Reprod 11:627–632 Werth R, Grusdew W (1898) Untersuchungen über die Entwicklung und Morphologie der menschlichen Uterusmuskulatur. Archiv der Gynäkologie 55:325–409 Wetzstein R (1965) Der Uterusmuskel: Morphologie. Archiv Gynecol 202:1–13 Leyendecker G, Herbertz M, Kunz G, Mall G (2002) Endometriosis results from the dislocation of basal endometrium. Hum Reprod 17:2725–2736 Leyendecker G, Bernart W, Bremen T, Beck H, Kunz G, Waibel S et al (1990) Influence of the duration of the oestradiol rise on the success rate in GnRH analogue/HMG-stimulated IVF cycles. Hum Reprod 5:52–55 Werner J (1989) Medizinische Statistik. Urban & Schwarzenberg, Munich, pp 167–171 Hartung J, Knapp G (2001) A refined method for meta-analysis of controlled clinical trials with binary outcome. Stat Med 20:3875–3889 Ferenczy A (1998) Pathophysiology of adenomyosis. Hum Reprod Update 4:312–322 Wassarman PM, Albertini DF (1994) The mammalian ovum. In: Knobil E, Neill JD (eds) The physiology of reproduction. Raven Press, New York, pp 79–122 Wassarman PM (1996) Oogenesis. In: Adashi EY, Rock JA, Rosenwaks Z (eds) Reproductive endocrinology, surgery, and technology. Lippincott-Raven, Philadelphia, pp 341–358 Avrech OM, Goldman GA, Rufas O, Stein A, Amit S, Yoles I et al (1997) Treatment variables in relation to oocyte maturation: lessons from a clinical micromanipulation-assisted in vitro fertilization program. J Assist Reprod Genet 14:337–342 Wittemer C, Ohl J, Bettahar-Lebugle K, Viville S, Nisand I (2000) A quantitative and morphological analysis of oocytes collected during 438 IVF cycles. J Assist Reprod Genet 17:44–50 Tan SL, Child TJ, Gulekli B (2002) In vitro maturation and fertilization of oocytes from unstimulated cycles ovaries: predicting the number of immature oocytes retrieved by early follicular phase ultrasonography. Am J Obstet Gynecol 186:684–689 Kok JD, Looman CW, Weima SM, te Velde ER (2006) A high number of oocytes obtained after ovarian hyperstimulation for in vitro fertilization or intra cytoplasmatic sperm injection is not associated with decreased pregnancy outcome. Fertil Steril 85:918–924 Kunz G, Noe M, Herbertz M, Wildt L, Leyendecker G (1998) Uterine peristalsis during the menstrual cycle. Effects of oestrogen, antioestrogen and oxytocin. Hum Reprod Update 4:647–654 Kunz G, Beil D, Huppert P, Leyendecker G (2006) Control and function of uterine peristalsis during the human luteal phase. Reprod Biomed Online 4:528–540 Cicinelli E, Einer-Jensen N, Cignarelli M, Mangiacotti L, Luisi D, Schonauer S (2004) Preferential transfer of endogenous ovarian steroid hormones on the uterus during both the follicular and luteal phases. Hum Reprod 19:2001–2004 Mueller A, Siemer J, Renner S, Hoffmann I, Maltaris T, Binder H et al (2006) Perfused non-pregnant swine uteri: a model for evaluating transport mechanisms to the side bearing the dominant follicle in humans. J Reprod Dev 52:617–624 Plachot M (1997) The human oocyte. Genetic aspects. Ann Genet 40:115–120 Takahashi K, Nagato H, Kitao M (1989) Clinical usefulness of determination of estradiol levels in the menstrual blood for patients with endometriosis. Acta Obstet Gynecol Jpn 41:1849–1850 Takemura M, Nomura S, Kimura T, Inoue T, Onoue H, Azuma C et al (1993) Expression and localisation of oxytocin receptor gene in human uterine endometrium in relation to the menstrual cycle. Endocrinology 132:1830–1835 Einspanier A, Bielefeld A, Kopp JH (1998) Expression of the oxytocin receptor in relation to steroid receptors in the uterus of a primate model, the marmoset monkey. Hum Reprod Update 4:634–646 Kitawaki J (2006) Adenomyosis: the pathophysiology of an oestrogen-dependent disease. Best Pract Res Clin Obstet Gynaecol 20:493–502 Turnbull LW, Rice CF, Horsman A, Robinson J, Killick SR (1994) Magnetic resonance imaging and transvaginal ultrasound of the uterus prior to embryo transfer. Hum Reprod 9:2438–2443 Chiang CH, Chang MY, Shiau CS, Hou HC, Hsieh TT, Soong YK (1999) Effect of a sonographically diffusely enlarged uterus without distinct uterine masses on the outcome of in vitro fertilization-embryo transfer. J Assist Reprod Genet 16:369–372 Devlieger R, D’Hooghe T, Timmermann D (2003) Uterine adenomyosis in the infertility clinic. Hum Reprod Update 9:139–147 Piver P (2005) Uterine factors limiting ART coverage. J Gynecol Obstet Biol Reprod (Paris) 34:30–33 Acknowledgments We owe the biologists Dr Uwe Mischeck and Dr Wolfgang Bernart a debt of gratitude for performing the analysis of the oocytes. No external funding was received for this study. Conflict of interest statement The author does not have any financial or commercial interest in this paper. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Kunz, G., Beil, D. Characterization of the uterine junctional zone prior to IVF/ICSI: an observational study. Arch Gynecol Obstet 281, 945–953 (2010). https://doi.org/10.1007/s00404-009-1285-8 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-009-1285-8