Home Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
Article Open Access

Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure

  • Nazli Navali , Esmat Sadat Kazemi EMAIL logo , Hosein Azizi , Parvin Hakimi and Elham Eghbali
Published/Copyright: June 13, 2025
Download Article (PDF)
Open Medicine
From the journal Open Medicine Volume 20 Issue 1

Abstract

Background and aim

Hysteroscopy is the gold standard for diagnosing endometrial and cervical canal pathology and can be used alone or in combination with other methods. The study aimed to compare abnormal findings of vaginal color Doppler ultrasonography (transvaginal sonography [TVS]) and hysteroscopy.

Methods

This study involved 100 infertile women with a history of two or more failed implantations of in vitro fertilization (IVF) from January 2020 to January 2021 in the infertility ward of Al-Zahra Hospital in Tabriz, Iran. All patients underwent hysteroscopy and TVS in the follicular phase to examine the endometrial cavity. We calculated the sensitivity and agreement of TVS color Doppler compared to hysteroscopy and using appropriate statistical tests.

Results

The overall proportion of abnormal findings was 69 and 66% through hysteroscopy and TVS. The sensitivity and kappa statistics of TVS compared to hysteroscopy were 95.6 and 93.2%, respectively. Endometrial polyps were the most common abnormalities in hysteroscopy (31%) and TVS (25%). In examining the relationship between hysteroscopy findings and vaginal color Doppler ultrasonography findings, a significant association was found between submucosal myoma and non-homogeneous myometrium (OR = 1.8 (1.02–5.3); P = 0.027), endometrial polyps and non-homogeneous myometrium (OR = 2.7 (1.04–7.4); P = 0.025), intrauterine adhesion and uterine artery PI (OR = 1.9 (1.3–8.2); P = 0.001), endometrial atrophy and endometrial thickness (OR = 2.4 (1.01–4.5); P = 0.034), and thick/irregular endometrium and adenomyosis (OR = 2.5 (1.4–15.9); P = 0.001).

Conclusion

Abnormal findings of hysteroscopy and TVS were observed more in patients who have a history of two or more unsuccessful IVFs. Comparing and evaluating the relationship between them can be considered a positive prognostic factor and a better diagnosis for achieving pregnancy in the IVF procedure in women with a history of recurrent implantation failure.

Keywords: hysteroscopy; vaginal color Doppler ultrasonography; in vitro fertilization; recurrent implantation failure; IVF

1 Introduction

Recurrent implantation failure (RIF), defined as two or more unsuccessful cycles of in vitro fertilization (IVF) embryo transfer, is challenging for clinicians and distressing for patients [1,2]. Despite technological advances in medicine, only about a quarter of IVF cycles lead to live births, and most patients remain infertile even after multiple IVF attempts. It has been reported that the infertility rate in different countries is between 5 and 30% [3]. A study conducted by Abangah et al. showed that the overall infertility rate in Iran is 10.9% [4]. Infertility can be attributed to fetal factors or uterine abnormalities. Several interventions have been suggested to improve the outcome of IVF after several failed attempts, only a few of which are evidence-based [1,5]. Therefore, first of all, these failure factors in IVF and fertility should be recognized.

Uterine abnormalities can be diagnosed by vaginal sonography, hysteroscopy, sonohysterography, and hysterosalpingography [6,7]. Hysteroscopy is mainly performed in cases of recurrent IVF failure and suspected intrauterine pathology because abnormalities of the uterine cavity can be easily evaluated with hysteroscopy. Therefore, it is considered the gold standard and definitive test in the evaluation of the uterine cavity [8]. In combination with hysteroscopy, vaginal color Doppler ultrasound is a non-invasive and easy imaging method with excellent clinical utility in the diagnosis of endometrial receptivity, which has recently attracted more attention [9,10]. This provides a unique tool for evaluating endometrial receptivity by virtue of its ability to monitor endometrial thickness, endometrial peristalsis wave, endometrial typing, and sub-endometrial blood flow parameters [11,12,13]. Considering that in patients with RIF with a long history of infertility, the comparison and relationship of hysteroscopy findings with vaginal color Doppler ultrasonography are poorly understood. Therefore, the present study aimed to compare correlations between the abnormal findings of hysteroscopy and vaginal color Doppler ultrasonography (TVS). It may be useful in predicting and improving the diagnostic power of abnormal findings in these patients.

2 Materials and methods

2.1 Study design and setting

The present study retrospectively was performed on 100 infertile women (between 20 and 41 years old) with a history of RIF from the beginning of January 2020 to the end of January 2021 in the infertility ward of Al-Zahra Educational and Treatment Hospital in Tabriz. They were infertile women due to various factors and underwent hysteroscopy and TVS color Doppler to assess the endometrial cavity in the follicular cycle by the same operator in our unit. The inclusion criteria for the study were as follows: Women aged 42 years and younger, not taking any specific medication for the past month, suffering from primary or secondary infertility, having a history of at least two unsuccessful transfers despite transferring at least one fresh or frozen embryo of good quality. Exclusion criteria included: (1) Smoking and alcohol consumption. (2) Having various diseases such as diabetes, cardiovascular, cancer, liver, thyroid, digestive, renal, hypertension, and rheumatoid arthritis. Based on the study type, we examined 100 patients who completed the steps. The sample size was set at 100 subjects based on the agreement percentage of hysteroscopy and TVS (0.77) based on a previous study [14] type I error (α = 0.05), Power = 0.8, and 10% compensation for poor information and accurate estimation. A total of 146 infertile women were referred to the infertility unit of Al-Zahra Hospital during the study. Of these, 100 subjects were included based on the study’s eligibility criteria. All patients signed an informed consent form before the study and treatment. The study has been approved by the Ethics Committee of Tabriz University of Medical Sciences (No: IR.TBZMED.REC.1400.954).

2.2 Technique of diagnostic hysteroscopy

Before the procedure, all patients underwent TVS color Doppler, and all abnormal findings were recorded. Then, hysteroscopy was performed under general anesthesia using a surgical hysteroscope (Carl Storz, Tatlinger, Germany). The uterine distention was performed by the glycine and using an electronic pump (Hysteromat; Karl Storz). Surgically assisted video hysteroscopy was performed using a monopolar electric resectoscope with an outer diameter of 9 mm. In patients with uterine pathology, appropriate treatment was performed simultaneously. In case of adhesion, polyp, or submucosal myoma, immediate adhesion lysis or hysteroscopic removal was performed. The septa were removed with a resectoscope or scissors. Cervical dilation was performed in patients with polyps larger than 2 cm or submucous myoma. If necessary, endometrial tissue samples were taken after examination of the cervical canal and uterine cavity, and then all samples were fixed in formaldehyde and sent for pathology evaluation.

2.3 Vaginal color Doppler ultrasonography

The same ultrasound device (Fukuda Denshi Co., Ltd., Tokyo, Japan) was used for this study, and the same physician performed all procedures. The vaginal ultrasound probe (8 MHz) was used for all subjects. TVS color Doppler was performed vaginally, and sonographic indexes of uterine vessels were reported as pulsatility index (PI), endometrial thickness, end-diastolic blood flow, and endometrial blood supply by mentioning Zone I, Zone II, Zone III, and sub-endometrium.

2.4 Statistical analysis

This study was analyzed using descriptive statistical methods and SPSS software (version 21.0, Chicago, IL, USA). Measurement data were expressed as mean ± standard deviation (mean ± SD) or number and percentage. The McNemar test was used to compare the abnormal findings of hysteroscopy and ultrasonography, and the agreement of the two methods to detect abnormal uterine findings was calculated using the kappa statistics. The relationship between abnormal findings of hysteroscopy and vaginal color Doppler ultrasonography was done using the Chi-square or Fisher exact test when the expected frequency of 2 by 2 table was less than 5, at least in a cell. The sensitivity of TVS was calculated compared to hysteroscopy (as a gold standard). Sensitivity is the ability of TVS to detect abnormalities in comparison with hysteroscopy. A P-value less than 0.05 was considered statistically significant.

3 Results

In this study, 100 infertile women who met our inclusion criteria were examined to determine hysteroscopy and TVS findings and their relationship. Patients’ demographic characteristics, including mean age (years), mean duration of infertility (years), mean number of failed IVF cycles, and cause of infertility, are presented in Table 1. Most patients showed some degree of abnormal uterine findings on hysteroscopy (69%) and ultrasonography (66%), while about one-third of the population had no obvious abnormal findings. Some abnormal findings of the uterus with hysteroscopy and TVS and their comparison are shown in Table 2. These findings include endometrial polyp, intrauterine adhesions, uterine septa, submucosal myoma, arcuate uterus, thick/irregular endometrium, and adenomyosis. The sensitivity and kappa statistics of TVS compared to hysteroscopy were 95.6 and 93.2%, respectively. The high agreement (100%) and sensitivity (100%) were estimated for submucosal myoma, while the minimum agreement and sensitivity were for uterine septa at 74.5 and 62.5%, respectively (Table 2).

Table 1

Characteristics of the participants

No. of women 100
Age (years) 34.32 ± 5.13
Duration of infertility (years) 9
Number of failed IVF cycles 2.56
Etiology of infertility
Male factor 30 (0%)
Ovulatory disorder 21 (21%)
Tubal/peritoneal factor 9 (9%)
Endometriosis 13 (13%)
Combined factors 2 (2%)
Unexplained 25 (25%)
Table 2

Comparison of the findings of transvaginal sonography (TVS) and hysteroscopy

Findings Hysteroscopy (n = 100) TVS (n = 100) kappa (%) Sensitivity
Normal findings 31 (31) 34 (34) — —
Abnormal findings 69 (69) 66 (66) 93.2 95.65
Endometrial polyp 31 (31) 25 (25) 80.2 80.64
Intrauterine adhesions 10 (10) 0 (0) 0 90.3
Uterine septa 8 (8) 5 (5) 75.4 62.5
Submucosal myoma 6 (6) 6 (6) 100 100
Arcuate uterus 6 (6) 4 (4) 79 80.8
Thick/irregular endometrium 10 (10) 8 (8) 80.8 —
Adenomyosis 0 (0) 11 (11) 44.5 0
Total 71 (71%) 59 (59%)

All patients were sampled after hysteroscopy to determine the pathological findings. 73% of the patients showed abnormal hysteroscopy pathological findings, and 27% had normal findings. Pathological findings, including endometrial polyp (17%), anovulatory endometrium (27%), disordered proliferative endometrium (29%), leiomyoma (8%), and endometrial atrophy (14%), were observed (Table 3).

Table 3

Distribution of hysteroscopy pathology findings

Pathology findings No. of cases (%)
Normal pathology findings 27 (27)
Abnormal pathology detected 73 (73)
Endometrial polyp 17 (17)
Anovulatory endometrium 27 (27)
Disordered proliferative endometrium 29 (29)
Leiomyoma 8 (8)
Atrophic endometrium 14 (14)

Before performing hysteroscopy, a vaginal color Doppler ultrasonography was done for all patients to evaluate the relation with hysteroscopy findings. These parameters include (endometrial thickness, endometrial pattern, myometrial echogenicity, uterine artery PI, end-diastolic blood flow, and endometrial vascularity parameters in women), which are mentioned in Table 4.

Table 4

Findings of the uterine scoring system (vaginal color Doppler ultrasonography)

Parameter No. of cases (%)
Endometrial thickness
 <7 mm 60 (60%)
 >7 mm 40 (40%)
Endometrial pattern
 3 layers 46 (46%)
 Others 54 (54%)
Myometrial echogenicity
 Homogeneous 49 (49%)
 Non-homogeneous 51 (51%)
Uterine artery PI
 PI < 3 50 (50%)
 PI > 3 50 (50%)
End diastolic blood flow
 Present 49 (49%)
 Absent 51 (51%)
Endometrial vascularity
 Zone 3 16 (16%)
 Zone 2 39 (39%)
 Zone 1 38 (38%)
 Subendometrium 7 (7%)

PI, pulsatility index.

In this study, there was a significant relation between the report of non-homogeneous myometrium in TVS color Doppler and the presence of submucosal myoma and uterine polyps in hysteroscopy, respectively (P-value = 0.027 and P-value = 0.025). In other words, all people (n = 6) with submucosal myoma and most (21 out of 31) with uterine polyps had non-homogeneous myometrium. In addition, a significant relation was observed between uterine artery PI (PI > 3) in TVS color Doppler and uterine adhesion in hysteroscopy (P-value = 0.001). All subjects with uterine adhesions (n = 10) had uterine artery PI > 3 on vaginal color Doppler ultrasonography. And, a significant relation was observed between uterine atrophy in hysteroscopy and endometrial thickness less than 7 mm in TVS color Doppler (P-value = 0.02). In other words, most people with uterine atrophy (12 out of 14 cases) had endometrial thickness less than 7 mm. Also, a significant relation was observed between thick/irregular endometrium in hysteroscopy and adenomyosis in TVS color Doppler (P-value = 0.001); most people with Thick/irregular endometrium had adenomyosis (Table 5). However, there was no relation between other hysteroscopic findings and TVS color Doppler findings (data not shown).

Table 5

Relation between the findings of vaginal color Doppler ultrasonography and the findings of hysteroscopy of the uterus

TVS findings Hysteroscopy findings P-value*
Submucosal myoma
Myometrial Yes (N = 6) No (N = 94) 1.8 (1.02–5.3)
 Homogeneous (N = 49) 0 (0%) 49 (100%)
 Non-homogeneous (N = 51) 6 (11.8%) 45 (88.2%) 0.027
Endometrial polyp
Myometrial Yes (N = 31) No (N = 69) 2.7 (1.04–7.4)
 Homogeneous (N = 49) 10 (20.4%) 39 (79.6%)
 Non-homogeneous (N = 51) 21 (41.2%) 30 (58.8%) 0.025
Intrauterine adhesions
Uterine artery PI Yes (N = 10) No (N = 90) 1.9 (1.3–8.2)
 PI < 3 (N = 50) 0 (0%) 50 (100%)
 PI > 3 (N = 50) 10 (20%) 40 (80%) 0.001
Atrophic endometrium
Endometrial thickness Yes (N = 14) No (N = 88) 2.4 (1.01–4.5)
 <7 mm (N = 60) 12 (20%) 48 (80%)
 >7 mm (N = 40) 2 (5%) 38 (95%) 0.034
Thick/irregular endometrium
Adenomyosis Yes (N = 10) No (N = 90) 2.5 (1.4–15.9)
 Yes (N = 11) 6 (54.6%) 5 (45.4%)
 No (N = 89) 4 (4.5%) 85 (95.5%) 0.001

*Fisher’s exact test. P-value < 0.05*.

4 Discussion

In this study, 100 infertile women who met our inclusion criteria were examined to determine the comparison and relationship of hysteroscopy findings and pathology with TVS color Doppler findings of the uterus in the follicular phase. Abnormal hysteroscopy findings were observed in 69% of patients, and this rate reached 73% in pathological examinations. Endometrial polyps (31%) and intrauterine adhesions (10%) were the most common disorders of hysteroscopy findings, while disordered proliferative endometrium (29%) and anovulatory endometrium (17%) were the most common pathological disorders. Also, a TVS color Doppler of the uterus was performed on all patients. Abnormal findings were observed in 66% of cases, and endometrial polyp (25%) was among the most common. The important findings of the present study were the relation between hysteroscopy findings and vaginal color Doppler ultrasound findings.

Hysteroscopy, transvaginal ultrasonography scan, and color Doppler can all be used as screening tests to evaluate the uterine cavity before IVF, especially after unsuccessful IVF. When an abnormality in the uterine cavity is suspected, hysteroscopy is the preferred diagnostic and treatment method, especially when a biopsy is taken from the target tissue and sent to the laboratory for final diagnosis [15,16,17]. This device has very high diagnostic accuracy and is also known for the practical and safe treatment of patients and for restoring fertility [18,19]. Since the strength of its therapeutic effect is related to the type of intrauterine pathology, recent studies show that hysteroscopy is the best minimally invasive method for treating isthmocele. So, the symptoms of all patients have been resolved, and the fertility rate in these patients has been reported as 56.3% [20]. In another study, its very high therapeutic effect on fertility results in uterine arteriovenous malformation patients has been mentioned. And yet, hysteroscopic treatment is only recommended for patients who are hemodynamically stable and who are not bleeding profusely [18].

Hysteroscopy endometrial scratching is another method used for implantation in infertile women. The new trend, the hysteroscopic endometrial fundal incision (EFI), has become one of the most controversial and interesting procedures in the field of reproduction. In this method, damage caused to the endometrium fundal during hysteroscopy could enhance reproductive results and live birth rates in oocyte recipients after implantation failure by regenerating new tissue [21,22]. In general, the mechanisms of the positive effect of endometrial scratching may include: (i) Increasing the endometrial inflammatory response; (ii) Encouraging decidualization; (iii) Increasing the synthesis of growth factors, cytokines, interleukin-11, macrophages, and dendritic cells; and (iv) Increasing the expression of specific endometrial genes [23,24]. In comparison, the importance of EFI for implantation can be justified by three possible reasons. First, unlike the pipelle, where the blind catheter scratches the anterior or posterior uterine wall and never the fundus itself, in this technique, the damage is directed to the fundus, and the depth of the damage is controllable by the surgeon. Second, in cases with an arcuate uterus (type U2a), scraping is simultaneously therapeutic because it restores this congenital variation of the uterine fundus, which was previously considered physiological, without affecting implantation. Third, this method can even detect a percentage of minor abnormalities that would have remained undetected in the group without hysteroscopy [25].

Many studies have been reported to investigate intrauterine abnormalities by hysteroscopy in RIF patients. According to previous studies, intrauterine pathologies in women with RIF diagnosed by hysteroscopy have been reported in 44/9, 52, 37.13, 51.2, and 39.1%, respectively, and the endometrial polyp was usually the most common hysteroscopy abnormality identified in these patients [16,26,27,28,29]. In this study, the rate of abnormal uterine findings with hysteroscopy was somewhat higher than in previous studies. The study content, the average age, and the duration of infertility in these patients may be the main reasons for this study. Additionally, the hysteroscopic findings from a prospective cohort interventional study by Makled et al., which assessed cases of unexplained infertility using diagnostic hysteroscopy and transvaginal sonography, showed that 31% were diagnosed with endometrial polyps, 15% with endometrial hyperplasia, 14% with endometritis, 7% with intrauterine synechiae, 6% with submucous myomas, 6% with cervical stenosis, 7% with congenital uterine anomalies, and 14% of patients had no uterine abnormalities [30]. The current study observed abnormal findings with hysteroscopy in 69% of patients. These findings included endometrial polyp (31%), intrauterine adhesions (10%), uterine septum (8%), submucosal myoma (6%), arcuate uterus (6%), and thick/irregular endometrium (10%). Our study’s prevalence of hysteroscopic findings is somewhat consistent with the above findings.

However, with hysteroscopy, physicians use other tools, such as ultrasonography, for comparison and further evaluation to help diagnose intrauterine pathology [31]. Transvaginal sonography (TVS) is the first-line imaging technique that allows for accurate assessment of the uterus and ovaries, the presence or absence of endometrioma or tubal pathology, the vagina, particularly the areas of the posterior and lateral vaginal fornices, and the rectovaginal septum. Intrauterine parameters, including adenomyosis, can be observed with two-dimensional (2D) TVS showing the typical myometrial features. Although the specificity and sensitivity of TVS in predicting adenomyosis and deeply infiltrating endometriosis (DIE) is high, their evaluation by TVS requires a high level of experience [32,33].

Three-dimensional transvaginal sonography (3D TVS) has also been suggested for assessing posterior sites of DIE without bowel involvement, which improves the diagnostic accuracy of 2D ultrasound [34]. Reports indicate that TVS has poor accuracy in diagnosing vaginal endometriosis [35]. One research team reported that 3D intrauterine ultrasound is an effective method for diagnosing and identifying endometriosis in rectovaginal septum (RVS). However, only a few studies show that 3D ultrasound is better than 2D ultrasound in diagnosing DIE [36,37,38].

Transvaginal four-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy) is a diagnostic tool for infertility. This device provides the contrast material inside the pelvic area, uterine cavity, and fallopian tubes. It provides the possibility of a 3D representation of the morphology and the path of the fallopian tube opening [39]. Transvaginal two-dimensional hysterosalpingo-contrast sonography (TVS 2D-HyCoSy) and transvaginal three-dimensional hysterosalpingo-contrast sonography (TVS 3D-HyCoSy) are widely considered to be noninvasive, accurate, safe, and reproducible [40]. However, it is not possible to use TVS 2D-HyCoSy to visualize the entire fallopian tube in one plane, and the effectiveness of this method is highly related to sufficient skill [41]. Although 3D-HyCoSy can access the entire fallopian tube, it provides limited information [41]. In contrast, the 4D-HyCoSy can prevent the abovementioned shortcomings in examining infertile women [42,43]. 2D and 3D scanning can also be performed immediately after 4D-HyCoSy to obtain additional diagnostic information.

In general, based on previous studies, RIF patients usually have an endometrial thickness of <7 mm, non-three-layer endometrial pattern, heterogeneous myometrium, uterine artery PI higher than 3, elimination of end-diastolic flow, and endometrial vascularity are reduced compared to healthy people, that the results of examining the findings of our study in RIF patients are also consistent with the above findings [44]. In one study, 789 women with recurrent pregnancy loss (RPL) or RIF were examined to determine the pathological findings of transvaginal ultrasonography in the follicular phase. Most of the patients (69%) did not have obvious abnormal findings in transvaginal ultrasound, but one-third of them (31%) showed uterine pathological findings. These findings in patients include endometrial polyps (10.6%), asherman’s syndrome (1.3%), endometrial hyperplasia (1.1%), arcuate uterus (11%), septate uterus (4.9%) and submucosal myoma (1.6%) [45,46]. While the overall rate of intrauterine pathologies detected by 3D TVS in infertile women was reported to be 15.58% in a recent study [31], our study found abnormal findings in 66% of cases, which included endometrial polyps (25%), intrauterine adhesions (0%), uterine septum (5%), submucosal myoma (6%), arcuate uterus (4%), thick or irregular endometrium (8%), and adenomyosis (11%). In this study, the rate of abnormal findings was higher than in the above study. This increase may be partly due to the differences in the content of these two studies; in our study, only RIF patients were examined, and it is considered one of the strengths of the study. While in the studies mentioned above, both intrauterine insemination and RPL were included or generally examined in infertile women alongside RIF. Also, the abnormal findings of ultrasonography and hysteroscopy were compared in the present study. These two methods usually overlap in the detection of abnormal findings, and this is consistent with previous studies [31,46].

Recently, the effects of adenomyosis on fertility have received much attention. Some of the studies suggest that the presence of adenomyosis does not significantly affect implantation, clinical pregnancy, or live birth rates. However, the RPL is significantly increased in women with adenomyosis. Among the adenomyosis types, diffuse adenomyosis in the junctional zone (JZ) and severe adenomyosis were associated with a significantly increased risk of miscarriage. In contrast, features of adenomyosis exclusively detected in the outer myometrium were associated with persistent pregnancy rates [33]. In support of the effect of adenomyosis on the miscarriage rate, other studies show that interrupted or irregular JZ is a promising predictor of pregnancy loss associated with adenomyosis [47]. These studies demonstrate the importance of examining ultrasound and accurate adenomyosis classification in evaluating and managing patients with RPL. In addition to that, recent studies on the biological basis of the adverse effect of adenomyosis on fertility state the change in endometrial acceptance and disruption in the regulation of hormonal metabolism, which leads to a hyperestrogenic environment [48].

Studies have shown that endometrial receptivity can be predicted and evaluated through the thickness and shape of the endometrium using vaginal color Doppler ultrasonography [49]. Some studies believe that endometrial blood flow is nearly correlated with endometrial receptivity and is helpful for embryo implantation and development [50]. Altogether, the findings show that endometrial patterns can predict the pregnancy results of RIF women and can be used as an essential indicator of endometrial reception in RIF patients [13]. Also, recent studies proved that the vascularity of the endometrium in the repeated implantation failure group is significantly lower than in the pregnancy group [51]. In this study, to improve the prediction and diagnostic power of pathological findings in RIF patients, the relationship between hysteroscopy findings and vaginal color Doppler ultrasonography findings was examined. The important findings of the present study were the significant relation between hysteroscopy findings (submucosal myoma and endometrial polyps) and vaginal color Doppler ultrasound findings (myometrial echogenicity). Also, intrauterine adhesion, endometrial atrophy, and thick/irregular endometrium in hysteroscopy findings were significantly related to uterine thickness, uterine artery parameters, and adenomyosis in vaginal color Doppler ultrasound findings, respectively.

While in other uterine parameters, there was no relation between hysteroscopy findings and vaginal color Doppler ultrasonography findings. This study shows that all subjects with submucosal myoma and endometrial polyps had heterogeneous myometrium. Also, all subjects with intrauterine adhesions had uterine artery PI higher than 3, and most subjects with atrophic endometrium and thick/irregular endometrium were associated with endometrial thickness of less than 7 mm and adenomyosis, respectively. Therefore, by examining the relationship between abnormal uterine findings using these two diagnostic tools, even with the availability of only one of the above tools, it may be possible to increase the estimation, prediction, and etiology of some intrauterine abnormalities in RIF patients. As a result, these findings can be considered strengths of our study in estimating and predicting abnormal uterine findings.

5 Conclusion

Considering that this study was conducted only on RIF patients, and they had a high average age with a long history of infertility, therefore we had a limited number of eligible patients, and more abnormal findings were observed in these patients. The findings of vaginal color Doppler ultrasound and hysteroscopy showed an acceptable overlap, and comparing the association between these abnormal findings may be useful in improving the diagnostic power and timely treatment, as well as in revealing possible causes and predicting uterine abnormalities in these patients. Given that these patients require additional examinations, vaginal color Doppler ultrasonography is also recommended alongside hysteroscopy evaluation to enhance diagnostic and therapeutic measures as effectively as possible.

Acknowledgments

This study is a thesis of specialty clinical in Obstetrics and Gynecology surgery of Esmat Sadat Kazemi (No: IR.TBZMED.REC.1400.954). We would like to thank the Clinical Research Development Unit of Al-Zahra Hospital, Tabriz University of Medical Sciences, for statistical support.

  1. Funding information: The authors state no funding information.

  2. Author contributions: Nazli Navali: supervision, conceptualization, methodology, Esmat Sadat Kazemi: investigation, writing – original draft, review & editing, Hosein Azizi: review & editing, formal analysis, Parvin Hakimi: conceptualization, methodology, Elham Eghbali: review & editing, visualization.

  3. Conflict of interest: The authors state no conflict of interest.

  4. Data availability statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

References

[1] Ma J, Gao W, Li D. Recurrent implantation failure: A comprehensive summary from etiology to treatment. Front Endocrinol. 2023;13:1061766.10.3389/fendo.2022.1061766Search in Google Scholar PubMed PubMed Central

[2] Simionescu G, Doroftei B, Maftei R, Obreja B-E, Anton E, Grab D, et al. The complex relationship between infertility and psychological distress. Exp Ther Med. 2021;21:1.10.3892/etm.2021.9737Search in Google Scholar PubMed PubMed Central

[3] Borumandnia N, Majd HA, Khadembashi N, Alaii H. Worldwide trend analysis of primary and secondary infertility rates over past decades: A cross-sectional study. Int J Reprod Biomed. 2022;20:37.10.18502/ijrm.v20i1.10407Search in Google Scholar PubMed PubMed Central

[4] Abangah G, Rashidian T, Nasirkandy MP, Azami M. A meta-analysis of the prevalence and etiology of infertility in Iran. Int J Fertil Steril. 2023;17:160.Search in Google Scholar

[5] Shingshetty L, Cameron NJ, Mclernon DJ, Bhattacharya S. Predictors of success after in vitro fertilization. Fertil Steril. 2024;121(5):742–51.10.1016/j.fertnstert.2024.03.003Search in Google Scholar PubMed

[6] Hou J-H, Lu B-J, Huang Y-L, Chen C-H, Chen C-H. Outpatient hysteroscopy impact on subsequent assisted reproductive technology: A systematic review and meta-analysis in patients with normal transvaginal sonography or hysterosalpingography images. Reprod Biol Endocrinol. 2024;22:18.10.1186/s12958-024-01191-0Search in Google Scholar PubMed PubMed Central

[7] Lin F, Chen C, Li M, Shi H, Xu X, Jiang X, et al. Complex uterine cavity abnormalities increase the risk of miscarriage in in vitro fertilization/intracytoplasmic sperm injection in fresh cycle-assisted pregnancies. J Minim Invasive Gynecol. 2022;29:891–904.10.1016/j.jmig.2022.04.010Search in Google Scholar PubMed

[8] Tiwari A, Singh BK, Mishra A. A comparative study to evaluate diagnostic accuracy and correlation between saline infusion sonography, hysterosalpingography and diagnostic hysterolaparoscopy in infertility. Int J Reprod Contracept Obstet Gynecol. 2020;9:670.10.18203/2320-1770.ijrcog20200356Search in Google Scholar

[9] Liu Z, Geng Y, Huang Y, Hu R, Li F, Song Y, et al. Letrozole compared with clomiphene citrate for polycystic ovarian syndrome: A systematic review and meta-analysis. Obstet Gynecol. 2023;141:523–34.10.1097/AOG.0000000000005070Search in Google Scholar PubMed

[10] Wang W-Q, Chu G-H, Hou X-X. A comparison of Doppler measures of ovarian blood flow between women with and without ovarian dysfunction and correlations of Doppler indices with ovarian dysfunction markers: A meta-analysis. Ann Transl Med. 2023;11.10.21037/atm-22-5813Search in Google Scholar PubMed PubMed Central

[11] Wu J, Zhu X, He J, Ye C, Pang B, Zhao T, et al. Clinical value of three-dimensional transvaginal ultrasound in diagnosis of endometrial receptivity and ovarian function in patients with infertility. Comput Math Methods Med. 2022;11;2022:8438131. 10.1155/2022/8438131.Search in Google Scholar PubMed PubMed Central

[12] Zhang C-H, Chen C, Wang J-R, Wang Y, Qian W-P. An endometrial receptivity scoring system basing on the endometrial thickness, volume, echo, peristalsis, and blood flow evaluated by ultrasonography. Front Endocrinol. 2022;13:907874.10.3389/fendo.2022.907874Search in Google Scholar PubMed PubMed Central

[13] Tong R, Zhou Y, He Q, Zhuang Y, Zhou W, Xia F. Analysis of the guidance value of 3D ultrasound in evaluating endometrial receptivity for frozen-thawed embryo transfer in patients with repeated implantation failure. Ann Transl Med. 2020;8(15):944. 10.21037/atm-20-5463.Search in Google Scholar PubMed PubMed Central

[14] Aguinaldo LD, Sullivant S, Lanzillo EC, Ross A, He J-P, Bradley-Ewing A, et al. Validation of the ask suicide-screening questions (ASQ) with youth in outpatient specialty and primary care clinics. Gen Hosp Psychiatry. 2021;68:52–8.10.1016/j.genhosppsych.2020.11.006Search in Google Scholar PubMed PubMed Central

[15] Carson A, Webster F, Polzer J, Bamford S. The power of potential: Assisted reproduction and the counterstories of women who discontinue fertility treatment. Soc Sci Med. 2021;282:114153.10.1016/j.socscimed.2021.114153Search in Google Scholar PubMed

[16] Acet F, Sahin G, Goker ENT, Tavmergen E. The effect of hysteroscopy and conventional curretage versus no hysteroscopy on live birth rates in recurrent in vitro fertilisation failure: A retrospective cohort study from a single referral centre experience. J Obstet Gynaecol. 2022;42:2134–8.10.1080/01443615.2022.2033963Search in Google Scholar PubMed

[17] Vitale SG, Angioni S, Parry JP, Di Spiezio Sardo A, Haimovich S, Carugno J, et al. Efficacy of hysteroscopy in improving fertility outcomes in women undergoing assisted reproductive technique: A systematic review and meta-analysis of randomized controlled trials. Gynecol Obstet Invest. 2023;88:336–48.10.1159/000534794Search in Google Scholar PubMed PubMed Central

[18] Calzolari S, Cozzolino M, Castellacci E, Dubini V, Farruggia A, Sisti G. Hysteroscopic management of uterine arteriovenous malformation. J Soc Laparoendosc Surg. 2017;21:e2016.00109.10.4293/JSLS.2016.00109Search in Google Scholar PubMed PubMed Central

[19] Calzolari S, Cozzolino M, Castellacci E. Uterine arteriovenous malformation: Hysteroscopic identification is possible. J Minim Invasive Gynecol. 2016;23:293–4.10.1016/j.jmig.2015.10.007Search in Google Scholar PubMed

[20] Calzolari S, Sisti G, Pavone D, Ciocia E, Bianchini N, Cozzolino M. Prevalence of infertility among patients with isthmocele and fertility outcome after isthmocele surgical treatment: a retrospective study. Ochsner J. 2019;19:204–9.10.31486/toj.18.0048Search in Google Scholar PubMed PubMed Central

[21] Peitsidis N, Tsakiridis I, Najdecki R, Michos G, Kalogiannidis I, Athanasiadis A, et al. Hysteroscopic endometrial fundal incision versus hysteroscopy only in oocyte recipients: a randomized controlled trial assessing the reproductive outcomes. Int J Fertil Steril. 2024;18:3.Search in Google Scholar

[22] Peitsidis N, Tsakiridis I, Najdecki R, Michos G, Chouliara F, Timotheou E, et al. Diagnostic hysteroscopy with endometrial fundal incision may improve reproductive outcomes in oocyte recipients after implantation failure. JBRA Assist Reprod. 2023;27:689.10.5935/1518-0557.20230037Search in Google Scholar PubMed PubMed Central

[23] Gnainsky Y, Granot I, Aldo PB, Barash A, Or Y, Schechtman E, et al. Local injury of the endometrium induces an inflammatory response that promotes successful implantation. Fertil Steril. 2010;94:2030–6.10.1016/j.fertnstert.2010.02.022Search in Google Scholar PubMed PubMed Central

[24] Chen T, Shi H, Fang LL, Su YC. The effect of endometrial injury on reproductive outcomes of frozen–thawed embryo transfer cycles in women with one implantation failure. J Int Med Res. 2020;48:0300060520913130.10.1177/0300060520913130Search in Google Scholar PubMed PubMed Central

[25] Najdecki R, Peitsidis N, Tsakiridis I, Michos G, Timotheou E, Chartomatsidou T, et al. Hysteroscopic endometrial fundal incision in oocyte recipients before embryo transfer may improve reproductive outcomes: A prospective study. Int J Fertil Steril. 2023;18:40.Search in Google Scholar

[26] El-Sheikh A, Abou Senna H, Hussein M. Role of hysteroscopic guided endometrial biopsy in diagnosis of endometrial pathology in patients with unexplained recurrent implantation failure. Al-Azhar Med J. 2020;49:775–84.10.21608/amj.2020.82591Search in Google Scholar

[27] Gao M, Sun Y, Xie H, Fang S, Zhao X. Hysteroscopy prior to repeat embryo transfer may improve pregnancy outcomes for asymptomatic women with repeated implantation failure. J Obstet Gynaecol Res. 2015;41:1569–76.10.1111/jog.12773Search in Google Scholar PubMed

[28] Pabuçcu EG, Yalçın İ, Bodur T, Çağlar GS, Pabuçcu R. Impact of office hysteroscopy in repeated implantation failure: Experience of a single center. J Turkish Ger Gynecol Assoc. 2016;17:197.10.5152/jtgga.2016.16166Search in Google Scholar PubMed PubMed Central

[29] Al-Turki HA. Hysteroscopy as an investigation tool in recurrent implantation failure in vitro fertilization. Saudi Med J. 2018;39:243.10.15537/smj.2018.3.21379Search in Google Scholar PubMed PubMed Central

[30] Abdellah AH, Ali AE-NAE-G, Fadel SA, Hashem H, Taha ASAM. Hysteroscopic endometrial biopsy after intracytoplasmic sperm injection failure for women with unexplained infertility. SVU-Int J Med Sci. 2024;7:592–9.Search in Google Scholar

[31] Naredi N, Sharma R, Gurmeet P. Can three-dimensional transvaginal sonography replace office hysteroscopy in detecting uterine abnormalities in infertility patients? J Hum Reprod Sci. 2021;14:392.10.4103/jhrs.jhrs_97_21Search in Google Scholar PubMed PubMed Central

[32] Exacoustos C, Zupi E, Piccione E. Ultrasound imaging for ovarian and deep infiltrating endometriosis. Semin Reprod Med. 2017;35(1):5–24.10.1055/s-0036-1597127Search in Google Scholar PubMed

[33] Cozzolino M, Cosentino M, Loiudice L, Martire FG, Galliano D, Pellicer A, et al. Impact of adenomyosis on in vitro fertilization outcomes in women undergoing donor oocyte transfers: A prospective observational study. Fertil Steril. 2024;121:480–8.10.1016/j.fertnstert.2023.11.034Search in Google Scholar PubMed

[34] Guerriero S, Alcázar JL, Ajossa S, Pilloni M, Melis GB. Three‐dimensional sonographic characteristics of deep endometriosis. J Ultrasound Med. 2009;28:1061–6.10.7863/jum.2009.28.8.1061Search in Google Scholar PubMed

[35] Hudelist G, Oberwinkler K, Singer C, Tuttlies F, Rauter G, Ritter O, et al. Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis. Hum Reprod. 2009;24:1018–24.10.1093/humrep/dep013Search in Google Scholar PubMed

[36] Guerriero S, Saba L, Ajossa S, Peddes C, Angiolucci M, Perniciano M, et al. Three-dimensional ultrasonography in the diagnosis of deep endometriosis. Hum Reprod. 2014;29:1189–98.10.1093/humrep/deu054Search in Google Scholar PubMed

[37] Pascual MA, Guerriero S, Hereter L, Barri-Soldevila P, Ajossa S, Graupera B, et al. Diagnosis of endometriosis of the rectovaginal septum using introital three-dimensional ultrasonography. Fertil Steril. 2010;94:2761–5.10.1016/j.fertnstert.2010.02.050Search in Google Scholar PubMed

[38] Pascual MA, Guerriero S, Hereter L, Barri-Soldevila P, Ajossa S, Graupera B, et al. Three‐dimensional sonography for diagnosis of rectovaginal septum endometriosis: interobserver agreement. J Ultrasound Med. 2013;32:931–5.10.7863/ultra.32.6.931Search in Google Scholar PubMed

[39] Briceag I, Costache A, Purcarea V, Cergan R, Dumitru M, Sajin M, et al. Fallopian tubes–literature review of anatomy and etiology in female infertility. J Med Life. 2015;8:129.Search in Google Scholar

[40] Kupesic S, Plavsic BM. 2D and 3D hysterosalpingo-contrast-sonography in the assessment of uterine cavity and tubal patency. Eur J Obstet Gynecol Reprod Biol. 2007;133:64–9.10.1016/j.ejogrb.2006.10.010Search in Google Scholar PubMed

[41] Exacoustos C, Di Giovanni A, Szabolcs B, Binder-Reisinger H, Gabardi C, Arduini D. Automated sonographic tubal patency evaluation with three-dimensional coded contrast imaging (CCI) during hysterosalpingo-contrast sonography (HyCoSy). Ultrasound Obstet Gynecol. 2009;34(5):609–12.10.1002/uog.7442Search in Google Scholar PubMed

[42] Wang Y, Qian L. Three-or four-dimensional hysterosalpingo contrast sonography for diagnosing tubal patency in infertile females: A systematic review with meta-analysis. Br J Radiol. 2016;89:20151013.10.1259/bjr.20151013Search in Google Scholar PubMed PubMed Central

[43] Wang W, Zhou Q, Gong Y, Li Y, Huang Y, Chen Z. Assessment of fallopian tube fimbria patency with 4‐dimensional hysterosalpingo‐contrast sonography in infertile women. J Ultrasound Med. 2017;36:2061–9.10.1002/jum.14244Search in Google Scholar PubMed

[44] Nesbit CB, Blanchette-Porter M, Esfandiari N. Ovulation induction and intrauterine insemination in women of advanced reproductive age: A systematic review of the literature. J Assist Reprod Genet. 2022;39:1445–91.10.1007/s10815-022-02551-8Search in Google Scholar PubMed PubMed Central

[45] Alcazar JL, Carriles I, Cajas MB, Costa S, Fabra S, Cabrero M, et al. Diagnostic performance of two-dimensional ultrasound, two-dimensional sonohysterography and three-dimensional ultrasound in the diagnosis of septate uterus—A systematic review and meta-analysis. Diagnostics. 2023;13:807.10.3390/diagnostics13040807Search in Google Scholar PubMed PubMed Central

[46] Shiva M, Ahmadi F, Arabipoor A, Oromiehchi M, Chehrazi M. Accuracy of two-dimensional transvaginal sonography and office hysteroscopy for detection of uterine abnormalities in patients with repeated implantation failures or recurrent pregnancy loss. Int J Fertil Steril. 2018;11:287.Search in Google Scholar

[47] Barbanti C, Centini G, Lazzeri L, Habib N, Labanca L, Zupi E, et al. Adenomyosis and infertility: The role of the junctional zone. Gynecol Endocrinol. 2021;37:577–83.10.1080/09513590.2021.1878131Search in Google Scholar PubMed

[48] Selntigia A, Molinaro P, Tartaglia S, Pellicer A, Galliano D, Cozzolino M. Adenomyosis: An update concerning diagnosis, treatment, and fertility. J Clin Med. 2024;13:5224.10.3390/jcm13175224Search in Google Scholar PubMed PubMed Central

[49] Asyura MMAZ, Komariah M, Amirah S, Faisal EG, Maulana S, Platini H, et al. Analysis of varying microRNAs as a novel biomarker for early diagnosis of preeclampsia: A scoping systematic review of the observational study. Int J Prev Med. 2023;14:36.10.4103/ijpvm.ijpvm_156_22Search in Google Scholar PubMed PubMed Central

[50] Shaulov T, Sierra S, Sylvestre C. Recurrent implantation failure in IVF: A Canadian fertility and andrology society clinical practice guideline. Reprod Biomed Online. 2020;41:819–33.10.1016/j.rbmo.2020.08.007Search in Google Scholar PubMed

[51] Bayati F, Eftekhar M, Homayoon N, Fatehi H. Comparison of Doppler ultrasound indices of uterine artery and sub endometrial blood supply in frozen embryo transfer with and without repeated implantation failure: A cross-sectional study. Int J Reprod BioMed. 2023;21:937.10.18502/ijrm.v21i11.14657Search in Google Scholar PubMed PubMed Central

Received: 2025-01-08
Revised: 2025-05-20
Accepted: 2025-05-21
Published Online: 2025-06-13

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Research Articles
  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
  8. CMSP exerts anti-tumor effects on small cell lung cancer cells by inducing mitochondrial dysfunction and ferroptosis
  9. Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
  52. rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
  53. Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
  63. Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
  64. MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
  66. Trends in research on preterm birth in twin pregnancy based on bibliometrics
  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
  68. Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
  69. Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
  70. Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
  71. Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
  72. CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. FAHD1 prevents neuronal ferroptosis by modulating R-loop and the cGAS–STING pathway
  126. Association of placenta weight and morphology with term low birth weight: A case–control study
  127. Investigation of the pathogenic variants induced Sjogren’s syndrome in Turkish population
  128. Nucleotide metabolic abnormalities in post-COVID-19 condition and type 2 diabetes mellitus patients and their association with endocrine dysfunction
  129. TGF-β–Smad2/3 signaling in high-altitude pulmonary hypertension in rats: Role and mechanisms via macrophage M2 polarization
  130. Ultrasound-guided unilateral versus bilateral erector spinae plane block for postoperative analgesia of patients undergoing laparoscopic cholecystectomy
  131. Profiling gut microbiome dynamics in subacute thyroiditis: Implications for pathogenesis, diagnosis, and treatment
  132. Delta neutrophil index, CRP/albumin ratio, procalcitonin, immature granulocytes, and HALP score in acute appendicitis: Best performing biomarker?
  133. Anticancer activity mechanism of novelly synthesized and characterized benzofuran ring-linked 3-nitrophenyl chalcone derivative on colon cancer cells
  134. H2valdien3 arrests the cell cycle and induces apoptosis of gastric cancer
  135. Prognostic relevance of PRSS2 and its immune correlates in papillary thyroid carcinoma
  136. Association of SGLT2 inhibition with psychiatric disorders: A Mendelian randomization study
  137. Motivational interviewing for alcohol use reduction in Thai patients
  138. 10.1515/med-2025-1198
  139. Polyphyllin II inhibits thyroid cancer cell growth by simultaneously inhibiting glycolysis and oxidative phosphorylation
  140. Relationship between the expression of copper death promoting factor SLC31A1 in papillary thyroid carcinoma and clinicopathological indicators and prognosis
  141. CSF2 polarized neutrophils and invaded renal cancer cells in vitro influence
  142. Proton pump inhibitors-induced thrombocytopenia: A systematic literature analysis of case reports
  143. The current status and influence factors of research ability among community nurses: A sequential qualitative–quantitative study
  144. OKAIN: A comprehensive oncology knowledge base for the interpretation of clinically actionable alterations
  145. The relationship between serum CA50, CA242, and SAA levels and clinical pathological characteristics and prognosis in patients with pancreatic cancer
  146. Identification and external validation of a prognostic signature based on hypoxia–glycolysis-related genes for kidney renal clear cell carcinoma
  147. Engineered RBC-derived nanovesicles functionalized with tumor-targeting ligands: A comparative study on breast cancer targeting efficiency and biocompatibility
  148. Relationship of resting echocardiography combined with serum micronutrients to the severity of low-gradient severe aortic stenosis
  149. Effect of vibration on pain during subcutaneous heparin injection: A randomized, single-blind, placebo-controlled trial
  150. The diagnostic performance of machine learning-based FFRCT for coronary artery disease: A meta-analysis
  151. Review Articles
  152. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  153. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  154. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  155. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  156. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  157. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  158. The application of augmented reality in robotic general surgery: A mini-review
  159. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  160. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  161. Plant polyphenols, terpenes, and terpenoids in oral health
  162. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  163. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  164. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  165. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  166. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  167. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  168. Giant borderline ovarian tumours – review of the literature
  169. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  170. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  171. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  172. Supplement strategies for infertility in overweight women: Evidence and legal insights
  173. Scurvy, a not obsolete disorder: Clinical report in eight young children and literature review
  174. A meta-analysis of the effects of DBS on cognitive function in patients with advanced PD
  175. Protective role of selenium in sepsis: Mechanisms and potential therapeutic strategies
  176. Strategies for hyperkalemia management in dialysis patients: A systematic review
  177. Case Reports
  178. Delayed graft function after renal transplantation
  179. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  180. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  181. Giant right atrial hemangioma presenting with ascites: A case report
  182. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  183. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  184. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  185. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  186. Rapid Communication
  187. Biological properties of valve materials using RGD and EC
  188. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  189. Letter to the Editor
  190. Role of enhanced external counterpulsation in long COVID
  191. Expression of Concern
  192. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  193. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  194. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  195. Corrigendum
  196. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  197. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  198. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  199. Retraction
  200. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  201. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  202. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  203. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  204. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  205. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  206. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  207. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  208. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  209. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  210. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  211. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  212. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  213. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  214. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  215. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  216. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  217. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  218. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  219. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  220. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  221. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  222. A review of brain research on T2DM-related cognitive dysfunction
  223. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  224. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  225. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
https://doi.org/10.1515/med-2025-1226
Keywords for this article
hysteroscopy; vaginal color Doppler ultrasonography; in vitro fertilization; recurrent implantation failure; IVF
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
  8. CMSP exerts anti-tumor effects on small cell lung cancer cells by inducing mitochondrial dysfunction and ferroptosis
  9. Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
  52. rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
  53. Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
  63. Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
  64. MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
  66. Trends in research on preterm birth in twin pregnancy based on bibliometrics
  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
  68. Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
  69. Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
  70. Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
  71. Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
  72. CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. FAHD1 prevents neuronal ferroptosis by modulating R-loop and the cGAS–STING pathway
  126. Association of placenta weight and morphology with term low birth weight: A case–control study
  127. Investigation of the pathogenic variants induced Sjogren’s syndrome in Turkish population
  128. Nucleotide metabolic abnormalities in post-COVID-19 condition and type 2 diabetes mellitus patients and their association with endocrine dysfunction
  129. TGF-β–Smad2/3 signaling in high-altitude pulmonary hypertension in rats: Role and mechanisms via macrophage M2 polarization
  130. Ultrasound-guided unilateral versus bilateral erector spinae plane block for postoperative analgesia of patients undergoing laparoscopic cholecystectomy
  131. Profiling gut microbiome dynamics in subacute thyroiditis: Implications for pathogenesis, diagnosis, and treatment
  132. Delta neutrophil index, CRP/albumin ratio, procalcitonin, immature granulocytes, and HALP score in acute appendicitis: Best performing biomarker?
  133. Anticancer activity mechanism of novelly synthesized and characterized benzofuran ring-linked 3-nitrophenyl chalcone derivative on colon cancer cells
  134. H2valdien3 arrests the cell cycle and induces apoptosis of gastric cancer
  135. Prognostic relevance of PRSS2 and its immune correlates in papillary thyroid carcinoma
  136. Association of SGLT2 inhibition with psychiatric disorders: A Mendelian randomization study
  137. Motivational interviewing for alcohol use reduction in Thai patients
  138. 10.1515/med-2025-1198
  139. Polyphyllin II inhibits thyroid cancer cell growth by simultaneously inhibiting glycolysis and oxidative phosphorylation
  140. Relationship between the expression of copper death promoting factor SLC31A1 in papillary thyroid carcinoma and clinicopathological indicators and prognosis
  141. CSF2 polarized neutrophils and invaded renal cancer cells in vitro influence
  142. Proton pump inhibitors-induced thrombocytopenia: A systematic literature analysis of case reports
  143. The current status and influence factors of research ability among community nurses: A sequential qualitative–quantitative study
  144. OKAIN: A comprehensive oncology knowledge base for the interpretation of clinically actionable alterations
  145. The relationship between serum CA50, CA242, and SAA levels and clinical pathological characteristics and prognosis in patients with pancreatic cancer
  146. Identification and external validation of a prognostic signature based on hypoxia–glycolysis-related genes for kidney renal clear cell carcinoma
  147. Engineered RBC-derived nanovesicles functionalized with tumor-targeting ligands: A comparative study on breast cancer targeting efficiency and biocompatibility
  148. Relationship of resting echocardiography combined with serum micronutrients to the severity of low-gradient severe aortic stenosis
  149. Effect of vibration on pain during subcutaneous heparin injection: A randomized, single-blind, placebo-controlled trial
  150. The diagnostic performance of machine learning-based FFRCT for coronary artery disease: A meta-analysis
  151. Review Articles
  152. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  153. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  154. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  155. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  156. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  157. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  158. The application of augmented reality in robotic general surgery: A mini-review
  159. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  160. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  161. Plant polyphenols, terpenes, and terpenoids in oral health
  162. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  163. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  164. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  165. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  166. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  167. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  168. Giant borderline ovarian tumours – review of the literature
  169. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  170. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  171. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  172. Supplement strategies for infertility in overweight women: Evidence and legal insights
  173. Scurvy, a not obsolete disorder: Clinical report in eight young children and literature review
  174. A meta-analysis of the effects of DBS on cognitive function in patients with advanced PD
  175. Protective role of selenium in sepsis: Mechanisms and potential therapeutic strategies
  176. Strategies for hyperkalemia management in dialysis patients: A systematic review
  177. Case Reports
  178. Delayed graft function after renal transplantation
  179. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  180. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  181. Giant right atrial hemangioma presenting with ascites: A case report
  182. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  183. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  184. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  185. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  186. Rapid Communication
  187. Biological properties of valve materials using RGD and EC
  188. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  189. Letter to the Editor
  190. Role of enhanced external counterpulsation in long COVID
  191. Expression of Concern
  192. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  193. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  194. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  195. Corrigendum
  196. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  197. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  198. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  199. Retraction
  200. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  201. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  202. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  203. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  204. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  205. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  206. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  207. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  208. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  209. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  210. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  211. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  212. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  213. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  214. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  215. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  216. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  217. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  218. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  219. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  220. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  221. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  222. A review of brain research on T2DM-related cognitive dysfunction
  223. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  224. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  225. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 5.11.2025 from https://www.degruyterbrill.com/document/doi/10.1515/med-2025-1226/html
Scroll to top button