Problems in the realization of childbearing are relevant in the medical, socio-economic and personal-psychological aspects. The endometrial factor occupies a significant place in the polyethiologic syndrome of reproductive losses. The full receptivity of the endometrium at the time of interaction with the blastocyst causes a successful completion of implantation and further progression of pregnancy. The review presents an analysis of current data on the morphological and proteomic (ultrastructural) levels of the receptivity of the endometrium and their role in the genesis of reproductive dysfunctions.
Aim: to evaluate the endometrial expression of e-cadherin in relation to the estrogen-progesterone-receptor status of the endometrium.Materials and methods. In total 137 women were examined including 81 patients with infertility and 40 with a history of early pregnancy loss (main group); for comparison, 16 healthy fertile women (control group) were also examined. Endometrial aspiration biopsy was performed on 6–8 days after ovulation; in parallel, a peripheral blood sample was taken to determine the levels of estradiol and progesterone. A histological and immunohistochemical study of the endometrium with determination of estrogen (ER) and progesterone (PR) receptors and e-cadherin expression was carried out.Results. All fertile women (n = 16) and only 44 % (n = 53) of patients in the main group had the normal pattern of hormonereceptor endometrial interactions, i. e., low expression of ER and PR in the endometrial glands as well as reduced expression of ER and high expression of PR in the endometrial stroma. The endometrial e-cadherin expression was assessed in the following cohorts: a) women with normal hormone-receptor interactions (16 women in the control group and 53 women in the main group); b) with abnormal variants of hormone-receptor interactions in the endometrium (68 patients in the main group). The frequency of reduced e-cadherin expression was significantly lower in the cohort of women with normal estrogenprogesterone-receptor endometrial status (a) than in the cohort of women with abnormal variants of the endometrial “response” (b): in the luminal epithelium – in 5 % (3 out of 63) (а) vs. 17 % (8 out of 47) (b) (p < 0.05); in the glands – in 13 % (9 out of 69) (a) vs. 37 % (25 out of 68) (b) (p < 0.05).Conclusion. The estrogen-progesterone-receptor status of the endometrium is significant for the e-cadherin expression in the luminal epithelium and glands of the endometrium.
A comparative analysis of the levels of estradiol and progesterone in the blood, immunohistochemical parameters of estrogen receptors and progesterone in endometrium in women with a history of reproductive disorders is presented. It was found that all women had an ovulatory ovarian cycle, levels of estradiol and progesterone in the blood were within the reference values. In women with reproductive failures in the history (n=107), four types of hormone-receptor response in the endometrium were identified. In 46 (43%) women, the first (normoreceptor) type of endometrial response was detected, without significant differences from the control group (n=15) corresponding to the middle stage of the secretion phase. Hyperreceptor (hyper-estrogen-progesterone-receptor, hyper-estrogen-receptor, hyper-progesterone-receptor) types have been identified in 61 patients (57%) with reproductive dysfunctions. The endometrium corresponded to the mid secretory phase was detected in 47 (44%), inadequate secretory phase of the endometrium - in 60 (56%) women with reproductive failures in the anamnesis. All women in the control group had a full secretory change in the endometrium. In general, more than half (61 (57%)) of women with reproductive failures in the history with the ovulatory menstrual cycle with normal values of the level of progesterone in the blood showed signs of a decreased endometrial receptivity status. This indicates that the ovulatory level of progesterone in the blood is not an unconditional predictor of full secretory transformations of the endometrium.
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