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.
Infertility and miscarriage are unresolved problems of obstetric and gynecological practice. Endometrial dysfunction is considered to be one of the most important factors in pathogenesis of reproductive losses. The usefulness of hormone-dependent cyclic transformation of the endometrium depends on the adequacy of the molecular interaction of sex hormones with specific receptors in the endometrium. The last also play an important role in the implementation of the correct “dialogue” between the blastocyst and endometrium. This review presents recent data on the role of the receptor apparatus of the endometrium in the genesis of reproductive dysfunctions.
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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