Asynchronous glands in the endometrium of women with recurrent reproductive failure

Asynchronous glands in secretory pattern endometrium: clinical associations and immunohistological changes

“…However, most patients presented with abnormal uterine bleeding, most commonly menorrhagia. This is similar to most earlier reports, but differs significantly from the study of Russell et al ,. in which the patients had recurrent reproductive failure.…”

“…It has also been proposed that local perfusion differences might explain variable endometrial glandular maturation (‘irregular ripening’), on the basis that epithelial cells more distant from spiral arterioles would be subject to a relatively diminished hormonal milieau . However, like Russell et al ., we believe this to be an unlikely explanation for the changes that we describe, as there was no association between the distribution of the AEGs and the endometrial vessels. The discrete nature of the morphological and immunophenotypic changes would also seem to be incompatible with a perfusion‐based mechanism.…”

“…It could be argued that the varied symptomatology and the often very focal nature of the histological changes indicate that AEGs represent an incidental histological finding of limited clinical significance. However, even relatively localized endometrial alterations may be significant in the pathogenesis of infertility or recurrent miscarriage . Furthermore, although, in our experience, AEGs constitute a relatively uncommon histological finding, Mai et al .…”

“…The definitions of deficient secretory maturation have also varied. It has been suggested that the maturation differences should be sufficiently distinct to be ‘obvious’, or that glandular asynchronicity should be >4 days according to a standard cycle . This contrasts with the criteria used to diagnosis LPD, where maturation delays of at least 2 days or 3 days have been applied .…”

“…Regardless of clinical significance, the discrete nature of AEGs strongly suggests a localized abnormality in endometrial maturation, possibly clonal in nature . In the context of recurrent reproductive failure, this is supported by specific alterations in hormone receptor profile, specifically persistent expression of ERα and PR, within the aberrant epithelial cells . Conversely, earlier reports of AEGs in patients presenting with DUB had indicated a loss of hormone receptors in the non‐secretory glands .…”