Comparative evaluation of morphological criteria of endometrial dysfunction in patients with infertility associated with pelvic inflammatory disease, external genital endometriosis and uterine myoma

Abstract

Background. The comparative evaluation of morphological criteria of endometrial dysfunction in patients with primary infertility associated with pelvic inflammatory disease, external genital endometriosis and uterine myoma revealed common morphological manifestations in the form of an imbalance of the endometrium receptor profile on the background of the high frequency of chronic endometritis.The aim of the study was the comparative evaluation of ER and Pg receptors expression, inflammatory markers and an inhibitor of cyclin-dependent kinases p16ink4a in the endometrium of women with infertility associated with pelvic inflammatory disease, endometriosis and uterine myoma.Materials and methods. The study was included 298 patients: 95 patients with infertility associated with pelvic inflammatory disease, 73 women with infertility associated with external genital endometriosis degree I-II, 70 patients with infertility associated with uterine myoma and 60 patients with infertility associated with male factor. All patients were examined and treated in FSBSI “The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott”. Endometrial biopsies were performed on 19-24 day of the cycle. Histological and immunohistochemical study of endometrial biopsies were performed by standard methods. The expression of ER and PgR receptors, inflammatory markers (CD8+, CD20+, CD4+, SD138+) and cyclin-dependent kinase inhibitor p16INK4a was studied by the immunohistochemical method. The evaluation of the markers expression was performed by semiquantitative method H-Score, as well as qualitative and quantitative methods of computer image analysis system “Morphology 5.0” (VideoTest, Russia). Statistical processing of the results was performed using statistical packages (STATGRAPHICS v.6.0).Results. There is a violation of the endometrium secretory transformation in patients with infertility associated with pelvic inflammatory disease, uterine myoma and external genital endometriosis on the background of the high frequency of chronic endometritis. Receptor imbalance is characterized by impaired ER and PgR receptor ratio in the glands and in endometrial stromal component as a result of chronic inflammation.

New approaches to the estimation of endometrial dysfunction

“…Д.О. Отта, показали высокую диагностиче-скую значимость данного метода при изучении репаративных процессов в зоне послеопераци-онного рубца после кесарева сечения, при оцен-ке экспрессии фактора роста нервов в очагах эндометриоидных гетеротопий, а также при изучении эндометриальной дисфункции у па-циенток с бесплодием [2,6,7].…”

“…Результаты наших многолетних исследо-ваний показали, что у пациенток с бесплоди-ем, ассоциированным с ВЗОМТ, у пациенток с НГЭ и пациенток с миомой матки имеет ме-сто общность морфологических проявлений патологии эндометрия, в том числе нарушение секреторной трансформации, связанное с хро-ническим воспалительным процессом в эндо-метрии [1,2].…”

Pelvic Inflammatory Disease, A Perturbing Trigger to Infertility: A Systematic Review

“…PID is a dynamic problem and continuous increase in the number is observed from 2009-2012.in acute cases of PID early diagnosis and intervention is drastically important (17).) Because endometrial secretary transformation is violated in patients with infertility associated with pelvic inflammatory disease (16).…”

Pathogenetic determinants of endometrial dysfunction in patients with myoma

“…Миома матки стабильно занимает лидиру-ющие позиции в структуре гинекологической патологии и оказывает значимое влияние на репродуктивную функцию женщины, при этом этиология и патогенез заболевания являются предметом дискуссии [1][2][3][4][5][6][7].…”