Endometrium in focus of the gynecologist’s attention: the role of hysteroscopy and immunohistochemistry in the diagnosis of chronic endometritis, the choice of treatment

Кишакевич, І. Т.; Коцабин, Н. В.; Radchenko, Volodymyr

doi:10.18370/2309-4117.2017.34.24-27

Cited by 5 publications

(1 citation statement)

References 7 publications

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“…Наявні на сьогодні наукові дані щодо того, чи має ожиріння значний вплив на ендометрій, є суперечливі. Деякі дослідження жінок із ожирінням, які отримали ембріони в донорській програмі, не показали різниці в частоті імплантації порівняно з нормальними суб'єктами контрольної групи, що привело дослідників до висновку, що ожиріння не впливає негативно на сприйнятливість ендометрію [9,16,[23][24][25]33]. Проте Desolle та ін.…”

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Structural and Functional Parameters of the Endometrium and Ovarian Tissue in Patients With Impaired Reproductive Potential and Obesity

Макарчук¹,

Римарчук²,

Островська³

et al. 2023

Scientific and practical journal

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According to the WHO, every second woman has a problem with excess weight, while about 23% of women indicate a pathological body mass index, and excess weight (the so-called “pre-obesity”) is noted in 25% of women. The aim of the research was to evaluate the structural and functional parameters of the endometrium and ovarian tissue and to optimize the diagnostic algorithm and monitoring of the endometrium in women with obesity and impaired reproductive function. Materials and methods. 110 patients of reproductive age with impaired reproductive health underwent a comprehensive clinical and laboratory examination within the framework of this research. The main group included 64 patients with overweight and class 1 obesity, and the comparison group consisted of 46 women with a normal body mass index. The proposed diagnostic algorithm included a sonographic study of the structural parameters of the endometrium and ovaries, as well as an assessment of the features of the blood supply to the pelvic organs and statistical processing of the results. Research results and their discussion. The presented results allow us to note a significant percentage of comorbidity of somatic and gynecological pathology in overweight and obese patients. Pregnancy is accompanied by a higher percentage of early reproductive losses (14.0%), preterm birth (10.9%), preeclampsia (42.2%), placental dysfunction (46.4%) and low birth weight (17.2%). The main clinical forms of endometrial pathology in the main group were polyposis (32.8%), endometrial hyperplasia (23.4%) and dyschronosis of morphological changes of the endometrium (28.1%). The combination of endometrial hyperplasia with/or uterine leiomyoma, adenomyosis, benign ovarian tumors and retention formations was noted in 53.6% of observations in both groups; in 46.4% of women the isolated form was noted. The morphological characteristics of endometrial polyposis allowed us to note the dominance of glandular-fibrous polyps (45.2%) and in the case of a combination with myoma or ovarian retention cysts - glandular forms (32.3%). The most frequent sonographic marker of dysfunction of the endometrial potential (inconsistency of the ultrasound image of the endometrium with the phase of the menstrual cycle) was revealed in more than half of the cases (62.5%). Sonographic evaluation of the structural parameters of the endometrium and ovarian tissue showed an increase in the anterior-posterior size of the uterus and the thickness of the endometrium by 2.8 times, the volume of the ovary – by 2.0 times. It should be noted that the patients of the main group had a greater proportion of cysts and endometriomas. According to dopplerometry data, significantly lower parameters of the vascular resistance index were confirmed in the ovarian arteries and in the arteries of the stroma; in almost half of the observations, varicose veins of the parametrium were noted. Conclusions. Changes in steroidogenesis against the background of lipid metabolism disorders are accompanied by an increase in the volume of the endometrium and ovarian tissue, growing proportion of cystic formations in the appendages, an increase in the hemodynamic imbalance of blood flow in pelvic organs, which requires optimization of the monitoring program at the stage of preconception preparation and elimination of risk factors for placental dysfunction.

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Structural and Functional Parameters of the Endometrium and Ovarian Tissue in Patients With Impaired Reproductive Potential and Obesity

Макарчук¹,

Римарчук²,

Островська³

et al. 2023

Scientific and practical journal

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The first experience of reproductive function restoration in patients with Asherman’s syndrome using autologous mesenchymal stem cells

Козуб

Gramatiuk²,

Kozub

et al. 2022

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The main goal of Asherman’s syndrome treatment is to restore the volume and shape of the uterine cavity, regenerate the endometrium and reproductive function. Recently, in addition to ultrasound diagnostics of intrauterine synechiae, office hysteroscopy is widely used. The most standardized stages of Asherman’s syndrome treatment are hysteroscopic dissection of the uterine cavity synechiae and endometrium re-adhesion prevention in the postoperative period, which is achieved by the introduction of the intrauterine device, anti-adhesive drugs or balloon catheters inserted intrauterinely. The main difficulties are to find effective ways to prevent adhesion that occurs after removal of mechanical means from the uterine cavity and ways to restore the endometrium morphology in patients wishing to achieve pregnancy. The most promising technique in this area is the use of autologous endometrial stem cells. Here is a case of treatment of a reproductive age patient with infertility and Asherman’s syndrome. The clinical case was a part of a clinical trial Clinical Trials.gov Identifier: NCT04675970. On the eve of the operative stage for uterine cavity synechiae separation 20.0 ml of venous blood was taken. Mesenchymal stem cells (MSCs) were isolated from the patient’s peripheral blood using the magnetic separation method of the autoMACS Pro Separator (Miltenyi Biotec). According to the international instructions, 6th passage MSCs were clinically used. Confirmation of belonging the derived cells to the MSCs group was performed using the set Bio-Techne FMC-020 (Great Britain). In addition, MSCs were differentiated to endometrial cells, which was confirmed using endometrial cell matching markers in generations P0-P3 (passage 0 – passage 3) with the MicroBead Kit (USA). The operative stage of treatment included office hysteroscopy, mechanical synechiolysis in the endocervix and endometrium and introduction of a silver-containing intrauterine device. Subendometrial injection of autologous endometrial MSCs was performed to restore the endometrium structure at the end of hysteroscopy. High dose adjuvant estrogen therapy followed for 3 weeks. Pregnancy was achieved spontaneously 2 years after the intervention. The patient gave birth to a full-term baby girl.The results of the clinical case indicate the prospects for the use of autologous blood stem cells converted into endometrial cells in the treatment of infertility in patients with CA in the absence of effect from previous attempts to restore fertility by traditional therapies.

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Immunomorphological signs of chronic endometritis in patients after failed attempts of auxiliary reproductive technologies

Романенко

Haiduk

2022

RHW

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The objective: to analyze the morphological and immunohistochemical features of the endometrium in the patients with chronic endometritis after unsuccessful attempts of assisted reproductive technologies (ART). Materials and methods. A prospective study was conducted in women with a history of chronic endometritis on the basis of the Medical Center LLC “ISIDA-IVF” for the period from 2019 to 2021. The I group included 55 women of reproductive age with chronic endometritis and repeated unsuccessful attempts of ART, the control group (CG) – 40 women of reproductive age without fertility disorders who are preparing for the replacement motherhood programs or who are oocyte donors. The results of the endometrial biopsy performed on the 5–7th and 19th–21st days of the menstrual cycle using a pipelle aspiration curette were studied for the assessment of the immunomorphological characteristics of the endometrium in the patients with chronic endometritis. The immunoperoxidase method with primary specific monoclonal antibodies was used for the immunomorphological study of estrogen and progesterone receptors. Differences at p<0.05 were considered statistically significant. Results. Pathomorphological study of the endometrium revealed characteristic signs of chronic inflammation – the presence of a large number of plasma cells in the endometrium stroma, lymphoid infiltrates near the blood vessels and the gland orifices, unevenly expressed stroma fibrosis, sclerotic changes in the walls of spiral arteries. All examined persons had two or more morphological signs of chronic endometritis (CE). An increase number of macrophages and monocytes in the endometrium glands and stroma was found by CE – 31.3±2.9 % versus 2.3±0.1 % in CG (р<0.05). An increase proliferative activity of epithelium cells of the endometrium glands and stroma on the 5-7th day of the menstrual cycle in patients in the I group compared to similar indicators of the secretion phase in CG was determined. The proliferation of glandular and stromal cells, detected on the 19th–21st days of the menstrual cycle, had the intensification of the programmed cell death process in the covering and glandular epithelium of the endometrium. This was characterized by the structural changes in the cell nuclei – the marginal state of chromatin, the appearance of karyorrhexis and karyopyknosis. In the endometrium stroma the presence of capillary-type vessels was found, the intensity of their development had a strong correlation with the degree of severity of the inflammatory changes (r=0.74; p<0.05). During the study of progesterone receptors mainly a decrease of the level of expression in the glands both compared to the indicators of healthy women and in the secretion phase compared to the proliferation phase - H-score 145.5±7.7 was found, in the proliferation phase versus H-score 55.5±10.4 in the secretion phase (р<0.05). Conclusions. Immunomorphological study of the endometrium in patients with chronic endometritis after unsuccessful attempts of assisted reproductive technologies demonstrates that the inflammatory changes in the tissues have clear morphological criteria, which are most pronounced on the 5-7th day of the menstrual cycle – the presence of plasma cells, stroma fibrosis, sclerosis vessel walls, decrease of the estrogen and progesterone level receptors. These morphological and immunohistochemical changes persist in the secretory phase of the menstrual cycle with the most significant manifestations in the form of a decrease in the level of progesterone receptors.

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Endometrium in focus of the gynecologist’s attention: the role of hysteroscopy and immunohistochemistry in the diagnosis of chronic endometritis, the choice of treatment

Cited by 5 publications

References 7 publications

Structural and Functional Parameters of the Endometrium and Ovarian Tissue in Patients With Impaired Reproductive Potential and Obesity

Structural and Functional Parameters of the Endometrium and Ovarian Tissue in Patients With Impaired Reproductive Potential and Obesity

The first experience of reproductive function restoration in patients with Asherman’s syndrome using autologous mesenchymal stem cells

Immunomorphological signs of chronic endometritis in patients after failed attempts of auxiliary reproductive technologies

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