Pathogenetic features of the macrotypes of chronic endometritis

Abstract

Aim. To expand the understanding of the pathogenesis of chronic endometritis based on the study of reception and markers of cell proliferation/apoptosis in its various macrotypes depending on the nature of microbial colonization.Methods. We prospectively examined a group of 345 women with early reproductive losses (history of missed miscarriage, spontaneous abortion, artificial abortion, in vitro fertilisation failures during up to 6 months after intrauterine intervention), who had histologically verified chronic endometritis. A microbiological study of cervical discharge, aspirate from the uterus, identification of the pathogens with PCR, hysteroscopic and pathomorphological study of the endometrium (paypel biopsy) were performed. Identification of hysteroscopic hyperplastic, hypoplastic and mixed macrotypes was carried out on the basis of groups of features characterizing the thickness, color and the structure of the mucous membrane, intensity of vascular pattern in the presence of chronic inflammatory process. Immunohistochemistry of endometrium was performed to determine endometrial receptors for estrogen, progesterone («Dako», Denmark), proliferative activity of endometrial epithelial cells; the intensity of the expression of Ki-67 marker, that marks the cell nucleus at G1-, G2- and S-phase of the mitotic cycle, was taken into account. Apoptosis activity in endometrial biopsies was evaluated on the basis of expression of CPP32 proteins.Results. Structural and functional disintegration of the endometrium in chronic endometritis is presented as disorders of strictly determined submicroscopic features of the cellular elements of the glandular epithelium and stroma of the endometrium, however, each of the macrotypes has its own characteristic disturbances of homeostasis and homeokinesis of endometrial tissue.Conclusions. Further study of the markers of signaling pathways regulating proliferative cascades at the endometrial level matched with endometrial response to the invasion of a pathogen and morphological transformations will allow optimizing the diagnosis and treatment of chronic endometritis and restoration of reproductive potential after reproductive losses.

Sonoelastography evaluation in the diagnosis of endometrial pathology combined with chronic endometritis in infertile women

“…Endometrial hyperplastic processes are registered in almost every third patient in groups with uterine fibroids (38.1%), adenomyosis (39.2%), in every second patient with a combination of three nosologies (43.5%). Endometrial polyps were found more often: practically in two-thirds (61.3%) with certain nosology and in every second woman (56.4%) with their combination [ 4 , 5 , 7 , 12 , 19 ].…”

“…Among the leading factors, the following disorders should be noted: extragenital diseases (thyroid dysfunction, overweight, pathology of the gastrointestinal tract, cardiovascular disease) and comorbidity of gynecological pathology (leiomyoma, adenomyosis, polycystic ovary syndrome, benign ovarian tumors [ 9 , 11 – 14 ]. It is necessary to emphasize recent data on the growth of chronic endometritis (CE) as one of the factors in the development of HPE [ 11 , 12 , 15 , 16 ]. Against the background of pelvic inflammatory disease and hormonal imbalance, there is a probability of developing pathological processes in the ovaries [ 1 – 3 , 13 ].…”

Local Immunity Status and Apoptosis Reactions in Endometrium of Women with a History of Non-Developing Pregnancy

“…The presence of bacterium-virus colonization in endometrium, as a rule, results from inability of the immune system and nonspecific body defenses (complement system, phagocytosis) to eliminate an infectious agent entirely, which leads to microorganisms persistence characterized by the appearance of mononuclear phagocytes, natural killer cells, synthesizing proinflammatory cytokines in the area of inflammation [10,17].…”

“…By consensus of obstetricians and gynaecologists in 2006 each case of nondeveloping pregnancy is regarded as being associated with chronic endometritis, both at the cause and the effect levels [7] Latest research has shown that chronic pelvic inflammatory diseases are not accompanied by disruption of parameters of cellular and humoral immunity detected in peripheral blood. Thus, in order to determine functional status of endometrium, we need to assess the local immunity [8][9][10]. Bacterium-virus colonization of endometrium is the result of failure of the immune system to eliminate infectious agent; but at the same time its spread is limited due to effector properties of Tlymphocytes, NK-cells and macrophages.…”

Modern Methods of Diagnosis and Treatment of Chronic Endometritis, in Preparing Patients for Assisted Reproductive Treatment Technologies (Lit Erature Review)

“…Despite the recent innovations in stimulation protocol schemes, reproductive immunology, culture medium, technical equipment, and application of preimplantation genetic testing, implantation and genetic health of embryos remain the leading cause behind the effective implementation of IVF programs [15,23,24].…”