Morphological evaluation of the hypoplastic endometrium in women with ineffective art protocols

Abstract

Hypothesis/aims of study. The hypoplastic endometrium has a significant negative impact on the probability of pregnancy and is one of the adverse factors influencing on the effectiveness of assisted reproductive technology (ART) protocols. Violation of the structural and functional characteristics of the endometrium associated with hypoplasia leads to endometrial dysfunction. In this regard, the relevance of a morphological study of the hypoplastic endometrium is beyond doubt. This study was aimed to determine the morphofunctional pattern of the hypoplastic endometrium in patients with a history of ineffective ART protocols.
 Study design, materials and methods. Histological and immunohistochemical studies of the endometrium were performed in 340 patients. The endometrial receptor profile (estrogen receptors, ER; progesterone receptors, PR) and pro-inflammatory markers (CD8+, CD20+, CD4+, CD138+) were evaluated by immunohistochemical method.
 Results. The morphological pattern of the hypoplastic endometrium in patients with ineffective ART protocols was characterized by polymorphic transformation variants with impaired endometrial receptor profile. This impaired proliferative and secretory transformation of the hypoplastic endometrium is underlain by damage to the endometrium basal layer resulted from intrauterine interventions and chronic endometritis with components of stromal fibrosis, sclerosis of the spiral arteries, and increased number of pro-inflammatory markers that led to endometrial dysfunction.
 Conclusion. This article first describes the morphological variants of the hypoplastic endometrium in women with ineffective ART protocols. Integration of comprehensive morphological diagnostics with verification of the transformation variant of the hypoplastic endometrium can serve as the basis for rehabilitation therapy.