THE ROLE OF MORPHOFUNCTIONAL CHANGES OF THE UTERUS IN THE DEVELOPMENT OF REPRODUCTIVE DISORDERS IN WOMEN WITH ADENOMYOSIS

Abstract

Difficulties in the clinical and instrumental diagnosis of adenomyosis is the reason for the insufficient study of its effect on the course and outcome of pregnancy.Purpose of the work - to determine possible morphofunctional uterine factors of reproductive disorders in patients with adenomyosis.Materials and methods. The study included 102 women with adenomyosis and infertility, 20 women who had given birth with adenomyosis without a miscarriage in anamnesis and 30 conditionally gynecologically healthy fertile women. It was studied the proteomic profile of the eutopic endometrium on the day of the proposed implantation window (homeobox gene 10 (HOXA10), leukemia inhibitory factor (LIF), soluble glycoprotein 130 (sgp130), interleukin-6 (IL-6), and expression of natural killer cells (NK cells) ). 31 patients of reproductive age were examined and operated in volume of hysterectomy, of which 15 women were with painful adenomyosis, 16 – with cervical intraepithelial neoplasia stage III. In the preoperative period, sonographic recording of the contractile activity of the subendometrial myometrial layers was performed on the 21-22nd day of the menstrual cycle. Expression of oxytocin receptors has been investigated in the remote uterus.Results and discussion. In infertile women with adenomyosis on the day of the expected implantation window in the eutopic endometrium there was a decrease in HOXA10 expression in the stroma by 1.52 (p <0.01) and in the glands - by 1.46 times (p <0.01), LIF in the glands – by 1.12 (p<0.01) and sgp130 – by 2.52 (p<0.01), as well as increased secretion in the glands of IL-6 by 1.99 (p<0.01) times; increased infiltration of eutopic endometrium with NK-cells CD56+ 11.84 times (p<0.01) and CD16+ – 23.45 times (p<0.01). In the operated women, an increased and discoordinated peristaltic activity of the uterus, increased expression of oxytocin receptors and a decrease in the ratio of cervico-fundal and fundo-cervical waves during the period of the expected implantation window by 5.59 times (p<0.01) were registered.Conclusions: the basis of reproductive disorders in adenomyosis are changes in the proteomic profile of the eutopic endometrium and increased infiltration of it with NK cells on the day of the expected implantation window, increased expression of oxytocin receptors in the myometrium, and increased and dyscoordinated peristaltic uterus activity.