THE PRINCIPLES OF INDIVIDUAL HORMONE PREPARATION OF THE ENDOMETRIUM IN PATIENTS WITH IN-VITRO FERTILIZATION FAILURES

Objective. To study the morphological characteristics of structural features in the superficial epithelium and the receptor status of the endometrium in patients with repeated implantation failures in the assisted reproductive technology programs, to elaborate prognostic criteria for the occurrence of pregnancy in them, and to identify groups of patients who are to have cyclic hormonal therapy as endometrial preparation for the following in-vitro fertilization (IVF) cycle. Subjects and methods. The study enrolled 97 reproductive-age patients with tuboperitoneal infertility and a history of 2 IVF failures or more. At its f irst stage, 2 comparison groups were formed in accordance with the efficiency of IVF procedures: 1) 15 patients in whom pregnancy had occurred; 2) 47 negative-pregnant women. These patients underwent Pipelle endometrial biopsy in the cycle before superovulatory induction on days 7-8 postovulation. At the second stage, Group 3 consisting of 35 patients with lower steroid receptivity was formed in accordance with the data of immunohistochemical studies. They were given hormonal therapy as preparation for the following procedure of IVF and embryo transfer. Group 3 patients treated with hormone drugs also underwent control biopsy on days 21-24 of a menstrual cycle. A control group included 15 fertile women without gynecologic pathology in whom the endometrial structure was examined. While studying the histological specimens, the percentage of superficial epithelial cells with pinopodia was calculated using a light microscopy at x400. A histology H-score was used to analyze immunohistochemical findings. The expression of estrogen receptor-α (ER-α) and progesterone receptor (PR) was estimated in scores. The data were statistically processed using the Statistica for Windows (version 7.0) software package (StatSoft Inc.). Results. The major favorable prognostic criteria for IVF pregnancy is the PR/ER-α ratio that is concordant with the endometrial morphological structure and superficial endometrial cells with pinopodia (≥50%) in the endometrium and the most unfavorable prognostic marker is persistent ER-α hyperexpression in the midluteal phase of the menstrual cycle. Conclusion. Cyclic hormonal therapy with natural estradiol and natural micronized progesterone in patients with the lower receptor status can normalize the structural and functional status of the endometrium and the formation of adequate morphological reactions of the superf icial epithelium, by enhancing the expression of PR and ER-α.

infertility, in-vitro fertilization, progesterone receptor, estrogen receptor-α, pinopodia