PREGESTATIONAL IMMUNOMORPHOLOGICAL EVALUATION OF THE ENDOMETRIUM AND RATIONALE FOR THERAPY IN WOMEN WITH REPRODUCTIVE DYSFUNCTION

Objective. To conduct a comprehensive immunomorphological study of the endometrium to substantiate pregestational preparation steps in women with reproductive disorders. Subject and methods. Two hundred patients with reproductive disorders, including 100 women with tuboperitoneal infertility and 100 with miscarriage, were examined. A control group consisted of 83 healthy women. Immunohistochemical study was used to determine the expression of CD20 +, CD138 +, estrogen and progesterone receptors in the glandular and stromal epithelium. Results. Endometrial morphofunctional examination using routine staining revealed the clinical picture of chronic endometritis in 17.0% of the patients with tuboperitoneal infertility and in 66.0% of those with miscarriage. Immunohistochemical study showed a higher CD20 + immunocyte density of 3.02±0.6 per mm 2 of the stroma in the women with miscarriage, with predominant arrangement close to the basement membrane of the endometrial glands. CD138 +-positive plasma cells were detected only in women with reproductive losses and had also a higher endometrial stromal numerical density of 2.91±1.2 in the miscarriage group, by showing a diffuse distribution, which suggested that the activity of immunological processes occurring in the endometrium was high. Conclusion. The comprehensive immunomorphological evaluation of the endometrium is of decisive importance in making the steps of pregestational preparations in patients with reproductive disorders. Evaluation of humoral immunity raises the question as to whether it is necessary to use repeated courses of empirical antibacterial therapy. Analysis of the level of estrogen and progesterone receptor expression makes it possible to substantiate hormonal therapy under echographic guidance.

endometrium, chronic endometritis, immunomorphology, reproductive disorders