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

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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.


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About the authors

Gulrukhsor Kh. Tolibova

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Author for correspondence.
Email: gulyatolibova@yandex.ru
ORCID iD: 0000-0002-6216-6220
SPIN-code: 7544-4825
Scopus Author ID: 23111355700

Russian Federation, Saint Petersburg

MD, PhD, DSci (Medicine), Leading Researcher, Head of the Laboratory of Immunohistochemistry

Tatyana G. Tral

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Email: ttg.tral@yandex.ru
Scopus Author ID: 37666260400

Russian Federation, Saint Petersburg

MD, PhD, Head of the Pathology Department

Igor Yu. Kogan

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Email: ikogan@mail.ru
ORCID iD: 0000-0002-7351-6900
SPIN-code: 6572-6450
Scopus Author ID: 56895765600

Russian Federation, Saint Petersburg

MD, PhD, DSci (Medicine), Professor, Corresponding Member of RAS, Director

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Histological types of transformation of the hypoplastic endometrium in women with ineffective ART protocols: a, dysplastic endometrium (×100); b, dissociated hypoplastic endometrium (×200); с, secretory hypoplastic endometrium (×200); d, hypoplastic endometrium with atypical hyperplasia (×200). Hematoxylin and eosin staining

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2.
Fig. 2. ER and PR expression in morphologic variants of the hypoplastic endometrium in women with ineffective ART protocols: a, decreased ER expression in the stromal component of proliferative hypoplastic endometrium; b, decreased PR expression in the stromal component of the proliferative hypoplastic endometrium; c, uneven distribution and decreased expression of ER in secretory hypoplastic endometrium; d, uneven distribution and decreased expression of PR in secretory hypoplastic endometrium; e, uneven distribution and decreased expression of ER in dissociated hypoplastic endometrium; f, uneven distribution and decreased expression of PR in dissociated hypoplastic endometrium. Hematoxylin and eosin staining (×200)

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Copyright (c) 2020 Tolibova G.K., Tral T.G., Kogan I.Y.

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