IMMUNOLOGICAL CHARACTERISTICS OF THE ENDOMETRIUM IN WOMEN WITH IMPAIRED FERTILITY

Аннотация

The main morphological criterion of chronic endometritis is the presence of inflammatory infiltrates consisting mainly of lymphoid elements and plasma cells with focal or diffuse location in the stroma and glands. Immunological research allows to evaluate the phenotypic composition of endometrial cells, identify the number of cytotoxic cells that limit embryo implantation and contribute to reproductive dysfunction, and determine the need for complex therapy. Keywords: endometrium, chronic endometritis, immunomorphology, reproductive disorders. Inflammatory diseases of the pelvic organs are the most common cause of women's health problems. Chronic endometritis occupies a special place in the structure. Many researchers note an increase in the frequency of pathological changes in the endometrium in the population of women of reproductive age. The frequency of chronic endometritis varies widely from 0.2 to 66.3%, but on average is 14%. The main contingent of patients with chronic endometritis are women of reproductive age 25-35 years. Data on the frequency of chronic endometritis among gynecological patients are variable (from 2.5 to 85%), primarily due to certain difficulties in diagnosis, clinical and morphological verification [15,18]. The mechanism of pregnancy termination in these patients is associated with the changes that occur in the endometrium as a result of disruption of secretory transformation processes caused by insufficient production or inadequate response of the target organ to progesterone. In the endometrium, there is underdevelopment of glands, stroma, vessels, insufficient accumulation of glycogen, proteins, growth factors, excessive amount of proinflammatory cytokines, which leads to inadequate development of the ovum, and as a result, miscarriage occurs [16,20]. A significant role in the development of chronic endometritis belongs to disorders of local and general immunity, manifesting inflammatory complications after childbirth and abortions. Long-term stimulation of immunocompetent endometrial cells by an infectious agent leads to decompensation of the regulatory mechanisms of local homeostasis, which maintains the persistence of the infectious process. Chronic activation of cellular and humoral proinflammatory reactions is accompanied by increased production of cytokines and other biologically active substances, causing microcirculation disorders, exudation and deposition of fibrin in the endometrial stroma, which forms connective tissue fibrinous adhesions in the stroma and/or intrauterine synechiae of varying degrees of severity [4,19]. There are many risk factors for the development of chronic endometritis, including one of the significant ones being various types of intrauterine manipulations. Medical abortions, curettage of the uterine cavity walls, endometrial biopsy, hysteroscopy, hysterosalpingography, hydrosonography, insemination, in vitro fertilization contribute to the development of chronic endometritis in 95% of cases [ 6,7]. The clinical picture of chronic endometritis is usually not very specific and largely reflects the depth and duration of pathomorphological changes in the uterine mucosa. A number of authors have noted that the main symptom of chronic endometritis (in 93% of cases) is perimenstrual bleeding. Among the clinical symptoms, a special place is 1622 ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 5 occupied by infertility (mainly secondary), unsuccessful IVF attempts and miscarriage [11,13]. Diagnosis of chronic endometritis is based on the analysis of clinical symptoms, anamnesis data, echographic picture and morphological examination of the endometrium [5,10,12]. The “gold standard” for diagnosing chronic endometritis is a morphological examination of the endometrium, which should be a mandatory part of the examination algorithm for patients with reproductive dysfunction [ 5,15,16]. Diagnostic curettage or biopsy of the uterine mucosa is performed in the middle and late phases of proliferation, on days 7-11 of the menstrual cycle. Generally accepted morphological criteria for the diagnosis of chronic endometritis: - The presence of inflammatory infiltrates consisting mainly of lymphoid elements and plasma cells with a focal nature of the arrangement - around glands and vessels. The diffuse nature of the arrangement of lymphoid elements is also not excluded. Infiltrates are located mainly in the functional layer, but their basal arrangement is also very typical. – Formation of lymphoid follicles in the functional layer of the endometrium. – Focal fibrosis of the stroma, which occurs during a long-term chronic inflammatory process in the endometrium and sometimes affects large areas. – Sclerotic changes in the spiral arteries with the formation of tangles of spiral arteries. – Dystrophic changes in the endometrial glands. Changes in the glandular and stromal components do not correspond to the days of the menstrual cycle. Morphometric analysis pr