Title : Features of endometrial receptivity in chronic endometritis in women with infertility
Abstract:
The normal receptor status of the endometrium is an important factor in successful embryo implantation. The most informative methods of studying endometrial receptivity are immunohistochemical and immunocytochemical research methods. The aim of our study was to determine the receptor status of the endometrium in women with chronic endometritis with infertility and unsuccessful IVF attempts; and to develop treatment methods depending on the receptor status of the endometrium.
Materials and Methods: In 2023, we examined 66 infertile women with a confirmed chronic endometritis at the MedSwiss clinic. Endometrial samples were collected on days 7-11 of the menstrual cycle by pipel biopsy. To determine the receptor status of the endometrium, immunocytochemical studies were performed by automated staining using the Dako AutostainerLink 48 system (Dako Denmark A/S, Denmark) using monoclonal (mouse) antibodies to human CD138, clone Ml15, Ready-to-Use (Dako Denmark A/S, Denmark).
Immunohistochemical examination of endometrial tissue was performed using the peroxidase technique on paraffin sections with a thickness of 3-4 microns. The UltraVision Quanto detection system (DAKO, Denmark) and DAKO monoclonal mouse antibodies were used: to estrogen receptors (clone 1D5), progesterone (clone PgR 636), Ki-67 protein (clone MIB-1); polyclonal rabbit antibodies Her2 in 1:700 dilution; to lymphocyte receptors - CD3 (clone SP 7); CD4 (clone 4B12); CD8 (clone), CD138 (clone); to epidermal growth factor EGFR (clone) and to androgen receptors (clone).
Results: In 26 women (40%), chronic endometritis occurred without activation of the autoimmune nature of the process (DP-DQ&DR – negative – 0 points). In 40 women (60%), chronic endometritis was determined with the autoimmune nature of the process (DP-DQ&DR – diffusely located cells with moderate cell expression in the visual field). All patients with the autoimmune nature of chronic endometritis had a normal receptive status of estrogens and progesterone and a normal proliferative activity index (KI67), with activation of cytotoxic B lymphocytes (CD 20c) and the presence of true killer cells (CD56).
Conclusion: The combination of immunocytochemical and immunohistochemical research methods is highly informative in terms of diagnosis of chronic endometritis. 60% of infertile women with chronic endometritis have an autoimmune nature of the process. Based on the data obtained, we have developed a specific treatment depending on the receptivity of the endometrium. Antibacterial therapy was used only when pathogenic and opportunistic bacteria were detected in the uterine cavity. With high efficiency of treatment, we used hormone therapy, therapy improving tissue trophism, microcirculation, vitamin therapy, physiotherapy.
Keywords: Immunohistochemical examination, immunohistochemical examination, chronic endometritis, infertility, endometrial receptivity.
