Morphological and functional features of the endometrium in infertility associated with external genital endometriosis in patients with a history of IVF failures

• Snezhana V. Volkova
• Marina B. Khamoshina
• Mekan R. Orazov
• Elena V. Kavteladze
• Lyudmila M. Mikhaleva
• Tatiana N. Khovanskaya

Abstract

Background. Endometriosis has traditionally been considered one of the leading causes of reproductive disorders in women. There is still a scientific debate about the true mechanisms of endometriosis-associated infertility, which is especially important in patients with previous history of IVF failure.

Aim - to expand the understanding of the pathogenesis of infertility in women with external genital endometriosis (EGE), to give morphological and functional characteristics of endometrium in patients with infertility associated with EGE, and with previous history of IVF failure.

Material and methods. The cohort of the studied patients was represented by women with EGE who applied to an assisted reproductive technology (ART) clinic to overcome infertility and had a history of one or more embryo transfer failures. The group of morphological control (n=5) consisted of endometrial biopsies of fertile women without EGE. In the studied cohort of women with one or more unsuccessful attempts to transfer embryos into the uterine cavity in the anamnesis, morphological (n=12) and immunohistochemical (n=11) studies of the eutopic endometrium were performed during the period of the supposed "implantation window". Immunohistochemical staining of tissue was performed using antibodies to steroid receptors (ER, PR), plasma cells (CD138), and NK cells (CD56).

Results. The characteristic morphological and functional features of the eutopic endometrium in women of this cohort were: displacement of the "implantation window" (75%), impaired local immunity (72.7%) and receptivity (50%). In every second patient with EGE, when compared with the morphological control group, IHC analysis of endometrial biopsies revealed impaired reception to sex steroids, which was expressed in a statistically significant (p<0.05) high ER expression (2.3 times; 19.5 versus 8.4%, respectively) against the background of low PR expression (2.5 times; 58 versus 23.4%, respectively). The expression of CD56 was increased 2.2 times in women with EGE in comparison with fertile women.

Conclusion. The pathogenesis of infertility in women suffering from EGE is based on disturbances in the sensitivity of steroid receptors and local immunogenesis in the eutopic endometrium, which is manifested by the displacement of the "implantation window". This is evidenced by statistically significant (p<0.05) high ER expression (2.3 times) against the background of low PR expression (2.5 times), high expression of CD56 (2.2 times) and mismatch of the endometrium with the mean the stage of secretion during the "window of implantation" in 75% of observations when compared with the group of morphological control.

Keywords:external genital endometriosis, infertility, endometrium, IVF and ET failures

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