Chronic endometritis in the pathogenesis of recurrent miscarriage

• Sergey A. Mikhalev
• Victor E. Radzinsky
• Mekan R. Orazov
• Diana N. Masalimova
• Lyudmila M. Mikhaleva

Abstract

The aim of the study was to expand the understanding of the pathogenesis of recurrent miscarriage.

Study design: open independent retrospective clinical and morphological study was conducted.

Material and methods. The study involved 348 patients of reproductive age (mean age 36±3.3 years). The patients of the studied cohort were stratified into two groups: the main one (n=230) – with a verified diagnosis of “recurrent miscarriage”, having a history of 2 or more pregnancy losses; and the comparison group (n=118), which included women with realized fertility. For morphological and immunohistochemical examination of the endometrium in all patients, the material was taken by pipelle biopsy on the 8^th–10^th day of the menstrual cycle (in the middle stage of the proliferation phase).

Results. Morphological signs indicating the presence of chronic endometritis were significant (p<0.001) increases in CD138⁺ expression (2.15±2.27 cells vs 0.19±0.39 cells), increases in CD56⁺ expression (25.1±8.68 cells vs 6.36±6.25 cells) in comparison with biopsies of the morphological control group, as well as the presence of fibrosis in endometrial stroma (60.8% vs 2.5%).

Conclusion. The pathogenesis of recurrent miscarriage is based on persistent inflammation/damage of the basal endometrial compartment against the background of abnormal invasion of its stroma by plasmocytes. This is evidenced by a significant (p<0.05) increase in CD138⁺ expression (2.15±2.27 cells vs 0.19±0.39 cells) and CD56⁺ expression (25.1±8.68 cells vs 6.36±6.25 cells), as well as a pronounced prevalence of fibrosis (60.8% vs 2.5%) in comparison with biopsies of the morphological control group. Molecular biological studies on a large sample are needed to clarify the ultrathin mechanisms of the development of recurrent pregnancy loss in women with chronic endometritis (CE). Rational consideration of clinical and morphological data on CE determines the direction of therapeutic, diagnostic and preventive measures in women at risk in order to improve reproductive outcomes.

Keywords: recurrent miscarriage; chronic endometritis; morphology; immunohistochemistry

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