{"paper_id":"e4613e58-0427-40da-b979-35b60f01ee99","body_text":"ORIGINAL\n SCIENTIFIC \nAR\nTICLE   \n   ORIGINAL\n SCIENTIFIC \nAR\nTICLE\nORIGINALNI NAUČNI RAD\nUDK: 612.1.015\n \n \nUDK: 000.00\n-\n000.0/.0\n-\n000; 000.000/ \n \nSer J Exp Clin Res 2019; 20 (1): 3\n-\n13\n \nDOI: \n10.2478/sjecr\n-\n2021\n-\n0023\n \nCorresponding author: \n \nAna Dević\n \nTel. No. +381 63 8138333\n \nE\n-\nmail: anavjestica74@gmail.com\n \n \nIMMUNOHISTOCHEMICAL ANALYSIS OF THE EXPRESSION OF THE \nGLYCODELIN CYTOKINE IN ENDOMETRIAL TISSUE AND THE \nENDOMETRIAL POLYP, BEFORE AND AFTER HYSTEROSCOPY, \n \nIN INFERTILE FEMALE PATIENTS \n \nAleksandar Dević\n1\n, Ana\n \nDević\n1\n, \nMarija Šorak\n2\n, \nGoran Zajić\n3\n \nand\n \nSlobodanka Mitrović\n4\n \n1\n \nClinical Hospital Center Zemun\n, Hospital for Gynecology and \nObstetrics\n, Serbia\n \n2\n \nUniversity of Kragujevac, \nFaculty of Medical Sciences, \nDepartment of Gynecology, \nKragujevac, Serbia\n \n3\nAcademy of Technical and Art Applied Studies Belgrad\ne\n-\n \nICT College of Applied Studies, \nBelgrade, Serbia\n \n4\n \nUniversity of Kragujevac, \nFaculty of Medical Sciences, \nDepartment of Pathology, \nKragujevac, Serbia\n \n \nIMUNOHISTOHEMIJSKA ANALIZA EKSPRESIJE CITOKINA \nGLIKODELINA U TKIVU ENDOME\nTRIJUMA I POLIPU \nENDOMETRIJUMA, PRE I POSLE HISTEROSKOPIJE, KOD INFERTILNIH \nPACIJENTKINJA \n \nAleksandar Dević\n1\n, Ana Dević\n1\n, Marija Šorak\n2\n, Goran Zajić\n3\n \ni \nSlobodanka Mitrović\n4\n \n1\n \nKliničko bolnički centar Zemun, Bolnica za ginekologiju i akušerstvo, Srbija\n \n2\nUniverzitet u Kragujevcu, \nFakultet medicinsk\nih nauka, \nKatedra za ginekologiju, \nKragujevac, Srbija\n \n3\nAkademija tehničko\n-\numetničkih strukovnih studija Beograd \n–\n \nVisoka ICT škola\n, \nSrbija\n \n4\n \nUniverzitet u Kragujevcu, \nFakultet medicinsk\nih nauka, \nKatedra za \npatološku anatomiju\n, \nKragujevac, Srbija\n \nReceived/Primljen:\n \n20.02.2021.\n \nAccepted/Prihvaćen:\n \n07.04.2021.\nABSTRACT\n \nAn endometrial polyp is most commonly a benign, localized \nproliferation of the glands and the endometrial stroma, covered \nwith epithelium and protruding above the level of the mucosa. \nThese polyps are most often diagnosed during investigation into \nthe caus\nes of irregular menstrual bleeding or infertility.  It is pro-\nduced in the highest concentration during the secretory phase of \nthe endometrial cycle.  The level of glycodelin reaches its peak 12 \ndays after ovulation. The aim of this paper was to determine t\nhe \nchanges in the immunohistochemical expression of glycodelin at \nthe level of the endometrium and in the tissue of the polyp, before \nand after hysteroscopic polypectomy, in infertile female patients \nwith an endometrial polyp, and in the endometrial tissue\n \nof female \npatients without an endometrial polyp. The study included 82 in-\nfertile female patients. The infertile patients were divided into two \ngroups. The first was the experimental group which included 56 \ninfertile female patients who had an endometrial \npolyp. The sec-\nond group was the control group, composed of 26 infertile female \npatients who did not have an endometrial polyp. The results ob-\ntained primarily indicate the existence of changes in the immuno-\nhistochemical expression of the cytokine glycodelin\n \nin the female \npatients from both the experimental and the control group, not \nonly prior to but also after hysteroscopy. A larger number of pa-\ntients who have an endometrial polyp show a lack of glycodelin \nexpression, more pronouncedly so in the bioptate of\n \nthe endome-\ntrium than in the endometrial polyp.\n \n \nKeywords\n:\n \nGlycodelin\n, polyp, endometrium, infertility\n.\n \nSA\nŽ\nETAK\n \nPolip\n \nendometrijuma\n \nje\n \nnaj\nč\ne\nšć\ne\n \nbenigna\n \nlokalizovana\n \nprolif-\neracija\n \nž\nlezda\n \ni\n \nstrome\n \nendometrijuma\n \npokrivena\n \nepitelom\n \niznad\n \nravni\n \nsluzoko\nž\ne\n. \nNaj\nč\ne\nšć\ne\n \nse\n \ndijagnostikuju\n \nza\n \nvreme\n \nispitivinja\n \nuzroka\n \nneurednog\n \nkrvarenja\n \niz\n \nmaterice\n \nili\n \nneplodnosti\n. \nU \nnajvećoj koncentraciji se produkuje tokom sekretorne faze endo-\nmetrijalnog ciklusa. Nivo glikodelina dostiže svoj vrhunac 12 \ndana nakon ovul\nacije. Cilj ovog rada je bio da utvrdi promene u \nimunohistohemijskoj ekspresiji Glikodelina na nivou endometri-\njuma i u tkivu polipa, pre i posle histeroskopske polipektomije kod \ninfertilnih pacijentkinja sa endometrijalnim polipom i u tkivu en-\ndometrijuma k\nod pacijntkinja bez endometrijalnog polipa. \nIstraživanjem je bilo obuhvaćno 82 infertilne pacijentkinje. Infer-\ntilne pacijentkinje su bile podeljenje u dve grupe. Prva grupa je \noznačena kao eksperimentalna grupa pacijentkinja i činilo je 56 \ninfertilnih paci\njentkinja sa polipom endometrijuma. Druga grupa \nje označena kao kontrolna grupa pacijentkinja i činilo je 26 infer-\ntilnih pacijentkinja bez polipa endometrijuma. Dobijeni rezultati \nprvenstveno ukazuju na postojanje promena u imunohisto-\nhemijskoj ekspresiji c\nitokina Glikodelina  kod pacijentkinja ek-\nsperimentalne i kod pacijentkinja kontrolne grupe, kako pre his-\nteroskopije tako i nakonhisteroskopije. Veći broj pacijentkinja sa \npolipom endometrijuma ne pokazuje ekspresiju Glycodelina, i to \nizraženije u bioptatu \nendometrijuma nego u polipu endometri-\njuma.\n \nKljučne\n \nreči\n:\n \nGlycodelin\n, polip, endometrijum, infertilitet\n.\n \n\nABBREVIATIONS\n \nkDa\n \n-\n \nkilodalton\n \n(\natomic mass unit\n)\n \n1k\n \nDa\n \n= 1\n,\n000 dalton\ns\n \nDa\n \n-\n \nOne d\nalton\n \nis defined as \n1/12 \nof the \nm\na\ns\ns\n \n \nof a single \ncarbon\n-\n12 atom\n.\n \nNK\n \n-\n \nn\natural killer cells\n \nSI\nS\n \n-\n \nsonohysterography\n \nHE\n \n-\n \nhematoxylin\n-\neosin\n \nPBS\n \n-\n \np\nhosphate \nb\nuffered \ns\naline\n \nUK NEQAS\n \n-\n \nUK National External Quality Assess-\nment Scheme for Immunocytochemistry\n \nWHO\n \n-\n \nWorld Health Organization\n \nIH\nC\n \n–\n \nimmunohistochemistry\n \n \n \n \nINTRODUCTION\n \nAccording to the World Health Organization (WHO), in-\nfertility is a disease of the reproductive system defined by the \nfailure to achieve a clinical pregnancy after a year or more of \nregular unprotected sexual intercourse \n(\n1)\n. \nIn the world, \naround 10% of cou\nples are infertile, and in Serbia the per-\ncentage of infertile couples is 15% \n(1\n).\n \nEndometrial polyps \nare thickenings of the uterine mucosa consist\ning\n \nof endome-\ntrial glands, stroma and blood vessels \n(2\n). \nA polyp is formed \nas a focal \nproliferation of the endometrial basal layer\n, while \nthickened blood vessels can be found in the \nbase \nof the polyp \n(\n3,\n \n4\n). \nThe rate of recurrence of endometrial polyps in the \noverall population is around \n24%. \nPathological uterine bleed-\ning is the most common\n \nclinical symptom of an endometrial \npolyp. In infertile women, the diagnosis of an endometrial \npolyp is usually a coincidental finding \n(4)\n.\n \nThe diagnosis of endometrial polyp is established on the \nbasis of histopathology and sonographic findings. Hyster-\nosc\nopy is the golden standard in the diagnosis and therapy of \nendometrial \npolyps (\n5\n,\n \n6\n,\n \n7\n)\n. \nCytokines are polypeptides and \nglycopeptides with a molecular mass of \n6\n \n-\n \n10 kDa.\n \nCyto-\nkines demonstrate their effects through specific receptors \nwithin the cell or \nin\n \nthe cell membrane \n(8)\n. \nWith the activa-\ntion of specific receptors\n,\n \ncertain genes are activated, and as \na result of this\n \nactivation,\n \nphenotypic and functional changes \noccur \nin the target cell. Cytokines may be positive or negative \nregulators of immune response. The basic function of cyto-\nkines is in intercellular communication \n(9)\n. \nThe activity of \ncytokines depends on their concentration. Depending on the \ninfluence that they \nh\nave\n \non the inflammatory reaction\n,\n \ncyto-\nkines are divided into proinflammatory and anti\n-\ninflamma-\ntory cytokines \n(\n10\n).\n \nGlycodelin, placental protein\n-\n14 or oste-\nopontin \n(\n8\n)\n \nis a glycoprotein deposited in the glandular and \nepithelial cells of the endometrium\n \n(1\n1, 12\n).\n \nIt affects the en-\ndometrium through different cells \n(13)\n. \n \n \nIn the human endometrium, during ovulation, the level \nof glycodelin is low 6 days before and 5 days a\nfter ovulation \n(\n14, \n15)\n. \nThis can facilitate or allow fertilization to occur \n(16)\n. \nDuring implantation the level of glycodelin signifi-\ncantly increases, prevents the action of NK cells, prepares the \nendometrium for implantation, and, to a certain extent, \npr\notects the embryo from the harmful effect of NK cell\n \nactiv-\nity \n(17\n).\n \n \nMATERIALS AND METHODS\n \nThe research was conducted in the form of a\n \nrandomized \ncross\n-\nsectional study on a sample of 82 infertile female pa-\ntients\n,\n \nin the generative period. The first, experimental group \ncomprised 56 infertile female patients with a diagnosis of en-\ndometrial polyp. The second, control group\n,\n \nconsisted of 26 \ninfertile patients who did not have an endometrial polyp. The \nstudy was carrie\nd out \nat\n \nthe \nObstetrics and Gynecology \nClinic \nNarodni Front\n \nin Belgrade and at the \nCenter for Mo-\nlecular\n \nMedicine and\n \nStem Cell Research\n \nof the \nFaculty of \nMedical Sciences, University of Kragujevac\n.\n \nThe criteria for \ninclusion in the study were: infertility lasting at least one \nyear, age between 20 and 42 years, regular menstrual cycle, \nno use of any type of hormonal contraceptives or other hor-\nmon\ne\n \nproducts in the six months prior to the study, the fi\nnd-\ning of an endometrial polyp confirmed by transvaginal 2D \nultrasound examination or by SIS\n \n(for the experimental \ngroup\n, only\n)\n, no other endometrial pathology confirmed by \ntransvaginal ultrasound examination\n \n(4)\n.\n \nThe criteria for ex-\nclusion from the \nstudy, for both groups of patients\n,\n \nwere: \nthe \npresence of submucosal myoma, endometriosis, endometrial \ncarcinoma, uterine anomalies, patients who had undergone \nsurgery of the uterus and \nfallopian tubes, patients with previ-\nous unsuccessful ovulation stimula\ntion, and patients aged \nover 42 years. The study was approved by the \nEthics Com-\nmittee of the Obstetrics and Gynecology Clinic \nNarodni \nFront, \nNo. 04\n-\n24 / 3\n-\n1i and by the Ethics Committee of the \nFaculty of Medical Sciences, University of Kragujevac, No: \n01\n-\n3\n593 (4). Surgical procedures were performed \non\n \ninfertile \npatients in the first phase of the menstrual cycle, when the \nendometrial\n \nmucosa is the thinnest and when there is the least \nprobability of interfering with early undiagnosed pregnancy \n(\n4,\n \n7\n)\n. \n \nResearch Methodology\n \nFor the purpose of im\nm\nun\no\nhistochemical \nanalysis, t\nhe tis-\nsue of the endometrium and the polyp were fixed for 24 hours \nin 4% neutral buffered formalin, at room temperature\n. Then, \nthe\n \ntissue\n \nsections\n \nwere dehydrated, \ncleared in xylol \nand \n\ninfiltrated with paraffin in the apparatus for automatic tissue \nsample fixation \n–\n \nthe Leica TP1020 \nT\nissue \nProcessor and\n \nwere then embedded into paraffin \nblocks\n. \nP\naraffin molds\n \nob-\ntained in this way\n \nwere sectioned in the automatic Leica \nRM2155 Rotary Microto\nme into 4µm sections; they were \nthen immersed in water at 56\n \n°C and were finally placed on \nSuperfrost glass microscope slides \n(18)\n. \n \nHematoxylin and Eosin \nS\ntaining \n(HE)\n \nThe staining of paraffin tissue sections was performed b\ny\n \nthe\n \napplication of \nHeidenhain’s \nh\nematoxylin\n-\neosin\n \nmethod\n \nand in keeping with \nGurr’s \nrecommendations \n(\n19,\n \n20\n)\n. \nS\nl\nides\n \nwith tissue sections obtained in this way were buffered in for-\nmaldehyde \nbuffer for 10 seconds, rinsed with running water \nand finally immersed for two minutes in Mayer’s hematoxy-\nlin \n(Merck). \nThe tissue sections\n \nwere\n \nthen\n \nrinsed for one mi-\nnute\n \nin running wa\nter and stained with alcoholic eosin \n(Merck) \nfor one minute. After dehydration, tissue sections\n \nwere \ndipped\n \nin a series of \nincreasing\n \nethanol concentrations, \nafter which the \nclearing\n \nprocedure was carried out, when the \nsections\n \nwere immersed for 50 seconds in a mixture of xylol \nand ethanol (ratio \n1:\n1), and then twice in pure xylol, 50 sec-\nonds each time. A drop of Canada balsam (Centrohem, Ser-\nbia) was placed on the tissue sections\n. \nThe\n \ntissue sections\n \nwere covered with \ncover slips. After drying for 24 hours, the \npreparations were analyzed under a light microscope \n(\n21, \n2\n2\n)\n.\n \nT\nissue sections\n \nwere heated at \n56\n \nºC \nfor a period of 60 \nminutes and were mounted onto adherent \nSuperFrost® \nslides. The slides with tissue sections\n \nwere immersed in xy-\nlol, and then in a series of decreasing concentrations of etha-\nnol. For the purpose of antigen unmasking, tissue sections\n \nwere h\neated in a microwave oven in citrate buffer \n(pH\n \n= 6.0) \nfor a period of 21 minutes. After cooling \ndown, the prepara-\ntions were rinsed in distilled water and were then incubated \nthree times, 10 minutes each time, in \np\nhosphate \nb\nuffered \ns\na-\nline\n \n(PBS\n).\n \nFor the pu\nrpose of fixation and permeabilization \nof the tissue sections, the slides with tissue sections were\n \nim-\nmersed in icy cold acetone, at 4 ºC, for 10 minutes.\n \nThey were \nthen rinsed in PBS. For the purpose of blocking the activity \nof endogenous peroxidase, seve\nral drops of Hydrogen Perox-\nide Block\ning Reagent\n \nwere applied on them. After \nten \nminutes of \nincubation\n,\n \nthe preparations were rinsed \ntwice \nwith PBS\n \nand then several drops of Protein Block were ap-\nplied on them\n. A\nfter a \nten\n-\nminute incubation period, \nthe Pro-\ntein Block was \nrinsed\n \nout,\n \nonce\n,\n \nin PBS. \n \nImmunohistochemical staining\n \nTissue sections were incubated \novernight \nwith primary \nantibodies in a humidity chamber\n \nat \n4 ºC. \nThe appropriate \nmouse monoclonal antibodies (Ab17247, m\nonoclonal 001\n-\n13, provided by Abcam) were used in the appropriate attenu-\nation (1:200) dissolved in PBS (22). Tissue sections were \nrinsed in PBS, and appropriate commercial detection kits \nwere used for antigen visualization (4, 23, 24).\nThe repara-\ntions were \ncovered with glycerol and a cover slip. Immuno-\nhistochemical staining\n \nwas performed, with control for \nquality and specificity of staining, in keeping with the UK \nNEQAS (UK National External Quality Assessment Scheme \nfor Immunocytochemistry) standards, and w\nith the use of \npositive and negative controls \n(20\n). \nDifferent expression of \nepithelial endometrial cells was obtained with staining, in \nproportion \nto\n \nthe binding of the dye to the cells \n(21)\n. \n \nStatistical data processing\n \nSample size \nwas \ndetermined on the basis of the formula \nfor calculating large samples\n,\n \nimplemented in the PASS 11.0 \nsoftware. All the data obtained were processed using descrip-\ntive statistics methods \n(25)\n. \nAll results were processed with \nthe aid of the \nSPSS 22.0 \nsoftware p\nackage \n(\n2\n6\n)\n. \nThe results \nobtained were compared to those of other authors available \nin literature \n(27)\n. \nConclusions were made on the basis of the \nresults obtained \n(4,\n \n22)\n.\n \nFor values that had a normal distri-\nbution, we used the Student’s t test and Student’s paired t test, \nand for other distributions nonparametric Mann\n-\nWhitney and \nWilcoxon test is used. All statistical analyzes were performed \nwith a 95% confidence interval. \nIf the probability level of the \nnull hypothesis is <5%, and if the significance of the test is p \n<0.05 the results of the statistical analysis were accepted as \nstatistically significant.\n \n \nRESULTS\n \nThis segment presents the analysis of the expression of \nthe cytokine glycodelin obtained through the application of \nthe \nimmunohistochemistry method.  \n \nImmunohistochemical expression of glycodelin\n \nTable 1 and Graph 1 show the immunohistochemical \n(IHC) expre\nssion of the cytokine glycodelin in the polyp and \nthe endometrium of the patients belonging to the experi-\nmental group and the endometrium of the patients from the \ncontrol group.\n \n \nTable\n \n1\n.\n \nImmunohistochemical expression of glycodelin, \n \nin polyp tissue, endometrial biopsy of patients \n \nwith polyp and without polyp\n \nExperimental group \n \nN\n \n%\n \nPol\nyp\n \n9\n \n18\n \nBiop\ntate\n \nof the endometrium\n \n1\n \n2\n \nControl group\n \nBiop\ntate\n \nof the endometrium\n \n1\n \n3.8\n \n \nN \n–\n \nnumber of patients\n \n% \n–\n \nnumber of patients in percentages\n \n \n \n \n\nGraph\n \n1\n.\n  \nImmunohistochemical expression of glycodelin, \nin polyp tissue, endometrial biopsy of patients with polyp and \nwithout polyp\n \n \nStatistical processing of the data shown in Table 1 and \nGraph 1 found that a very highly statistically significant\nly\n \ngreater\n \nnumber of patients from the experimental group did \nnot have IHC expression of glycodelin in the polyp  \n(χ2\n \n=\n \n20.480; p<0.001)\n,\n \nas\n \ncompared to the patients within the \ngroup who did have IHC expression of glycodelin in the \npolyp\n. \nIn the endometrial bioptate of the same patient group \na very highly statistically significant\nly\n \ngreater \nnumber of pa-\ntients did not demonstrate IHC expression\n \nof glycodelin \n(χ2\n \n=\n \n46.080; p<0.001)\n \nas compared to those within this group \nwho did demonstrate IHC expression in the endometrial bi-\noptate\n. \nIn the control group of infertile female patients there \nwas also a very highly statistically significant\nly\n \nlarger n\num-\nber of patients who did not demonstrate IHC expression of \nglycodelin in the endometrial bioptate as compared to the \nnumber of patients in whom IHC expression of glycodelin \nwas found in the endometrial bioptate \n(χ2\n \n=\n \n22.154; \np<0.001).\n \nWhen IHC glycodelin \nexpression was compared between \nthe polyp and the endometrial bioptate of the experimental \ngroup of patients, a statistically significant difference in IHC \nglycodelin expression was found \n(Z\n \n=\n \n-\n2.530; p<0.05).\n \nSignal intensity of immunohistochemical glycod\nelin \n \nexpression\n \nTable 2 and Graph 2 show the signal intensity of gly-\ncodelin immunohistochemical expression in the polyp and \nthe endometrium of the patients from the experimental group \nand the endometrium of the patients from the control group.\n \nAs shown in Table 2 and Graph 2, \nin most subjects, an \nIHC signal of glycodelin expression was registered neither\n \nin \nthe polyp \nor\n \nthe endometrial bioptate of the experimental pa-\ntient group, \nnor\n \nin the endometrial bioptate of the control \ngroup of patients\n. \nIn the polyp of the experimental group, in \npatients who demonstrated glycodelin expression, a low\n-\nin-\ntensity signal was registered in 5 \n(10%) \nof patients, a me-\ndium\n-\nintensity signal was registered in three\n \n(6%)\n \npatients, \nand a high\n-\nintensity signal was registered in one\n \n(2%)\n \npatient\n. \nIn the endometrial bioptate of the experimental group, a low\n-\nintensity signal of ICH glycodelin expression was registered \nin only one (2%) patient\n, \nwhich was also the case in the co\nn-\ntrol group of patients \n–\n \na low\n-\nintensity signal was registered \nin \none\n \n(3,8%) \npatient\n.\n \nTable\n \n2\n.\n \nSignal intensity of IHC glycodelin expression, \nin polyp tissue, endometrial biopsy of patients with polyp and \nwithout polyp\n \nExperimental \ngroup \n \nLow\n-\nin-\ntensity \nsignal\n \n(%)\n \nMedium\n-\nintensity \nsignal\n \n(%)\n \nHigh\n-\nin-\ntensity sig-\nnal\n \n(%)\n \nPolyp\n \n10\n \n6\n \n2\n \nBiop\ntate\n \nof the \nendometrium\n \n2\n \n0\n \n0\n \nControl group\n \nBiop\ntate\n \nof the \nendometrium\n \n3.8\n \n0\n \n0\n \nSignal intensity\n: \nlow\n-\nintensity signal, \n \nmedium\n-\nintensity signal, high\n-\nintensity signal\n \n \n \nGraph 2.\n \nSignal intensity of IHC glycodelin expression, \n \nin polyp tissue, endometrial biopsy of patients \n \nwith polyp and without polyp\n \n \nStatistical processing of the data shown in Table 2 and \nGraph 2 found a very highly statistically significant differ-\nence in the signal intensity of IHC glycodelin expres\nsion, \nboth in the polyp \n(χ2\n \n=\n \n87.280; p<0.001)\n \nand in the endome-\ntrial bioptate (χ2\n \n=\n \n46.080; p<0.001) of the experimental \ngroup of patients. The same was \ntrue for\n \nthe control group. \nThe frequency of no signal registered was very highly statis-\ntically signif\nicantly greater than the registering of a low\n-\nin-\ntensity signal \n(χ2\n \n=\n \n22.154; p<0.001). \nIn the experimental \ngroup of patients, t\nhe distribution \nof IHC glycodelin expres-\nsion signal intensity was statistically significantly different \nbetween the endometrial b\nioptate and the polyp\n \n(Z\n \n=\n \n-\n2.511; \np<0.05).\n \nThe signal intensity of IHC glycodelin expression \nin the polyp of the experimental group of patients and the en-\ndometrial bioptate of the control group of patients d\nid\n \nnot \nshow a statistically significant differen\nce \n(Z\n \n=\n \n-\n1.753; \np>0.05)\n, as \nwas\n \nthe case \nwithin\n \nthe control group of patients\n \namong the endometrial bioptate specimens\n.\n \n(Z\n \n=\n \n0.474; \np>0.05).\n \n \n\n\nMicroscopic view of immunohistochemical glycodelin \n \nexpression\n \nImage 1 shows the microscopic view of the signal inten-\nsity of IHC glycodelin expression in the endometrial bioptate \nof the patients from the control group, at \nx\n10 magnification. \nImages 2 and 3 represent microscopic views of the signal in-\ntensity of IHC glyc\nodelin expression \nin the endometrial \npolyp of the experimental patient group, at \nx\n10 and \nx\n20 \nmag-\nnification\n, respectively. Image\n \n4\n \nshows\n \na microscopic view \nof the signal intensity of IHC glycodelin expression in the \nendometrial bioptate of patients from the\n \ncontrol group, at \nx\n10\n \nmagnification\n. Image 5 shows a microscopic view of \nIHC glycodelin expression in the tissue of the placenta and \nthe epithelium of the chorionic villi, at \nx\n20 magnification (ex-\nternal positive control of \nimmunohistochemical staining).\n \nImage \n1\n.\n \nMicroscopic view of IHC glycodelin expression in \nthe endometrial bioptate of the infertile patients without a \nverified endometrial polyp ( x10 magnification)\n \n \nImage\n \n2\n.\n \nMicroscopic view of IHC glycodelin expression in \nthe tissue of the endometrial polyp of infertile patients with-\nout a verified endometrial polyp ( x10 magnification)\n \n \nImage 3. \nMicroscopic view of IHC glycodelin expression \n \nin the tissue of the endometrial polyp of infertile patients \nwith a verified endomet\nrial polyp ( x20 magnification)\n \n \n \nImage\n \n4\n.\n \nMicroscopic view of IHC glycodelin expression \n \nin the endometrial bioptate of infertile patients without\n \na \n \nverified endometrial polyp( x10 magnification)\n \n \nImage 5.\n \nMicroscopic view of IHC glycodelin \nexpression in \nthe tissue of the placenta and the epithelium of the chorionic \nvilli (external positive control of immunohistochemical \nstaining, x20 magnification)\n \n \n \n \nLITERATURE\n \n \n1.\n \nZegers\n-\nHochschild F, Adamson GD, de Mouzon J, \nIshihara O, Mansour R, Nygren K,\n \nSullivan E, Van der \nPoel S. The international committee for monitoring \nassisted reproductive\n \ntechnology (ICMART) and the \nworld health organization (WHO) revised glossary on \nART\n \nterminology. Hum Reprod. 2009 Oct \n4;24(11):2683\n-\n7.\n \n2.\n \nBassil S. Changes in endometrial thickness, width, \nlength and pattern in predicting pregnancy\n \noutcome \nduring ovarian stimulation in in vitro fertilization. \nUltrasound Obstet Gynecol. 2001\n \nSep;18:258\n-\n63.\n \n3.\n \nMahajan N, Kaur S, Alonso MR. Window of \nimplantation is significantly displaced in\n \npatients with \nadenomyosis with previous implantation failure as \ndetermined by endometrial\n \nreceptivity assay. J Hum \nReprod Sci. 2018 Oct;11(4):353.\n \n4.\n \nSorak M, Devic A. A\nnalysis of Glycodelin Levels \nBefore and After Hysteroscopic\n \nPolypectomy in Infertile \nPatients. 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