A morphological study of human endometrial stroma in vivo and in vitro

Despite its crucial role in fertility, relatively little has been published on the human \nendometrial stroma. The first experiment reported in this thesis was designed to provide \nquantitative baseline data on the human stroma during the mid to late luteal phase, when it plays \na major part in normal pregnancy. Subsequent chapters investigate the effects of an antioestrogen \n(clomiphene citrate-CC); growth hormone (GH) supplementation of patients on \nhormone replacement therapy (HRT) due to lack of endogenous ovarian steroids; and patients \nwith unexplained recurrent miscarriage. Finally a novel 3-dimensional in vitro model of human \nstroma is described along with the effects of steroid supplementation on stromal cells grown in \nthe model. \nIn all cases of in vivo studies, conventional stereological methods were used to obtain \nquantitative morphological data from at least 6 subjects per group, from both control (fertile) \nand experimental (infertile) subjects using light and electron microscopy. In addition, several \nstaining techniques were also used to demonstrate qualitative changes that occur in human \nendometrial stroma. \nDuring the mid to late luteal phase, endometrial stroma and blood vessels underwent \nsubstantial changes, and thus quantitative and qualitative baseline data have been established to \nfill a gap in this important area of reproductive biology. CC caused no substantial changes in \nstromal structure in women of proven fertility and therefore its advantageous effects on \novulation are not negated at the level of the endometrium. GH supplementation had no effects \non infertile human endometrial stroma from subjects on HRT, (in either premature ovarian \nfailure or Turner's syndrome groups). However, both infertile groups had endometrial stroma \nwhich significantly differed from matched fertile endometrium, suggesting an impaired \nendometrial development in infertile subjects which was not reversed by HRT, either with or \nwithout Gil treatment. Stromal morphology did not differ between the recurrent miscarriage \ngroups, however data suggested the existence of several subgroups which made firm \nconclusions difficult. The tissue culture model provided preliminary data suggesting it to be a \npotentially very useful technique for the study of stromal cell biology.