Implantation microenvironment in chronic endometritis

Objective. To study the immune patterns of the endometrium in women with infertility of uterine genesis in the phase of "implantation window". Materials and methods. Forty-two infertile women of reproductive age were prospectively examined. At the first stage, the contingent of women was divided into groups in accordance with the causes of infertility diagnosed before the current treatment: with chronic endometritis (CE) (n = 10); with tubal peritoneal infertility (TPI) (n = 32). A comprehensive examination of women included sonography of pelvic organs, hysteroscopy, examination of endometrial material in the period of the "implantation window" (morphological, immunohistochemical, real time (RT) PCR study,). The resulting for distinguishing molecular phenotypes of chronic inflammation (n = 30) and "normal" endometrium (n = 12) were the data of immunohistochemical studies of the immune profile (in the glandular epithelium and stromal cells (TNF-, IL-10, NRF2, GM-CSF and CXCL16), in the glandular epithelium BCA1, in the stroma TGF-) compared with the indicators of healthy fertile women (control group, n = 10). CE was verified based on pathomorphological and immunohistochemical studies (CD 138+). Results. Structural features of the endometrium in women with CE in the phase of the "implantation window" corresponded to the average stage of secretion in 36.4 %; variants of "out-of-phase" were identified in 63.6 % (late stage of the proliferation phase (16.7 %), dissociated development (13.3 %), early stage of the secretion phase (43.3 %)). Molecular characteristics of the immunologically tolerant endometrium, favorable for implantation, are determined by the balanced production of pro-and anti-inflammatory cytokines, growth factors and chemokines. Aggressive "microenvironment" in the endometrium of women with the phenotype of chronic inflammation was determined by the dominant of proinflammatory cytokines of the Th1/Th17 profile (an increase in comparison with the control of the expression level of TNF- and GM-CSF by 1.1 times and 1.2 times, in the glandular epithelium of chemokines CXCL16 and BCA1 by 1.2 times, CXCL16 in the stroma in 1.2 times) on the background of reduced production of protective factors (TGF- (1 point), IL-10 (in the glandular epithelium by 2 times, in the stroma by 1.8 times), NRF2. Conclusions. Different molecular characteristics of the endometrium in women with TPI and CE determine the heterogeneity of potencies for blastocyst implantation.