Pathogenetic determinants of endometrial dysfunction in patients with myoma

Introduction. Among the patients with infertility associated with small forms of uterine fibroids (subserous and intra mural), there are a high incidence of inflammatory changes in the cervix, chronic salpingo-opharitis, hydrosalpinx, adhesive process in pelvic organs, chronic endocervicitis and endometrial dysfunction were identified more frequently. The aim of the study was to investigate the clinical and morphological features of endometrial dysfunction in patients with infertility associated with uterine myoma. Material and methods. The study included 165 patients: 70 patients with primary infertility, 65 women with secondary infertility and 30 patients in the control group. All patients were examined and treated in The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott. Laparoscopic and hysteroscopic examination followed by endometrial biopsy was performed on the 19-24th day of the menstrual cycle. Immunohistochemical method was used to study the expression of ER, PR receptors, proinflammatory markers (CD8+, CD20+, CD4+, CD138+), endothelial marker (CD34+) and p16ink4a oncoprotein expression. Estimation of ER and PR expression was carried out by semi-quantitative method of H-Score, other markers, by computer image analysis system “Morphology 5.0” (VideoTest, Russia). Statistical processing of the results was performed using statistical packages (Stata 13). Results. In group of patients with infertility associated with small forms of subserous and intramural uterine myomas, pathognomonic signs of endometrial dysfunction were: high frequency of chronic endometritis, pathological activation of neoangiogenesis, positive expression of inhibitor of cyclin-dependent kinase p16ink4a, reduction of ER and PR expression in the stromal endometrial component, change in receptor affinity of sex steroid hormones.