MORPHOLOGICAL AND MOLECULAR CRITERIA OF THE ENDOMETRIAL RECIPTIVITY VIOLATION IN PATIENTS WITH INFERTILITY ASSOCIATED WITH CHRONIC ENDOMETRITIS

The goal is to study the morphological and molecular features of endometrial receptivity in reproductive-age women with chronic endometritis and infertility and unsuccessful attempts in vitro fertilization (IVF) in anamnesis. Material and methods. The study included 120 reproductive-age women with morphologically verified chronic endometritis: the first group included 64 patients with infertility and unsuccessful IVF attempts in history; in the 2nd group there were 56 women without violation of the fertility; the control group consisted of 30 healthy reproductive-age women, in whom samples of the endometrium were taken in the II phase of the menstrual cycle. A comparative analysis of the morphological and molecular criteria of endometrial receptivity in all study groups was carried out. Results. In patients of the 1st group there was a significant twofold prevalence rate of the average duration of chronic endometritis since the moment of its morphological verification, which led to a critical decrease in the receptivity of the endometrium and the development of infertility has been established in 5.50 ± 0.06 years (p < 0.001). In the first group of patients following morphological features of chronic endometritis were established: the presence of classical signs of inflammation in the mucous membrane of the uterus with an autoimmune component revealed in 90.6[%] of observations: high expression of CD16, CD20, CD56 and low HLA-DRII (p < 0.001). Morphological criteria of endometrial receptivity disorders in patients with infertility on the background of chronic endometritis were such as the delay in the maturation of the endometrium from the day of the menstrual cycle and a decrease in the number of mature pinopodia in the apical part of the superficial epitheliocytes. Molecular criteria of the infertility in the endometrial receptivity violation include the significant decrease in the expression of steroid ER and PR receptors in glands and stroma, LIF in glands and in the surface of the pinopodia, CLDN4 - in the apical part of the superficial epithelial cells and in the base of the pinopodia (p < 0.001). Conclusion. Chronic endometritis, associated with the infertility, in 90.6[%] of cases has an autoimmune genesis and is characterized by a long (more than 5 years) course with the development of morphological and molecular criteria of endometrial receptivity disorders.