Hysteroscopic and morphological evaluation of endometrium in reproductive age women with comorbid polycystic ovarian syndrome and chronic endometritis in the protocols of in vitro fertilization

Abstract

Summary. Today, infertility, which is associated with polycystic ovary syndrome, is a pressing problem in obstetrics, gynecology and reproductive medicine. Polycystic ovary syndrome (PCOS) is a common endocrine disease that affects about 6 to 20 % of women of childbearing potential. Its main signs are ovulatory and menstrual dysfunction (including anovulation), increased levels of gonadotropin-releasing hormone, hypersecretion of luteinizing hormone, hyperandrogenemia, metabolic disorders and morphological changes in the endometrium and ovaries.

The aim of the study – to evaluate hysteroscopic and morphological changes in the endometrium of women with infertility against the background of PCOS and chronic endometritis and to analyze the effect of a modified treatment regimen in the protocols of in vitro fertilization on the manifestations of chronic endometritis.

Materials and Methods. We examined 140 women with endocrine infertility against the background of PCOS and chronic endometritis, which were divided into 2 study groups, depending on the cause and treatment approach for infertility, as well as 35 women with male-caused infertility who comprised the control group. All examined patients underwent hysteroscopy, targeted biopsy and immunohistochemical study of the endometrium. Histological study of the endometrium was performed by staining the tissue with hematoxylin and eosin according to a standard protocol in order to understand the structural changes of the endometrium in women of the study groups. Immunohistochemical testing involved the detection of CD138 using standard Daco antibody kits (Denmark).

Results. Patients with PCOS and chronic endometritis used standard anti-inflammatory treatment which followed our modified protocol. This resulted in significantly reduced manifestations of chronic endometritis. The modified protocol includes inositol and alpha-lipoic acid in pre-pregnancy preparation; PRP therapy of the uterine cavity; and lipofundin infusions on day 2–3 of the menstrual cycle and on the day of embryo transfer.

Conclusions. Histological examination of the endometrium with manifestations of stromal-adenomatous polyps revealed reduced signs of cytogenic stroma proliferation, decreased perivascular edema and the number of erythrocyte diapedesis. The number of glandular elements and the size of the glands also decreased.