Features of the nuclear steroid receptors expression in endometrium of women with failed in vitro attempts in history
Authors:   Ivan Franko National University of Lviv, Ukraine, Kotsabyn N.V. , Makarchuk O.M. ,   Ivan Franko National University of Lviv, Ukraine
Published: December 2020

Structural and functional maturity of the endometrium is formed in a condition of dynamic fluctuations of ovarian steroid hormones – estrogens and progesterone during the menstrual cycle. The objective: of the research was to determine the reactivity of estrogene core receptors-б and progesterone core receptors in endometrial stroma and glands. Patients and methods. Endometrial samples were obtained during hysteroscopy in 42 patients with infertility on day LH + 6 – LH + 11 of the menstrual cycle. The control group (CG) consisted of 18 healthy women who had at least one physiological pregnancy that resulted in the birth of a healthy child. Receptivity of the endometrium to the hormones was studied by immunoperoxidase method using mouse MAbs for estrogen receptors-a (ER-a) (clone ID5, «DAKO», Denmark) and progesteron receptor (RP) (clone A6, «DAKO», Denmark). The color intensity was assessed by tree-point system. The expression levelі of ER-a and RP were set by calculating semiquantitative index: IRS = SI ґ PP, where IRS – immunoreactivity index; SI – optical intensity staining; PP – the percentage of positively stained nuclei. Results. Normal ER-a and RP immunoreactivity was observed in 8 (19.05%) women with failed in vitro fertilization attempts in history, total reduction of ER-a and RP immunoreactivity (medium and severe) in glands and stroma was observed in 6 (14.29%) of infertile patients. Normal levels of ER-a and RP immunoreactivity were observed among KG women. Noteworthy is the presence of comorbidity. So in 4 of the six cases of endometrial polyp appeared on the background of chronic endometritis. In 4 women diagnosed with simple hyperplasia without atypia the defective rejection of the endometrium from the previous cycle and the incompatibility of endometrium structure to the day of cycle were found. In the group of infertile women high reactivity of receptors was observed only in 8 (19.05%) biopsies. Deviation of the morphological structure of the endometrium in this subgroup was observed significantly more often than in KG: incompatibility of morphological endometrial structure to the day of menstrual cycle was found in 12.50% of cases, simple hyperplasia without atypia – of 55.00%, endometrial polyp – 12.50%, chronic endometritis – 25.00%. Conclusions. The change of immunoreactivity of estrogen receptor-б and progesterone plays an important role in the formation of implantation failure in women with unsuccessful in vitro fertilization attempts. The obtained data confirm the hypothesis of multiple factors of development regulation of the endometrium in natural cycles and in IVF cycles. High frequency of structural and functional inferiority of the endometrium is the indication for in-depth study. Correction of the endometrial condition need to be done before pregnancy. Key words: infertility, failed in vitro fertilization attemp, immunoreactivity, receptors estrogen-a, progesterone receptors.