Histomorphological Study of Endometrium in Primary Infertility in Rural Setup
Authors: Agrawal Laxmi , Hiwale Kishor , Bhake Arvind 
Published: August 2024

Background:
In our society, females are blamed for infertility. Females especially in rural places face many problems socially and emotionally. Infertility is an obstacle in the development of couple when it does not take place normally. Infertility is a curse for women, the cause of which should be diagnosed accurately and early. Taking the abovemaintained silent plight of infertile females, this study was conducted based on uterine infertility as a step to increase understanding of pathological causes of primary infertility and serve community on the whole.

Aim:
This study aims to study histomorphological features of endometrium in primary infertility to know the etiological factors in a rural setup.

Objectives:
(1) To find various histomorphological patterns of endometrium in primary infertility. (2) To categorize the various etiologic causes under the following heads: (i) Hormonal cause. (ii) Infectious cause. (3) To find the principle cause for primary infertility in the ruler setup. (4) To know the importance of endometrial biopsy/dilatation and curettage (D and C) in primary infertility.

Materials and Methods:
A total of 99 endometrial sample of primary infertility were received from Department of Obstetrics and Gynecology of confirmed case of primary infertility. The endometrial biopsy or D and C were send in 10% formalin to department of pathology. The samples were processed, stained with hematoxylin and eosin and were studied and categorized into normal proliferative phase, inadequate proliferative phase, anovulatory phase, normal secretory phase, inadequate secretory phase/luteal phase defect (LPD), glandulostromal disparity (GSD), acute endometritis, chronic nonspecific endometritis, and tubercular endometritis.

Observation and Results:
It was observed that 42.42% patients had normal secretory phase or normal proliferative phase, i.e., it correlates with day of menses. The most common etiological cause for primary infertility was anovulation which was 28.28%. The second most common was LPD/inadequate secretory phase which was 15.15%. Inadequate proliferative phase was 8.08%. GSD was 3.03%. Endometrial hyperplasia was 4.04% among which 3.03% patients had simple hyperplasia without atypia and 1.01% patient had atypical complex hyperplasia. In infections, tubercular endometritis was 2.02% and chronic nonspecific endometritis was 1.01%. In the present study, anovulation was the principle cause of female primary infertility. There were 51.51% patients of primary infertility with hormonal cause and 3.03% patient with infective cause.

Conclusion:
Anovulation was the principle cause of female primary infertility and LPD was the second common cause of female primary infertility. In infections, tubercular endometritis was common whereas chronic nonspecific endometritis was less. Endometrial biopsy/D and C is a standard tool to know causes of primary infertility, which gives information at cellular level and detects hormonal causes, infective causes for infertility. Thus, by endometrial biopsy/D and C, we come to know the probable cause of female primary infertility, and accordingly, the treatment can be given to patient.