Медицинская иммунология (Jan 2024)
Options for correction of local immune status in patients with chronic endometritis
Abstract
Chronic endometritis with impaired receptivity of uterine cavity epithelium (the “thin” endometrium) is considered the most common cause of recurrent implantation failures during in vitro fertilization (IVF). Chronic inflammation, accompanied by autoimmune mucosal reactions, may lead to a perverse immune response of lymphocytic cells with altered cascade of cytokine reactions, thus preventing efficiency of decontamination therapy, followed by potential inability to perform reproductive function in the patients. The article concerns our experience of complex preimplantation preparation of patients with recurrent implantation failures caused by chronic endometritis during a course of intrauterine administration of cavitated solution of recombinant interleukin 2 (rIL-2). Our aim was to assess some changes in local immune status in the patients with chronic endometritis and repeated implantation failures during complex preparation for the IVF procedure, using a cavitated solution of rIL-2.A study of the local immune changes of uterine cavity in the patients with recurrent implantation failures suffering with chronic endometritis was carried out under complex preparation for IVF with thawed embryos (n = 82). A control group included the infertile women with normal endometrial thickness (> 7 mm at M-echo), with excluded diagnosis of chronic endometritis (n = 30). Complex therapy included decontamination and contamination; hormone replacement therapy; intrauterine ultrasonic cavitation of rIL-2 solution. Dynamic assessment of the local immunity was tested in the endometrial biopsies. We performed analysis of the main subpopulations of immune lymphoid cells, morphological composition, phagocytic responses and cytokine status.he state of immunocompetent cells and cytokine profile of endometrial samples in the patients with chronic endometritis indicates a possible Th2 shift of the local immune response, with changing ratio of cytokines leading to impaired molecular, subcellular and cellular structures, which, along with fluctuating activity of other components of uterine cavity homeostasis, may determine a recurrent course of the disease with impaired endometrial morphology. Preimplantation preparation with intrauterine irrigation with a cavitated solution of rIL-2 in patients with recurrent implantation failures accomplished by chronic endometritis helps to improve the indices of local immunity, being more effective (an average of twofold), compared with the group of conventional preparation for IVF with thawed embryos. The treatment may promote the proliferative processes in epithelium of the uterine cavity thus contributing to increased potential of endometrium for implantation and occurence of clinical pregnancy.
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