Comparative characteristics of obstetric/neonatal outcomes and histologic findings in the placenta during in vitro fertilization for normal endometrial extracellular matrix remodeling and incomplete secretory transformation
DOI:
https://doi.org/10.37800/RM.4.2024.414Keywords:
obstetric/neonatal outcomes, endometrial biopsy, placenta, in vitro fertilization, endometrial extracellular matrix, secretory transformationAbstract
Relevance: Reproductive losses are complex conditions that affect a large number of the population, increase the risk of various adverse obstetric and perinatal outcomes, and raise many questions regarding causes and treatment options. Some couples experience repeated failures after the transfer of good-quality embryos without any obvious cause, and this becomes a serious ongoing problem after IVF procedures. It can be assumed that in these couples, endometrial insufficiency may be a possible cause of implantation failure, so endometrial morphological examination remains relevant.
The study aimed to compare the clinical and morphological characteristics of the mother-placenta-fetus system during in vitro fertilization depending on the histochemical pattern of endometrial extracellular matrix remodeling.
Materials and Methods: The study groups included 109 cases of pregnancy after IVF in women with normal remodeling of the ECM of the mid-secretory endometrium and 118 pregnancies after IVF in women with incomplete secretory remodeling of the ECM of the endometrium. Endometrial biopsies were obtained on day 21 of the menstrual cycle from the fundus and upper part of the anterior and posterior uterine wall. All cases were reviewed by two pathologists who had no information on the pregnancy outcome and clinical data. Statistical analysis was performed using SPSS.
Results: Clinical and biochemical pregnancy losses were more frequent in the incomplete secretory remodeling of the endometrial extracellular matrix compared to the group with normal endometrial remodeling (p<0.05), and newborns in the group with incomplete secretory remodeling of the endometrial extracellular matrix were characterized by lower weight. Placentas with incomplete secretory remodeling of the endometrial extracellular matrix were more often damaged by chronic hypoxic injuries of the MVM type and more often characterized by maturation disorders of the AVM type compared to the group with normal remodeling of the extracellular matrix (p<0,05).
Conclusion: These results indicate reproductive losses and chronic hypoxic placental injuries with incomplete secretory remodeling of the extracellular matrix of the endometrium, which shows the need for further studies to stratify groups at risk of reproductive losses.
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