Aim. To expand the understanding of the pathogenesis of chronic endometritis based on the study of reception and markers of cell proliferation/apoptosis in its various macrotypes depending on the nature of microbial colonization.Methods. We prospectively examined a group of 345 women with early reproductive losses (history of missed miscarriage, spontaneous abortion, artificial abortion, in vitro fertilisation failures during up to 6 months after intrauterine intervention), who had histologically verified chronic endometritis. A microbiological study of cervical discharge, aspirate from the uterus, identification of the pathogens with PCR, hysteroscopic and pathomorphological study of the endometrium (paypel biopsy) were performed. Identification of hysteroscopic hyperplastic, hypoplastic and mixed macrotypes was carried out on the basis of groups of features characterizing the thickness, color and the structure of the mucous membrane, intensity of vascular pattern in the presence of chronic inflammatory process. Immunohistochemistry of endometrium was performed to determine endometrial receptors for estrogen, progesterone («Dako», Denmark), proliferative activity of endometrial epithelial cells; the intensity of the expression of Ki-67 marker, that marks the cell nucleus at G1-, G2- and S-phase of the mitotic cycle, was taken into account. Apoptosis activity in endometrial biopsies was evaluated on the basis of expression of CPP32 proteins.Results. Structural and functional disintegration of the endometrium in chronic endometritis is presented as disorders of strictly determined submicroscopic features of the cellular elements of the glandular epithelium and stroma of the endometrium, however, each of the macrotypes has its own characteristic disturbances of homeostasis and homeokinesis of endometrial tissue.Conclusions. Further study of the markers of signaling pathways regulating proliferative cascades at the endometrial level matched with endometrial response to the invasion of a pathogen and morphological transformations will allow optimizing the diagnosis and treatment of chronic endometritis and restoration of reproductive potential after reproductive losses.

To evaluate the prognostic value of a comprehensive endometrial study after early reproductive losses (RL). A group of 306 women with early RL (missed abortion (n = 120), spontaneous miscarriage (n = 120), and ineffective in vitro fertilization attempts (n =66) were prospectively examined up to 6 months after the discharge of the uterus at the hospital bases of the Department of Obstetrics and Gynecology with the Сourse of perinatology at the PFUR Medical Faculty. Hysteroscopic macrotypes differentiation - hyperplastic (n = 89), hypoplastic (n = 94) and mixed (n = 87) - was carried out on the basis of features grouping characterizing the thickness, color and structure of the mucosa, the intensity of a vascular pattern in the presence of a chronic endometritis (CE). Evaluation of sonographic accuracy after hysteroscopic CE macrotypes differentiation showed the presence of false-negative conclusions: about unchanged mucosa (6.9%); endometrium polyps (3.5%); intrauterine synechiae (4.2%). Immunohistochemical staining with CD138 isolation showed higher diagnostic accuracy in CE detecting in comparison with the morphological method: in a hyperplastic macrotype (90.5% and 84.1%, respectively), hypo- (93.7% and 89.8%) and mixed (81.6% and 79.4%). Great diagnostic value is shown in identifying histopathic CE features in the context of hysteroscopic macrotypes differentiation in groups of women with RL.

At the beginning of the 21st century we still face the problem of reproductive health of women, children and adolescents in Russia. Final overcoming of the "Russian Cross" primarily relates to preventing further decline of women in reproductive age and children aged 0-17 years.The following medico-social determinants of women's reproductive health are considered: family prosperity, somatic growth and sexual maturation, chronic extragenital diseases, sexual and reproductive behavior, environmental wellbeing of territory and gynecological care organization. Analysis of gynecological morbidity of Russian girls and adolescents at the beginning of this century spots an upward trend. The results of our anonymous questionnaire survey of socially adapted students among 3327 girls of 13-19 years testify that 59.9% of respondents in this age cohort do not practice daily genitalia toilet. According to our population-based studies, 24.0% of women have first pregnancy at the juvenile age followed by labor in 18.4% of young women, abortion in 81.6%. Menstrual disorders represent the most common symptoms and strong indications of reproductive health problems related, inter alia, to progesterone deficiency which can lead to serious consequences (infertility, miscarriage, breast disease). The choice of medication for the menstrual disorders treatment should consider instruction indications, the lack of limitations and contraindications, need for contraception, concomitant diseases and states, proved efficacy of the medication. Prospects of solving reproductive and demographic problems in the twenty-first century are largely beyond the control of clinicians being aggravated by unresolved environmental and social problems.

Luteal phase deficiency (LPD) is described as a condition of insufficient progesterone exposure to maintain a regular secretory endometrium and allow for normal embryo implantation and growth. There is evidence that both follicular and luteal phase abnormalities can result in LPD cycles. The aim of this randomized prospective noncomparative study is to evaluate the effectiveness of combination therapy in patients with LPD. This prospective study included 35 women of the reproductive age. They were diagnosed with the LPD with sonographically and laboratory-verified methods. The age of patients was 36 ± 0.46 years. The results of the study sonographically demonstrated an increase in the diameter of the corpus luteum from 1.36 ± 0.32 (initially) to 2.16 ± 0.21 mm after combination therapy. In addition, there was a statistically significant increase in the level of estrogens and progesterone in the corresponding phases of the menstrual cycle. Thus, the combination therapy for patients with LPD contributes to the recovery of cyclic events in the hypothalamic-pituitary-gonadal system, which determines the restoration of the endocrine function of the ovaries and promotes adequate secretory rearrangement of the endometrium in women of reproductive age.

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