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.

Chronic endometritis (CE) is a disease of continuous and invisible inflammation characterized by infiltration of plasma cells in the stromal region of the endometrium. Numerous studies have proven that CE leads to repeated implantation failures. While it is believed that the etiology of CE is mainly associated with microorganisms, the key links in pathogenesis are yet not fully understood, although there is a modern evidence that CE causes local immune disorders and impaired endometrial decidualization. Considering the insufficient effectiveness of antibiotic therapy for CE, especially in cases of resistant pathogens, or in the case of viral chronic endometritis, regimens with additional treatment that affect other etiopathogenetic pathways of CE development and maintenance are necessary. One of the methods that affects etiopathogenesis of CE is a cytokine therapy. In this review, the authors tried to consider CE with special emphasis on the etiology, epidemiology, clinical features, pathophysiology, and treatment of CE and reproductive disorders in women in association with repeated implantation failures. The review ends with a description of the clinical case.

Endometriosis remains an unresolved problem in gynecology. The urgency of the fight against this disease is due to its high prevalence among women of reproductive age. Endometriosis, especially its infiltration forms, affects all aspects of the patients life, its clinical manifestations pelvic pain, dyspareunia, dysmenorrhea, dyschezia, lead to social disadaptation, problems in personal life, depression and anxiety. The socio-economic burden of the disease motivates researchers to further study the pathogenesis of endometriosis and search for pathogenetically justified pharmacological solutions.

Relevance. Despite lots of studies, issues on a choice of the most effective treatment method for patients with recurrent external genital endometriosis (EGE) as well as a role and features of assisted reproductive technology programs and ways to improve their performance are still unresolved. Aim. To provide a current understanding on etiopathogenesis and management strategy for patients with recurrent EGE and infertility according to Russian and foreign literature date. Materials and methods. In order to write this review, domestic and foreign publications were searched in Russian and international search systems (PubMed, eLIBRARY, etc.) for the last 2-15 years. The review includes articles from peer-reviewed literature. Results. The article provides risk factors for EGE development, disease pathogenesis and clinical manifestation as well as drug and surgical methods for a treatment of endometriosis. Conclusion. Endometriosis remains still to be a mysterious disease for modern science. An individual approach given an age, ovarian reserve and a history of surgical treatment (numbers of surgical interventions for EGE) will allow you to elaborate a personal approach for each woman with subfertility.

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