Anovulatuvar Kadınlarda Menotropin İndüksiyonuyla Oluşan Endometriyumun Premenstrual Evredeki Yapısı
Öz
Bu çalışmada, insan menapoz gonadotropini (HMG) ve insan koryon gonadotropini (HCG) vererek ovülasyon indüksiyonu sağlanan sekiz kadının endometriyumlarındaki temel yapılar olan salgı bezi ve stroma, menstrüal siklusun geç luteal evresinde ışık ve elektron mikroskobik olarak incelendi. Bu inceleme, bir takım histolojik kriterlerin (bazısı bu çalışmayı yapan yazar tarafından öne sürülmüştür) yarı-sayısal değerlendirilmesi ve daha sonra da üç temel doku elemanının (salgı bezleri, stroma, arteriyol ve kapiller) histolojik ve ince yapı değişimlerinin ortaya konmasıyla gerçekleştirildi. Elde edilen bulgular sonunda yapılan sınıflandırmaya göre, çalışmaya alınan kadınların © 50'sinde başarılı doku cevabı elde edilirken, X 25'nin salgı bezleri, © 12.5'nin stroma, geri kalan © 1255'nin de hem salgı bezi hem de stroma açısından hatalı gelişim içinde olduğu saptandı. Salgı bezleri yönünden dengesiz gelişme gösteren dokularda salgı bezi biçim ve aktivitesinde heterojenite, stroma dengesizliği gösteren dokularda da, kesitte birbirine komşu bölgelerde bile izlenebilen desidua transformasyonu yetersizlikleri izlendi. Bunların yanında, gelişmekte olan desidua hücreleriyle endotel hücreleri arasında bağlantı kompleksi birimlerinin bulunmadığı ilginç hücre temasları, desidua hücrelerinde yoğun protein sentezi basamakları, bunun yanında sterolid sentezine ilişkin yapıların bulunmayışı gibi ince yapı düzeyinde de bir takım bulgular saptandı. Sonuç olarak, desiduaya dönüşüm basamaklarında oluşacak dengesizliğin implantasyon işlevi üzerinde negatif yönde etkili olduğu belirlendi. Ayrıca, infertilite tedavisinde verilecek uygun tedavi ajanlarının yanı sıra bir hedef organ olma özelliğinden ötürü endometriyum doku yanıtlarının da araştırılması gerekliliği ortaya çıkarıldı.
Anahtar Kelimeler
Kaynakça
- 1. Birkenfeld A ve ark : Advanced secretory changes in the proliferative human endometrial epitelium following clomiphene treatment, Fertil Steril 45 : 462, 1988,
- 2. CookelID Morgan CA Parry TE ; Correlation of endometrial biopsy and plasma progesteron levels in infertile women, JI Obster Br Comm 79 : 647, 1972.
- 3. Cornillie FJ Lauweryns JM Brosen IA ; Normal human endometrium. An ultrastructural survey, Gynecol Obstet Invest 20 ; 113, 1985,
- 4. Dallenbaçh-Hellweg G : The endometrium in natural and artificial luteal phases, Hum Reprod 3: 165, 1988,
- 5. Dallenbaçh-Hellweg G : Histopathology of the Endometrium, 4. bası, 1987, Springer Verlag, sayfa : 64-81, 136-143,
- 6. Dockery P ve ark ; The ultrastructure of the glandular epithelium in the timed endometrial biopsy, Hum Reprod 3 : 828, 1988.
- 7. Dockery P veark : An examination of the variatoin in timed endometrial biopsies, Hum Reprod 3 : 715, 1988.
- 8. Garcia JE ve ark : Advanced endometrial maturation after ovulation induction with human menopausal gonadotropin/human choörionic gonadotropin for in vitro fertilization, Fertil Steril 41 : 31, 1987.
- 9. Henzi MR ve ark : Lysosomal concept of menstrual bleeding in human, J Clin Endocrinol 34 : 860, 1972.
- 10. Johannisson E ve ark : Endometrial morphology and peripheral hormone levels in women with regular menstual cycles, Fertil Steril 48 : 401, 1987.
- 11. Law AM Wilson EW Finn CA ; The ulirastructure of human decidual and predecidual cells, J Reprod Fertil 28 : 85, 1971.
- 12. Li TC ve ark : A comparison between two methods of chronological dating of human endometrial biopsies during the luteal phase and their correlation with histologic dating, Vertil Steril 48 : 928, 1987.
- 13. li TC ve ark : A new method of histologic dating of human endometrium in the luteal phase, Fertil Steril 50 : 52, 1988.
- 14. Martel D ve ark : Scanning electron microscopy of postovulatory human endometrium in spontaneous ecycles stimulated by hormone treatment, J Endocrinol 114 : 319, 1987.
- 15. Murphy CR Rogers AW : Eflects of ovarian hormones on cell membranes in the rat uterus. İll. Surface carbohydrates at the apex of the luminal epithelium, Celi Biophys 3 : 305, 1981.
- 16. Noyes RW Hertig MD Rock J : Dating the endometrial biopsy, Fertil Steril 1 » 3, 1950.
- 17. O'Shea JD Kleinfeld RG Morrow HA : Ultrastructure of decidualization on the pseudopregnant rat, Am J Anat 166 : 271, 1983.
- 18. Psyohoyos A Martel D ; Problems related to the implantation of the human egg after in vitro fertilisation, Acta Eur Fertil 16 : 107, 1985.
- 19. Roberison WEB : A reappraisal ol the endometrium in infertility, Clin Obstet Gynaecol 11 : 209, 1984.
- 20. Scott RT ve ark : The interobserver variation in dating endometrial histology on the diagnosis of luteal phase defects, Fertil Steril 50 ;: 888, 1988.
- 21. Seif MW Aplin JD Buckley CH : Luteal phase defect : the possibility of an immunohistochemical diagnosis, Fertil Steril 51 : 273, 1989.
- 22. Sundstrom P Nilsson O Liedholm P : Scanning electron microscopy of human prsimplantatlon endometrium in normal/human chorionic gonadotropin-stimulated cycle, Fertil Steril 40 : 442, 1983.
- 23. Tekelioğlu-Uysal M Edwards RG Kişnişçi HA : Ultrastructural relationships between decidua, trophoblast and Iymphocytes at the beginning of human pregnancy, J Reprod Fert 42 : 431, 1975.
- 24. Umapathysivam K ve ark : Morphological characteristics and protein profile of isolated human deçidual cells, Europ J Obstet Gynec Reprod Biol 15 : 141, 1983.
- 25. Verma V : Ultrastructural changes in human endometrium at diffrent phases ol the menstrual cycle and their functional significance, Gynecol Obstet Invest. 15; 193, 1983.
- 26. Wentz AC ; Endometrial biopsy in the evaluation of infertility, Fertil Steril 33 : 121, 1980,
- 27. Wentz AC ve ark : Outcome of progesterone treatınent of luteal phase inadeguacy, Fertil Steril 41 : 856, 1984.
- 28. Witten BI Martin SA ; The endometrial biopsy as a guide to the management of luteal phase defect, Fertil Steril 44 : 460, 1988.
- 30. Wynn RM : Ultrastructural development of the human decidua, Am J Obstet Gynecol 118 : 652, 1974,
- 31. Wynın RM Woolley RS : Ultrastructural cyelic changes in the human endometrium, Fertil Steril 18 : 721, 1967.
Öz
«In» and «out of phase» criteria in the transformations of the glandular and stromal tissue elements of late luteal phase endometria of the women already treated with human menopausal gonadotropin (HMG) and human chroionic gonadotropin (HCG) were endeavoured to determine after light and electron microscopic observations on a diagnostic base. 50 © of them was found responded successfully while 25 7 was defective in glands and related cells, © 12.55 was deİective in stroma and 125 © wag inappropriate both in glands and stromal componenis, Due to the above data, tissue elements were classified on a base of the synchronicity of transformation among different some important cellular properties were considered such as the configuration of close cellular contracts in between the plasmalemmal interfaces of developing decidual and capillary endothelial cells, having none of the units of junctional compiexes namely tight or gap junctions. Decidual cells did manifest as protein producers with highly elaborated cisternae of granular endoplasmic reticulum and free ribosomes in their cytoplasms. None of the fine structural manifestation of sterold production could be detected in cytoplasms of decidual cells. In conclusion, transformational behaviors of glandular and stromal endometrial cells were decided to have a crucial role in the endometrial receptivity of an implanting embryo. Besides, reguirement of an appropriate hormonal therapy regimen in an infertility treatmeni, a precise tissue evaluation of the endometrium was also reguired as being an end-organ,
Anahtar Kelimeler
Kaynakça
- 1. Birkenfeld A ve ark : Advanced secretory changes in the proliferative human endometrial epitelium following clomiphene treatment, Fertil Steril 45 : 462, 1988,
- 2. CookelID Morgan CA Parry TE ; Correlation of endometrial biopsy and plasma progesteron levels in infertile women, JI Obster Br Comm 79 : 647, 1972.
- 3. Cornillie FJ Lauweryns JM Brosen IA ; Normal human endometrium. An ultrastructural survey, Gynecol Obstet Invest 20 ; 113, 1985,
- 4. Dallenbaçh-Hellweg G : The endometrium in natural and artificial luteal phases, Hum Reprod 3: 165, 1988,
- 5. Dallenbaçh-Hellweg G : Histopathology of the Endometrium, 4. bası, 1987, Springer Verlag, sayfa : 64-81, 136-143,
- 6. Dockery P ve ark ; The ultrastructure of the glandular epithelium in the timed endometrial biopsy, Hum Reprod 3 : 828, 1988.
- 7. Dockery P veark : An examination of the variatoin in timed endometrial biopsies, Hum Reprod 3 : 715, 1988.
- 8. Garcia JE ve ark : Advanced endometrial maturation after ovulation induction with human menopausal gonadotropin/human choörionic gonadotropin for in vitro fertilization, Fertil Steril 41 : 31, 1987.
- 9. Henzi MR ve ark : Lysosomal concept of menstrual bleeding in human, J Clin Endocrinol 34 : 860, 1972.
- 10. Johannisson E ve ark : Endometrial morphology and peripheral hormone levels in women with regular menstual cycles, Fertil Steril 48 : 401, 1987.
- 11. Law AM Wilson EW Finn CA ; The ulirastructure of human decidual and predecidual cells, J Reprod Fertil 28 : 85, 1971.
- 12. Li TC ve ark : A comparison between two methods of chronological dating of human endometrial biopsies during the luteal phase and their correlation with histologic dating, Vertil Steril 48 : 928, 1987.
- 13. li TC ve ark : A new method of histologic dating of human endometrium in the luteal phase, Fertil Steril 50 : 52, 1988.
- 14. Martel D ve ark : Scanning electron microscopy of postovulatory human endometrium in spontaneous ecycles stimulated by hormone treatment, J Endocrinol 114 : 319, 1987.
- 15. Murphy CR Rogers AW : Eflects of ovarian hormones on cell membranes in the rat uterus. İll. Surface carbohydrates at the apex of the luminal epithelium, Celi Biophys 3 : 305, 1981.
- 16. Noyes RW Hertig MD Rock J : Dating the endometrial biopsy, Fertil Steril 1 » 3, 1950.
- 17. O'Shea JD Kleinfeld RG Morrow HA : Ultrastructure of decidualization on the pseudopregnant rat, Am J Anat 166 : 271, 1983.
- 18. Psyohoyos A Martel D ; Problems related to the implantation of the human egg after in vitro fertilisation, Acta Eur Fertil 16 : 107, 1985.
- 19. Roberison WEB : A reappraisal ol the endometrium in infertility, Clin Obstet Gynaecol 11 : 209, 1984.
- 20. Scott RT ve ark : The interobserver variation in dating endometrial histology on the diagnosis of luteal phase defects, Fertil Steril 50 ;: 888, 1988.
- 21. Seif MW Aplin JD Buckley CH : Luteal phase defect : the possibility of an immunohistochemical diagnosis, Fertil Steril 51 : 273, 1989.
- 22. Sundstrom P Nilsson O Liedholm P : Scanning electron microscopy of human prsimplantatlon endometrium in normal/human chorionic gonadotropin-stimulated cycle, Fertil Steril 40 : 442, 1983.
- 23. Tekelioğlu-Uysal M Edwards RG Kişnişçi HA : Ultrastructural relationships between decidua, trophoblast and Iymphocytes at the beginning of human pregnancy, J Reprod Fert 42 : 431, 1975.
- 24. Umapathysivam K ve ark : Morphological characteristics and protein profile of isolated human deçidual cells, Europ J Obstet Gynec Reprod Biol 15 : 141, 1983.
- 25. Verma V : Ultrastructural changes in human endometrium at diffrent phases ol the menstrual cycle and their functional significance, Gynecol Obstet Invest. 15; 193, 1983.
- 26. Wentz AC ; Endometrial biopsy in the evaluation of infertility, Fertil Steril 33 : 121, 1980,
- 27. Wentz AC ve ark : Outcome of progesterone treatınent of luteal phase inadeguacy, Fertil Steril 41 : 856, 1984.
- 28. Witten BI Martin SA ; The endometrial biopsy as a guide to the management of luteal phase defect, Fertil Steril 44 : 460, 1988.
- 30. Wynn RM : Ultrastructural development of the human decidua, Am J Obstet Gynecol 118 : 652, 1974,
- 31. Wynın RM Woolley RS : Ultrastructural cyelic changes in the human endometrium, Fertil Steril 18 : 721, 1967.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Histoloji ve Embriyoloji |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 1990 |
| Yayımlandığı Sayı | Yıl 1990 Cilt: 43 Sayı: 3 |
