ULTRASTRUCTURAL ASPECTS OF ENDOMETRIUM IN INFERTILE WOMEN WITH SEPTATE UTERUS

Objectives: To evaluate the endometrial surface morphology in patients with septate uterus and primary infertility in an attempt to throw li ght on the question of whether endometrial anomalies are involved in t he pathogenesis of infertility in women with mullerian malformations. Design: Endometrial biopsies were performed in eight women with septat e uterus and primary infertility during hysteroscopy scheduled in the preovulatory phase of the cycle (when a follicle > 17 mm was identifie d by ultrasonography and E(2) levels were >200 pg/mL [conversion facto r to SI unit, 3.671]). Two samples were obtained from each patient, on e from endometrium covering the septum and the other from endometrium lining the lateral wall of the uterus. All specimens were examined by scanning electron microscopy. Main Outcome Measures: The number of gla ndular ostia, the ciliated:nonciliated cell ratio, and the number of c ilia on ciliated cells mere analyzed in endometrial specimen from both the covering of the septum and the corresponding uterine lateral wall . Results: In five patients septal endometrium showed the following de fective preovulatory changes with respect to endometrium of the latera l uterine wall: a reduced number of glandular ostia, irregular noncili ated cells with rare microvilli, incomplete ciliogenesis on ciliated c ells, and decrease in the ciliated:nonciliated cell ratio (1:52 +/- 11 versus 1:21 +/- 8). Conclusions: Our results indicate a decrease in t he sensitivity of endometrium covering the septa of malformed uteri to preovulatory hormonal changes. This could play a role in the pathogen esis of primary infertility in patients with septate uterus.