摘要：

The purpose of this thesis was to investigate whether the peri-implantation endometrium of women with recurrent miscarriage differed from that of women who had achieved a successful pregnancy. The finding of an 84% incidence of idiopathic repeated pregnancy loss, leads on to an in-depth study of a relatively unexplored area in the idiopathic group - the peri-implantation endometrial development. All endometrial biopsies are precisely timed using the luteinising hormone (LH) surge. A detailed endocrinological analysis of the study cycle in which the biopsy is performed is evaluated, with particular reference to the possible relationship with endometrial development in recurrent pregnancy loss. Women with recurrent miscarriage are found to have significantly higher serum concentrations of follicular follicle stimulating hormone (FSH), and significantly lower luteal progesterone (P), than a control group of normal fertile women. Serum concentrations of LH, oestradiol (E2), and prolactin are similar between the groups. No correlation is found between endometrial development and follicular, or peak levels of LH. The endometrial study encompasses traditional histological evaluation together with morphometric analysis. A subgroup of patients then undergo an immunohistochemical and functional assessment of their peri-implantation endometrium, using a panel of monoclonal antibodies, D9B1, 5D4, HMFG-1 and BC3, together with the secretory endometrial proteins PP14 and CA-125. All parts of the study are controlled using fertile volunteers as the control group. Sixty percent of the idiopathic recurrent miscarriage group are found to have abnormal endometrial development around the expected time of nidation. Defective production of D9B1, 5D4, HMFG-1, and BC3 epitopes, occurring in the presence of normal circulating hormones, provides immunohistochemical back up to the morphological study, and strengthens the hypothesis of intrinsic endometrial dysfunction in recurrent miscarriage.

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