There are a lot of pathologists, which can lead to impaired endometrial receptivity. First of all, we need to identify the risk factors of endometrial pathology, and when we see a patient, we can ask about her case history, and we can determine these risk factors. I think there can be menstrual cycles disturbances, endocrine disorders, history of intrauterine interventions like abortions, curettage and pregnancy loss, usage of intrauterine contraception, chronic pelvic inflammatory diseases f.e. obstruction of the tubes, some of the gynaecological conditions like endometriosis, fibroids which also can influence the endometrial receptivity.
Sometimes when we know that patient has a risk factor, first, we recommend checking the uterine condition by hysteroscopy and the endometrial biopsy to reveal some pathology and to treat it if it is possible. We also can find endometrium that is not growing with normal doses of estrogens and in such cases, we have to prescribe higher doses of estrogens to prepare endometrium. Sometimes, we can also find endometrial polyps, they represent another endometrial growth disorder that may result from a hyperestrogenic state. If they find the polyps inside the uterine cavity, we need to remove it before the preparation is started. Also, we can find, endometrial lesions, and it can be another reason for implantation failures or pregnancy loss. We know that among infertile women, about 45% has chronic endometritis and in particular, these patients that have recurrent implantation failures. Chronic endometritis can be diagnosed during the histological examination, and in some cases, we can add immunohistochemistry to diagnose it, we can also try to find the bacteria which caused this pathology.
Sometimes we cannot find any bacteria, we can just find a proportion of normal bacteria in the reproductive tract, and this also can lead to this chronic inflammation. If you find chronic endometritis, we need to treat it before we start preparation. I also need to say a few words about a common gynaecological disease which is uterine fibroids, and if they find submucosal fibroid which is protruding the uterine cavity into the endometrium, it should be removed before they start endometrium preparation. If we’re talking about another type of fibroids, we can remove them or not, it depends on the size, its location, so not all of them need to be removed. Submucosal fibroids, on the other hand, should be removed in every case.