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The distribution of immune cells and macrophages in the
endometrium of women with recurrent reproductive failure. II:
adenomyosis and macrophages
Kelton P. Tremellen a,b,∗, Peter Russell c,d
a Repromed, Adelaide, Australiab School of Pharmacy andMedical Science, University of South Australia, Australiac GynaePath,DouglassHanly Moir Pathology, Australia
d Department of Obstetrics andGynaecology, TheUniversity of Sydney, Australia
a r t i c l e i n f o
Article history:
Received 22 September 2011
Received in revised form
23 November 2011
Accepted 5 December 2011
Keywords:
Endometrium
IVF
CD163
Macrophages
Adenomyosis
a b s t r a c t
Adenomyosis, a condition usually associated with multiparity, is not generally seen as a
cause of infertility. However, recent studies have reported a reduction in IVF implantation
rates and a link with miscarriage, suggesting that adenomyosis may interfere with success-
ful implantation. To investigate this hypothesis, the clinical records and laboratory results,
which routinely include immunohistochemicalexamination of a late luteal phase endome-
trial biopsy for leukocytes, were retrospectively reviewed for 64 women with implantation
failure and who previously had been screened for the presence of adenomyosis by pelvic
MRI.
The presence of either diffuse or “adenomyoma” type of adenomyosis was associated
with a marked increase ( p= 0.004) in the density of macrophages and natural killer cells
in the endometrial stroma, compared to those women with mild focal adenomyosis or no
disease. These findings point to an immunologicalmechanismby which adenomyosis might
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