A morphological study of human endometrial stroma in vivo and in vitro.

Despite its crucial role in fertility, relatively little has been published on the human
endometrial stroma. The first experiment reported in this thesis was designed to provide
quantitative baseline data on the human stroma during the mid to late luteal phase, when it plays
a major part in normal pregnancy. Subsequent chapters investigate the effects of an antioestrogen
(clomiphene citrate-CC); growth hormone (GH) supplementation of patients on
hormone replacement therapy (HRT) due to lack of endogenous ovarian steroids; and patients
with unexplained recurrent miscarriage. Finally a novel 3-dimensional in vitro model of human
stroma is described along with the effects of steroid supplementation on stromal cells grown in
the model.
In all cases of in vivo studies, conventional stereological methods were used to obtain
quantitative morphological data from at least 6 subjects per group, from both control (fertile)
and experimental (infertile) subjects using light and electron microscopy. In addition, several
staining techniques were also used to demonstrate qualitative changes that occur in human
endometrial stroma.
During the mid to late luteal phase, endometrial stroma and blood vessels underwent
substantial changes, and thus quantitative and qualitative baseline data have been established to
fill a gap in this important area of reproductive biology. CC caused no substantial changes in
stromal structure in women of proven fertility and therefore its advantageous effects on
ovulation are not negated at the level of the endometrium. GH supplementation had no effects
on infertile human endometrial stroma from subjects on HRT, (in either premature ovarian
failure or Turner's syndrome groups). However, both infertile groups had endometrial stroma
which significantly differed from matched fertile endometrium, suggesting an impaired
endometrial development in infertile subjects which was not reversed by HRT, either with or
without Gil treatment. Stromal morphology did not differ between the recurrent miscarriage
groups, however data suggested the existence of several subgroups which made firm
conclusions difficult. The tissue culture model provided preliminary data suggesting it to be a
potentially very useful technique for the study of stromal cell biology.