Histological study of hysteroscopy guided endometrial biopsy from secondary infertile patients after removal of a copper intrauterine contraceptive device

ABSTRACT

The intrauterine device [IUD] is a long-acting reversible method of contraception. Copper T380 IUD is a copper-wrapped T-shaped IUD containing no hormones. Although the IUD has been a contraceptive method for about 50 years, the possibility of causing subsequent secondary infertility remains controversial. This work was conducted to study the endometrial structure in patients suffering from secondary infertility after copper IUD removal. Thirty secondary infertile patients aged between 20 and 35 years were classified into two groups the control group [10 patients], with no past history of IUD insertion, and the IUD group [20 patients], with a history of copper IUD insertion for 6 months to 3 years [subgroup B1] or for more than 3 years [subgroup B2]. Preovulatory hysteroscopy-guided endometrial biopsies were obtained and processed for light microscopy and transmission and scanning electron microscopy. Specimens from subgroup B1 showed focal loss of surface epithelium, cytoplasmic vacuolation, and small dark nuclei in surface epithelial cells. The stroma showed extravasated red blood cells, wide empty spaces, and cellular infiltration. In addition, the uterine glands of subgroup B2 appeared irregular and dilated with accumulated secretion and cellular debris as well as epithelial stratification. Ultrastructurally, focal loss, distortion and swelling of microvilli, indented nuclei, dilated rough endoplasmic reticulum, swollen mitochondria, and secondary lysosomes were observed in the surface epithelial cells. Scanning electron microscopy showed focal loss of microvilli, irregular surface, and mushroom-like protrusions in subgroup B1. These changes were more prominent in subgroup B2 with the appearance of fissures and corrugation of the surface. Copper IUD could induce different degrees of structural changes in the endometrium, which were directly proportional to the duration of IUD insertion. These changes could explain the secondary infertility that may occur in some cases after IUD removal