Lymphoid follicles of the endometrium in women wearing an intrauterine device

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ATSUMI ISHIHAMA, M.D. T 0 S H I S H I G E M A K I N 0, M . D . Morioka City, Japan

The frequency of appearance of lymphoid follicles in the endometrium of women wearing IUD's was compared with that of normal women serving as controls. The rate of frequency of lymphoid follicles in the endometrium appeared to be unrelated to the presence of an IUD.

Experimental results

M A N Y R E P o R T s have recently appeared concerning the influence of the IUD on the endometrium. In the present study, the frequency of lymphoid follicles, which have been considered to have some relationship with the implantation of the fertilized ovum, was studied in the endometria of 2 groups of women: one wearing the IUD and another control group.

1. Frequency of appearance of lymphoid follicles was studied with the endometrium of the IUD group; the lymphoid follicles were found in 11.5 per cent during the proliferative stage (Fig. 2) and in the secretory stage in 19.2 per cent. Lymphoid follicles in the control endometrium were present in 8.9 per cent in the proliferative stage, and 16.1 per cent in the secretory stage (Fig. 3) (Table I). 2. When the frequency of lymphoid follicles vvas compared for all of the women the figures were 14.55 per cent for the IUD cases and 11.8 per cent for the controls (Fig. 4). The difference was not significant (Table

Materials and methods

Among multiparas between the ages of 19 and 45 \Vith regular menstruation, 580 \vomen who wished the removal of an IUD were selected for study. Mainly the endometrium attached to the IUD was obtained. The period of use of the IUD ranged from 1 to 12 years. Endometrium obtained by curettage from 76 healthy women with normal menstruation was used as control. Among 580 cases, 518 cases proved satisfactory for study. The endometrium obtained was fixed with Carnoy's fluid, embedded in paraffin, and stained with hematoxylin-eosin and periodic acid-Schiff. The IUD used was the "Yusei Ring" made of nylon coikd with polyethylene (Fig. 1).

II).

3. Table III summarizes relationship of the periods of insertion of the IUD an;! appearance of lymphoid follicles. Comment

Concerning the lymphoid follicles in the uterine endometrium or lymph follicle-lik<:> tissue structure, no view has been definitely accepted as to whether the appearance is physiologic or pathologic, nor as to its significance. Although the frequency of appearance of lymphoid follicles by biopsy has been said to be about 10 per cent, detailed exami-

From the Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine. This study was supported by a grant from The Population Council.

rate as high as 82 per cent. Such a high rate 535

536

June 15, 1970

lshihama and Makino

AmN .

.J. Ohstd . C>ynec.

Fig. 1. The Yusei ring.

Fig. 3. Lymphoid follicle of the endometrium with an IUD. Secretory stage. (x400.)

Fig. 2. Lymphoid follicle of the endometrium with an IUD. Proiiferative stage. (x200.)

Fig. 4. Lymphoid follicle of the endometrium without an IUD. Proiiferative stage. ( x400.)

Table I. The lymphoid follicles in the endometria Endometrium with IUD Stage

Proliferative Secretory Total

No. of _I endometria

Lymphoid follicles

I

Control endometrium

Per cent

No. of endometria

I Lymphoid L follicles

I

Per cent

304 214

35 40

11.5 19.2

45 31

5

8.9 16.1

518

75

14.5

76

9

11 .8

4

Table II. Relationship between the appearance of lymphoid follicles in the endometrium of the IUD group and the control group

IUD group Non IUD group

No. of endometria

Lymphoid follicles

Per cent

5 18

75

14.5

76

9

11.8

Uo

0.673

Significance

0.50

< p < 0.51

Lymphoid follicles and IUD

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Table III. Relationship between the lymphoid follicles and term of insertion of IUD Endometrium

Term of insertion (yr.)

No.

Lymphoid follicles

Per cent

0-2 3+

329 189

45 30

13.7 15.9

SIB

75

14.5

Total

seems to suggest the physiologic significance of such phenomenon. According to the conventional pathologic view, it has been assumed that some relationship between lymphoid follicles and inflammation, such as tuberculosis, exist. In the recent survey of Matsuura/ the relationship between tuberculous endometritis and appearance of lymphoid follicles is denied. Sen and Fox 1 recently proposed that the appearance of lymphoid follicles was a process of

facilitating the immunologic adaptation of the mother toward the embedding of the fertilized ova. Ovarian function, especially estrogen and prog-esterone, may be related. In our observation, such phenomenon \A:cre more frcqu.ent in the secretory stage

in both groups, suggesting a relationship with the secretion of progesterone. Although the studies were carried out in search of a mechanism by which the IUD might interfere with nidation, no significant difference between the 2 groups, i.e., the ICD group and the control group was noted, with respect to presence of lymphoid follicles. No particular relationship was found between the duration of the insertion of the IUD and the frequency of appearance of lymphoid follicles. The IUD thus appears to have no influence on the appearance of lvmphoid follicles. The authors are grratly indrbted to Professor Rata for his instruction.

REFERENCES

I. Sen, D. K., and Fox, H.: Gynaecologia 163: 3 71, 196 7.

2. Matsuura, R.: Obstet. Gynec. 43: 720, 196H. (Japanese.)