51
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A review of the pathophysiology of recurrent implantation failure. Fertil Steril 2021; 116:1436-1448. [PMID: 34674825 DOI: 10.1016/j.fertnstert.2021.09.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 11/20/2022]
Abstract
Implantation is a critical step in human reproduction. The success of this step is dependent on a competent blastocyst, receptive endometrium, and successful cross talk between the embryonic and maternal interfaces. Recurrent implantation failure is the lack of implantation after the transfer of several embryo transfers. As the success of in vitro fertilization has increased and failures have become more unacceptable for patients and providers, the literature on recurrent implantation failure has increased. While this clinical phenomenon is often encountered, there is not a universally agreed-on definition-something addressed in an earlier portion of this Views and Reviews. Implantation failure can result from several different factors. In this review, we discuss factors including the maternal immune system, genetics of the embryo and parents, anatomic factors, hematologic factors, reproductive tract microbiome, and endocrine milieu, which factors into embryo and endometrial synchrony. These potential causes are at various stages of research and not all have clear implications or immediately apparent treatment.
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52
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Chen P, Chen P, Guo Y, Fang C, Li T. Interaction Between Chronic Endometritis Caused Endometrial Microbiota Disorder and Endometrial Immune Environment Change in Recurrent Implantation Failure. Front Immunol 2021; 12:748447. [PMID: 34671363 PMCID: PMC8521098 DOI: 10.3389/fimmu.2021.748447] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/13/2021] [Indexed: 12/31/2022] Open
Abstract
Objective To investigate the Interaction between chronic endometritis (CE) caused endometrial microbiota disorder and endometrial immune environment change in recurrent implantation failure (RIF). Method Transcriptome sequencing analysis of the endometrial of 112 patients was preform by using High-Throughput Sequencing. The endometrial microbiota of 43 patients was analyzed by using 16s rRNA sequencing technology. Result In host endometrium, CD4 T cell and macrophage exhibited significant differences abundance between CE and non-CE patients. The enrichment analysis indicated differentially expressed genes mainly enriched in immune-related functional terms. Phyllobacterium and Sphingomonas were significantly high infiltration in CE patients, and active in pathways related to carbohydrate metabolism and/or fat metabolism. The increased synthesis of lipopolysaccharide, an important immunomodulator, was the result of microbial disorders in the endometrium. Conclusion The composition of endometrial microorganisms in CE and non-CE patients were significantly different. Phyllobacterium and Sphingomonas mainly regulated immune cells by interfering with the process of carbohydrate metabolism and/or fat metabolism in the endometrium. CE endometrial microorganisms might regulate Th17 response and the ratio of Th1 to Th17 through lipopolysaccharide (LPS).
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Affiliation(s)
- Peigen Chen
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Panyu Chen
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yingchun Guo
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cong Fang
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tingting Li
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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53
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Wang L, Li L, Li Y, Huang C, Lian R, Wu T, Ma J, Zhang Y, Cheng Y, Diao L, Zeng Y. A History of Endometriosis Is Associated With Decreased Peripheral NK Cytotoxicity and Increased Infiltration of Uterine CD68 + Macrophages. Front Immunol 2021; 12:711231. [PMID: 34531861 PMCID: PMC8438297 DOI: 10.3389/fimmu.2021.711231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/16/2021] [Indexed: 01/20/2023] Open
Abstract
Women with endometriosis may have a defective immune system. However, evidence of the immune responses of endometriosis patients with a history of endometriosis surgery is lacking, and the association between the location of endometriosis lesions and immune responses is unclear. This retrospective study included 117 females with reproductive failure and a history of endometriosis and 200 females with reproductive failure but without endometriosis to analyze their endometrial and peripheral immune responses. The results show that endometriosis was associated with decreased peripheral natural killer (NK) cytotoxicity and increased uterine macrophages. Peripheral NK cytotoxicity at effector-to-target ratios of 25:1 and 50:1 was significantly reduced in women with a history of endometriosis from that of the control group (26.6% versus 33.3% and 36.1% versus 43.3%, respectively, both P < 0.001). Furthermore, after further division of patients into three subgroups according to the location of endometriosis lesions, we observed that NK cytotoxicity in the endometriosis subgroups, especially the mixed endometriosis group, was strongly decreased from that of the controls (P = 0.001). The endometrial CD68+ macrophage proportion in the mixed endometriosis subgroup was higher than that in the control group (2.8% versus 2.1%, P = 0.043). In addition, the baseline estradiol (E2) level was weakly correlated with the percentage of endometrial macrophages (r = 0.251, P = 0.009), indicating a potential association among the endocrine system, endometrial immune environment, and endometriosis. This study indicated that peripheral NK cytotoxicity and endometrial immune cell profiles could be useful for diagnosing and treating endometriosis and endometriosis-related reproductive diseases.
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Affiliation(s)
- Linlin Wang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China.,Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Longfei Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China.,Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Yuye Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Chunyu Huang
- Department of Paediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong, SAR China
| | - Ruochun Lian
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Tonghua Wu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Jingwen Ma
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China.,Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Zhang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yanxiang Cheng
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lianghui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
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54
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Chen W, Wei K, He X, Wei J, Yang L, Li L, Chen T, Tan B. Identification of Uterine Microbiota in Infertile Women Receiving in vitro Fertilization With and Without Chronic Endometritis. Front Cell Dev Biol 2021; 9:693267. [PMID: 34485281 PMCID: PMC8409574 DOI: 10.3389/fcell.2021.693267] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/21/2021] [Indexed: 01/13/2023] Open
Abstract
In vitro fertilization (IVF) is an important assisted reproductive technology in treating infertility, whose failure rate is still high. Studies suggested that uterine microbiota are related to women’s reproductive diseases and persisting intrauterine bacterial infectious conditions, such as chronic endometritis (CE), impairing the pregnant processes. However, the relationship between uterine microbiota and IVF outcomes is still an open question. In the present study, 94 patients diagnosed with infertility were enrolled and were divided into CE (E group, n = 25) and non-CE (NE group, n = 69) groups depending on the hysteroscopy and immunohistochemistry. Subsequently, E (Ep, n = 8 and Enp, n = 17) and NE (NEp, n = 41 and NEnp, n = 28) groups were divided into pregnancy and non-pregnancy groups depending on the IVF outcomes, respectively. The uterine fluids were collected and microbial profiles were examined through the V4 region of 16S rRNA gene high-throughput sequencing. The results demonstrated that patients with CE had significantly lower clinical pregnancy rate compared with the non-CE patients (32 vs. 58.42%, p = 0.0014). The relative abundances of Proteobacteria and Acidobacteria were higher in the non-CE group, whereas high abundances of Actinobacteria and Fusobacteria were observed in the CE group at the phylum level. At the genus level, high relative abundances of Gardnerella were observed in the CE group and non-pregnancy groups, which significantly referred to the negative IVF outcome. In conclusion, CE may be a key factor for the negative outcome after IVF, of which the uterine microbiota plays a pivotal role, and the microbial diversity in uterine may serve as a biomarker to forecast the success of IVF outcome.
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Affiliation(s)
- Weijun Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Kehong Wei
- Institute of Translational Medicine, Nanchang University, Nanchang, China
| | - Xia He
- Institute of Translational Medicine, Nanchang University, Nanchang, China
| | - Jing Wei
- School of Life Sciences, Nanchang University, Nanchang, China
| | - Lijuan Yang
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lin Li
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Tingtao Chen
- Institute of Translational Medicine, Nanchang University, Nanchang, China
| | - Buzhen Tan
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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55
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Han S, Cicek AF, Tokmak A, Yildirir Ustun T, Ercan Gokay N, Uludag MO, Demirel MA. Effects of Resveratrol on Receptor Expression and Serum Levels of Estrogen and Progesterone in the Rat Endometritis Model. Reprod Sci 2021; 28:2610-2622. [PMID: 33966185 DOI: 10.1007/s43032-021-00586-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
Endometritis is characterized by inflammation of the endometrial lining that leads to reduced reproductive potential. Restoring the impaired hormonal balance is an important component of endometritis treatment. The purpose of the current study was to evaluate the effects of resveratrol on estrogen and progesterone hormone status in endometritis. Mature female Sprague Dawley rats were used, and endometritis was induced by intrauterine infusion of Escherichia coli. Animals were treated with resveratrol alone or combined with marbofloxacin. Compared to the non-treated endometritis group, resveratrol treatment reduced serum oestradiol levels, increased serum progesterone levels, enhanced estrogen receptor (ER) expression in the uterine stroma, decreased ESR1 gene expression, and raised ESR2 gene expression. Resveratrol administration combined with marbofloxacin also increased ER expression in the uterine gland and progesterone receptor expression in the uterine epithelium. The findings of this study suggest that the actions of resveratrol on progesterone levels and estrogen receptor expression might be responsible for its beneficial effect in rats with endometritis.
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Affiliation(s)
- Sevtap Han
- Department of Pharmacology, Faculty of Pharmacy, Gazi University, Etiler, 06330, Ankara, Turkey.
| | - Ali Fuat Cicek
- Department of Pathology, Gülhane Research and Education Hospital, Etlik, 06010, Ankara, Turkey
| | - Aytekin Tokmak
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Research and Education Hospital, Altindag, 06230, Ankara, Turkey
| | - Tugce Yildirir Ustun
- Department of Microbiology, Faculty of Veterinary, Ankara University, Dışkapı, 06110, Ankara, Turkey
| | - Nilufer Ercan Gokay
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Research and Education Hospital, Altindag, 06230, Ankara, Turkey
| | - Mecit Orhan Uludag
- Department of Pharmacology, Faculty of Pharmacy, Gazi University, Etiler, 06330, Ankara, Turkey
| | - Murside Ayse Demirel
- Laboratory Animal Care and Research Unit, Department of Pharmacology, Faculty of Pharmacy, Gazi University, Etiler, 06330, Ankara, Turkey
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Mitter VR, Meier S, Rau TT, Gillon T, Mueller MD, Zwahlen M, von Wolff M, Kohl Schwartz AS. Treatment following hysteroscopy and endometrial diagnostic biopsy increases the chance for live birth in women with chronic endometritis. Am J Reprod Immunol 2021; 86:e13482. [PMID: 34218478 PMCID: PMC8596418 DOI: 10.1111/aji.13482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Problem Repeated implantation failure and recurrent pregnancy loss are associated with chronic endometritis, a persistent endometrial inflammation. Its diagnosis and treatment may increase pregnancy and live birth rates. The aim of this study was to assess the effectiveness of endometrial diagnostic biopsy and subsequent antibiotic treatment in cases of chronic endometritis on reproductive outcomes over a long observation period. Method of Study We conducted a historical cohort study (2014–2018) at our University‐based infertility center that included women (n = 108) with repeated implantation failure or recurrent pregnancy loss without known pathologies associated with either condition. Forty‐one women underwent a hysteroscopy only (reference group); the remaining 67 women underwent, in addition to the hysteroscopy, an endometrial diagnostic biopsy with immunohistochemically staining for CD138 to detect plasma cells (biopsy group). If one or more plasma cells were detected, the women were treated with doxycycline 100 mg twice a day orally for 2 weeks. We performed stratified survival analysis (Kaplan‐Meier) and Cox regression. Results The biopsy group had higher chances of pregnancy (hazard ratio 2.28; 95% confidence interval 1.23–4.24; p = .009) and of live birth (hazard ratio 2.76; 95% confidence interval 1.30–5.87; p = .008) compared with the reference group. In the sensitivity analysis, repeated implantation failure or recurrent pregnancy loss did not affect the outcome. Conclusion Endometrial diagnostic biopsy followed by antibiotic treatment in case of chronic endometritis in women with repeated implantation failure or recurrent pregnancy loss may increase the chances for live birth.
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Affiliation(s)
- Vera R Mitter
- Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Sheila Meier
- Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tilman T Rau
- Institute for Pathology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tessa Gillon
- Department of Gynecology and Gynecological Oncology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Gynecology and Gynecological Oncology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Michael von Wolff
- Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Alexandra S Kohl Schwartz
- Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.,Division of Reproductive Medicine and Gynecological Endocrinology, Lucerne Cantonal Hospital, Lucerne, Switzerland
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57
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Ticconi C, Di Simone N, Campagnolo L, Fazleabas A. Clinical consequences of defective decidualization. Tissue Cell 2021; 72:101586. [PMID: 34217128 DOI: 10.1016/j.tice.2021.101586] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
Decidualization is characterized by a series of genetic, metabolic, morphological, biochemical, vascular and immune changes occurring in the endometrial stroma in response to the implanting embryo or even before conception and involves the stromal cells of the endometrium. It is a fundamental reproductive event occurring in mammalian species with hemochorial placentation. A growing body of experimental and clinical evidence strongly suggests that defective or disrupted decidualization contributes to the establishment of an inappropriate maternal-fetal interface. This has relevant clinical consequences, ranging from recurrent implantation failure and recurrent pregnancy loss in early pregnancy to several significant complications of advanced gestation. Moreover, recent evidence indicates that selected diseases of the endometrium, such as chronic endometritis and endometriosis, can have a detrimental impact on the decidualization response in the endometrium and may help explain some aspects of the reduced reproductive outcome associated with these conditions. Further research efforts are needed to fully understand the biomolecular mechanisms ans events underlying an abnormal decidualization response. This will permit the development of new diagnostic and therapeutic strategies aimed to improve the likelihood of achieveing a successful pregnancy.
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Affiliation(s)
- Carlo Ticconi
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Luisa Campagnolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Asgerally Fazleabas
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI, 49503, USA.
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58
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Odendaal J, Quenby S. Immunological Testing in Assisted Reproductive Technology. Semin Reprod Med 2021; 39:13-23. [PMID: 34161996 DOI: 10.1055/s-0041-1730908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Fetal implantation requires carefully orchestrated involvement of the maternal immune system. Aberrant function within implantation has been suggested as a cause of implantation failure. The emergence of immunological theories of miscarriage has led to immunological testing as an adjuvant treatment in assisted reproductive technology; however, it remains controversial, with mixed evidence both for immunological cause and the benefits of immunological testing. Literature on common methods of immunological testing within assisted reproductive technology is reviewed including those of peripheral and uterine natural killer cells, chronic endometritis, and T-helper cells cytokine ratio. There is little consensus in the evidence on immunological testing in the context of recurrent implantation failure. The field is limited by a lack of uniformity in approach to testing and heterogeneity of the pathophysiological cause. Nevertheless, the maternal immune system is heavily involved in implantation and the new era of personalized medicine ensures that a more defined approach to immunological testing will be achieved.
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Affiliation(s)
- Joshua Odendaal
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Siobhan Quenby
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
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Xiong Y, Chen Q, Chen C, Tan J, Wang Z, Gu F, Xu Y. Impact of oral antibiotic treatment for chronic endometritis on pregnancy outcomes in the following frozen-thawed embryo transfer cycles of infertile women: a cohort study of 640 embryo transfer cycles. Fertil Steril 2021; 116:413-421. [PMID: 33926717 DOI: 10.1016/j.fertnstert.2021.03.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the therapeutic effect of antibiotic treatment on pregnancy outcomes in the following frozen-thawed embryo transfer cycles of infertile women. DESIGN Retrospective study. SETTING University assisted reproduction unit. PATIENT(S) A total of 640 women were included. Among them, the number of CD138+ cells per high-power field (CD138+/HPF) in the endometrium at the first evaluation was 0 in 88 women; 315 women had 1-4 CD138+/HPF and the remaining 237 had ≥5 CD138+/HPF. Finally, 26 of 237 women had persistent chronic endometritis (PCE) diagnosed. INTERVENTION(S) Hysteroscopy and endometrial biopsy were performed in the proliferative phase. After antibiotic treatment, endometrial biopsy samples were collected again. MAIN OUTCOME MEASURE(S) Live birth rate. RESULT(S) No significant difference in pregnancy outcomes was found between women with CD138+/HPF = 0 and those with CD138+/HPF 1-4. The cure rate was 89.0% in women with CD138+/HPF ≥5 after treatment. The implantation rate (51.6% vs. 32.3%, relative risk [RR] 2.23, 95% confidence interval [CI] 1.07-4.66), clinical pregnancy rate (65.7% vs. 42.3%, RR 2.62, 95% CI 1.17-5.86), live birth rate (52.1% vs. 30.7%, RR 2.45, 95% CI 1.04-5.76), and cumulative live birth rate (64.2% vs. 38.5%, RR 2.88, 95% CI 1.27-6.51) were all significantly higher in women with CD138+/HPF ≤4 than in women with PCE. CONCLUSION(S) CD138+/HPF ≤4 in the endometrium had no negative impact on pregnancy outcomes. Antibiotic treatment was an effective way to improve the reproductive outcomes of women with CD138+/HPF ≥5. PCE was associated with poorer pregnancy outcomes.
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Affiliation(s)
- Yujing Xiong
- Reproductive Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Reproductive Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qi Chen
- Reproductive Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Reproductive Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Chunxiao Chen
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jinfeng Tan
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zengyan Wang
- Reproductive Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Reproductive Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Fang Gu
- Reproductive Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Reproductive Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yanwen Xu
- Reproductive Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Reproductive Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
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60
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Qu D, Yang M, Tong L, Yu X, Jing Q, Yang Y, Zhou H. Combination of Dydrogesterone and Antibiotic Versus Antibiotic Alone for Chronic Endometritis: a Randomized Controlled Trial Study. Reprod Sci 2021; 28:3073-3080. [PMID: 33886115 DOI: 10.1007/s43032-021-00583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
To evaluate the impact of dydrogesterone in the treatment of chronic endometritis with antibiotic treatment in premenopausal women. A total of 188 chronic endometritis patients diagnosed by syndecan-1 (CD138) expression were enrolled in this randomized controlled trial study. Dydrogesterone and doxycycline were given in the treatment group, while single antibiotic was given in the control group. CD138, estrogen receptor, and progesterone receptor expression in samples of the endometrium was analyzed by immunohistochemistry. Comparison of chronic endometritis cure rate between groups was performed based on conversion of CD138 expression from positive to negative. The 188 cases included in the statistical analysis consisted of 93 cases in the treatment group and 95 cases in the control group. The cure rates of chronic endometritis in the dydrogesterone and antibiotic combination group and the single antibiotic group were 86.0% (80/93) and 72.6% (69/95), respectively, with an overall cure rate of 79.3% (149/188). The dydrogesterone and antibiotic combination group showed better effects regarding the cure rate of chronic endometritis (P<.05). Multivariate analysis showed that the cure rate of chronic endometritis was not affected by age, clinical diagnosis, hysteroscopic resection, estrogen receptor status, or progesterone receptor status (all P>.05). Addition of dydrogesterone was effective for the treatment of chronic endometritis with antibiotic treatment in premenopausal women. The study was retrospectively registered to Chinese Clinical Trial Registry (ChiCTR2000040227) in November 2020.
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Affiliation(s)
- Dacheng Qu
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No 63, Wenhua Road, Nanchong, Sichuan province, China
| | - Maomei Yang
- Department of Obstetrics and Gynecology, Chengdu Second People's Hospital, Chengdu, China
| | - Lina Tong
- Department of Obstetrics and Gynecology, Nanbu County People's Hospital, Nanbu, China
| | - Xin Yu
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No 63, Wenhua Road, Nanchong, Sichuan province, China
| | - Qiao Jing
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No 63, Wenhua Road, Nanchong, Sichuan province, China
| | - Yamei Yang
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No 63, Wenhua Road, Nanchong, Sichuan province, China
| | - Honggui Zhou
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No 63, Wenhua Road, Nanchong, Sichuan province, China.
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61
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Ishida M, Takebayashi A, Kimura F, Nakamura A, Kitazawa J, Morimune A, Hanada T, Tsuta K, Murakami T. Induction of the epithelial-mesenchymal transition in the endometrium by chronic endometritis in infertile patients. PLoS One 2021; 16:e0249775. [PMID: 33826645 PMCID: PMC8026044 DOI: 10.1371/journal.pone.0249775] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/24/2021] [Indexed: 12/24/2022] Open
Abstract
Background The purpose of the present study was to evaluate the relationship between chronic endometritis and the epithelial-mesenchymal transition in the endometrium of infertile patients in the implantation phase. Methods Endometrial biopsy specimens from 66 infertility patients were analyzed. The presence of chronic endometritis was investigated by immunostaining for CD138. Immunohistochemical staining for E-cadherin, N-cadherin, Slug, and Snail was performed, and the expression profiles were statistically analyzed according to the presence of chronic endometritis. When the loss of E-cadherin expression and/or the positive expression of N-cadherin was detected, the specimen was considered epithelial-mesenchymal transition-positive. Epithelial-mesenchymal transition-positive cases were also statistically analyzed according to the presence of chronic endometritis. The characteristics of the patients in the epithelial-mesenchymal transition-positive and epithelial-mesenchymal transition-negative groups were compared. The association between variables, including age, body mass index, gravidity, parity, and each causative factor of infertility and epithelial-mesenchymal transition positivity was analyzed. Results The rates of the loss of E-cadherin expression, the gain of N-cadherin and epithelial-mesenchymal transition positivity were significantly higher in chronic endometritis patients. The expression of Slug, cytoplasmic Snail, and nuclear Snail was also detected at significantly higher rates in chronic endometritis patients. Chronic endometritis were related to the epithelial-mesenchymal transition. Conclusion The epithelial-mesenchymal transition was frequently detected in the endometrium in infertile patients with chronic endometritis. Since the epithelial-mesenchymal transition is associated with chronic endometritis, the epithelial-mesenchymal transition appears to be involved in the alteration of mechanisms of implantation.
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Affiliation(s)
- Mitsuaki Ishida
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
- * E-mail: (MI); (FK)
| | - Akie Takebayashi
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Fuminori Kimura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
- * E-mail: (MI); (FK)
| | - Akiko Nakamura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Jun Kitazawa
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Aina Morimune
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tetsuro Hanada
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Koji Tsuta
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Hirata K, Kimura F, Nakamura A, Kitazawa J, Morimune A, Hanada T, Takebayashi A, Takashima A, Amano T, Tsuji S, Kaku S, Kushima R, Murakami T. Histological diagnostic criterion for chronic endometritis based on the clinical outcome. BMC WOMENS HEALTH 2021; 21:94. [PMID: 33663485 PMCID: PMC7934457 DOI: 10.1186/s12905-021-01239-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 02/23/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The diagnostic criteria of chronic endometritis remain controversial in the treatment for infertile patients. METHODS A prospective observational study was conducted in a single university from June 2014 to September 2017. Patients who underwent single frozen-thawed blastocyst transfer with a hormone replacement cycle after histological examination for the presence of chronic endometritis were enrolled. Four criteria were used to define chronic endometritis according to the number of plasma cells in the same group of patients: 1 or more (≥ 1) plasma cells, 2 or more (≥ 2), 3 or more (≥ 3), or 5 or more (≥ 5) in 10 high-power fields. Pregnancy rates, live birth rates, and miscarriage rates of the non-chronic endometritis and the chronic endometritis groups defined with each criterion were calculated. A logistic regression analysis was performed for live births using eight explanatory variables (seven infertility factors and chronic endometritis). A receiver operating characteristic curve was drawn and the optimal cut-off value was calculated. RESULTS A total of 69 patients were registered and 53 patients were finally analyzed after exclusion. When the diagnostic criterion was designated as the presence of ≥ 1 plasma cell in the endometrial stroma per 10 high-power fields, the pregnancy rate, live birth rate, and miscarriage rate were 63.0% vs. 30.8%, 51.9% vs. 7.7%, and 17.7% vs. 75% in the non-chronic and chronic endometritis groups, respectively. This criterion resulted in the highest pregnancy and live birth rates among the non-chronic endometritis and the smallest P values for the pregnancy rates, live birth rates, and miscarriage rates between the non-chronic and chronic endometritis groups. In the logistic regression analysis, chronic endometritis was an explanatory variable negatively affecting the objective variable of live birth only when chronic endometritis was diagnosed with ≥ 1 or ≥ 2 plasma cells per 10 high-power fields. The optimal cut-off value was obtained when one or more plasma cells were found in 10 high-power fields (sensitivity 87.5%, specificity 64.9%). CONCLUSIONS Chronic endometritis should be diagnosed as the presence of ≥ 1 plasma cells in 10 high-power fields. According to this diagnostic criterion, chronic endometritis adversely affected the pregnancy rate and the live birth rate.
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Affiliation(s)
- Kimiko Hirata
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan.,Goto Ladies Clinic, 4-13 Hakubaicho, Takatsuki, Osaka, 569-1116, Japan
| | - Fuminori Kimura
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan.
| | - Akiko Nakamura
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Jun Kitazawa
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Aina Morimune
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Tetsuro Hanada
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Akie Takebayashi
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan.,Department of Obstetrics and Gynaecology, National Hospital Organization Shiga Hospital, 255 Gochi-cho, Higashioumi, Shiga, 527-8505, Japan
| | - Akiko Takashima
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Tsukuru Amano
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Shoji Kaku
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Ryoji Kushima
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
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Vomstein K, Feil K, Strobel L, Aulitzky A, Hofer-Tollinger S, Kuon RJ, Toth B. Immunological Risk Factors in Recurrent Pregnancy Loss: Guidelines Versus Current State of the Art. J Clin Med 2021; 10:869. [PMID: 33672505 PMCID: PMC7923780 DOI: 10.3390/jcm10040869] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
Around 1-5% of all couples experience recurrent pregnancy loss (RPL). Established risk factors include anatomical, genetic, endocrine, and hemostatic alterations. With around 50% of idiopathic cases, immunological risk factors are getting into the scientific focus, however international guidelines hardly take them into account. Within this review, the current state of immunological risk factors in RPL in international guidelines of the European Society of Reproduction and Embryology (ESHRE), American Society of Reproductive Medicine (ASRM), German/Austrian/Swiss Society of Obstetrics and Gynecology (DGGG/OEGGG/SGGG) and the Royal College of Obstetricians and Gynecologists (RCOG) are evaluated. Special attention was drawn to recommendations in the guidelines regarding diagnostic factors such as autoantibodies, natural killer cells, regulatory T cells, dendritic cells, plasma cells, and human leukocyte antigen system (HLA)-sharing as well as treatment options such as corticosteroids, intralipids, intravenous immunoglobulins, aspirin and heparin in RPL. Finally, the current state of the art focusing on both diagnostic and therapeutic options was summarized.
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Affiliation(s)
- Kilian Vomstein
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (K.F.); (L.S.); (A.A.); (S.H.-T.); (B.T.)
| | - Katharina Feil
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (K.F.); (L.S.); (A.A.); (S.H.-T.); (B.T.)
| | - Laura Strobel
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (K.F.); (L.S.); (A.A.); (S.H.-T.); (B.T.)
| | - Anna Aulitzky
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (K.F.); (L.S.); (A.A.); (S.H.-T.); (B.T.)
| | - Susanne Hofer-Tollinger
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (K.F.); (L.S.); (A.A.); (S.H.-T.); (B.T.)
| | - Ruben-Jeremias Kuon
- Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany;
| | - Bettina Toth
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (K.F.); (L.S.); (A.A.); (S.H.-T.); (B.T.)
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Pirtea P, Cicinelli E, De Nola R, de Ziegler D, Ayoubi JM. Endometrial causes of recurrent pregnancy losses: endometriosis, adenomyosis, and chronic endometritis. Fertil Steril 2021; 115:546-560. [PMID: 33581856 DOI: 10.1016/j.fertnstert.2020.12.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 12/19/2022]
Abstract
Chronic inflammatory processes affecting the endometrium, as encountered in endometriosis, adenomyosis, and chronic endometritis, alter endometrial receptivity. These disorders are associated with early pregnancy losses and possibly recurrent pregnancy losses (RPL). In the cases of endometriosis, other factors associated with the disease also are susceptible of causing miscarriages and possibly RPL, such as an impact of intrapelvic inflammatory processes affecting the oocyte and embryo in case of natural conception. Conversely these latter effects obviously are bypassed in case of assisted reproductive technology. Chronic inflammation of the endometrium in the condition known as chronic endometritis also causes early pregnancy losses and RPL with beneficial effects achieved when specific treatment is undertaken.
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Affiliation(s)
- Paul Pirtea
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medicine Paris Ouest, Suresnes, France.
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Bari, Italy; Piazza Giulio Cesare, Policlinico, Bari, Italy
| | - Rosalba De Nola
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Bari, Italy; Piazza Giulio Cesare, Policlinico, Bari, Italy
| | - Dominique de Ziegler
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medicine Paris Ouest, Suresnes, France
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medicine Paris Ouest, Suresnes, France
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Abstract
Recurrent pregnancy loss is a distressing pregnancy disorder experienced by ~2.5% of women trying to conceive. Recurrent pregnancy loss is defined as the failure of two or more clinically recognized pregnancies before 20-24 weeks of gestation and includes embryonic and fetal losses. The diagnosis of an early pregnancy loss is relatively straightforward, although progress in predicting and preventing recurrent pregnancy loss has been hampered by a lack of standardized definitions, the uncertainties surrounding the pathogenesis and the highly variable clinical presentation. The prognosis for couples with recurrent pregnancy loss is generally good, although the likelihood of a successful pregnancy depends on maternal age and the number of previous losses. Recurrent pregnancy loss can be caused by chromosomal errors, anatomical uterine defects, autoimmune disorders and endometrial dysfunction. Available treatments target the putative risk factors of pregnancy loss, although the effectiveness of many medical interventions is controversial. Regardless of the underlying aetiology, couples require accurate information on their chances of having a baby and appropriate support should be offered to reduce the psychological burden associated with multiple miscarriages. Future research must investigate the pathogenesis of recurrent pregnancy loss and evaluate novel diagnostic tests and treatments in adequately powered clinical trials.
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Kitazawa J, Kimura F, Nakamura A, Morimune A, Hanada T, Amano T, Tsuji S, Kasahara K, Satooka H, Hirata T, Kushima R, Murakami T. Alteration in endometrial helper T-cell subgroups in chronic endometritis. Am J Reprod Immunol 2020; 85:e13372. [PMID: 33155317 DOI: 10.1111/aji.13372] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 12/11/2022] Open
Abstract
PROBLEM The effect of chronic endometritis (CE) on the subpopulation of CD4+ T cells, Th1, Th2, Th17, and regulatory T cells in the endometrium is unknown. METHOD OF STUDY Lymphocytes were isolated from the endometrium of CE patients (n = 12) and non-CE patients (n = 7). The CD4+ T-cell profile was analyzed by flow cytometry and immunofluorescence. RESULTS In the endometrium of CE patients, there were significantly more Th1 cells among CD4+ cells and fewer Th2 cells in comparison to non-CE patients. No marked difference was observed in Th17 cells or Foxp3+ Treg cells. Moreover, the proportion of Th1 cells increased and the proportion of Th2 cells decreased as the number of CD138+ cells increased. Furthermore, when the localization of CD138+ cells and CD4+ cells was examined, CD4+ cells were found to be clustered around CD138+ cells in CE patients. CONCLUSION The CD4+ T-cell profile in the endometrium is altered in women with CE. This finding may help to clarify the pathophysiology and development of treatment methods for CE.
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Affiliation(s)
- Jun Kitazawa
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Fuminori Kimura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Akiko Nakamura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Aina Morimune
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Tetsuro Hanada
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Tsukuru Amano
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Kyoko Kasahara
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Hiroki Satooka
- Department of Fundamental Biosciences, Shiga University of Medical Science, Shiga, Japan
| | - Takako Hirata
- Department of Fundamental Biosciences, Shiga University of Medical Science, Shiga, Japan
| | - Ryoji Kushima
- Division of Human Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
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Li Y, Xu S, Yu S, Huang C, Lin S, Chen W, Mo M, Lian R, Diao L, Ding L, Zeng Y. Diagnosis of chronic endometritis: How many CD138 + cells/HPF in endometrial stroma affect pregnancy outcome of infertile women? Am J Reprod Immunol 2020; 85:e13369. [PMID: 33152123 DOI: 10.1111/aji.13369] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/17/2020] [Accepted: 10/27/2020] [Indexed: 12/30/2022] Open
Abstract
PROBLEM The definition of chronic endometritis (CE) differs among studies, and currently, there is no accepted consensus. This study aimed to establish the minimum number of immunohistochemical analysis of CD138+ plasma cells to identify a clinically relevant CE. METHOD OF STUDY We performed a retrospective study on 716 infertile patients who never did CE analysis and respective antibiotic treatment before. Samples were obtained by endometrial scratching in the mid-luteal phase before IVF-ET treatment. The number and distribution of CD138+ cells were analyzed by immunohistochemistry. Thirty high-power fields (HPF) were evaluated for each sample. Patients were classified in 2 main groups: (a) CD138low (<5 CD138+ cells in all HPFs), (b) CD138high (≥5 CD138+ cells in at least one HPF). Pregnancy outcome was compared among the groups. RESULTS In the CD138high group, β-hCG positive rate, clinical pregnancy rate and live birth rate were significantly decreased (P = .04, P = .01, P = .04, respectively). Also after adjusting for patient age, body mass index (BMI), and clinical characteristics, the β-hCG positive rate (P = .05), clinical pregnancy rate (P = .01) and live birth rate (P = .02) were significantly lower in the CD138high than those in the CD138low group. Within the CD138low group, these parameters were not significantly different between patients without any plasma cells and patients with up to 4 plasma cells/HPF. CONCLUSION We conclude that immunohistochemical analysis of CD138+ cells is a reliable method to detect CE which can be identified by the presence of ≥5 plasma cells in at least one out of 30 HPF.
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Affiliation(s)
- Yuye Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Shiru Xu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China.,Center for Reproductive Medicine, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong University, Jinan, China
| | - Shuyi Yu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Chunyu Huang
- Department of Paediatric and Adolescent Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Shenglai Lin
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Wanru Chen
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Meilan Mo
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Ruochun Lian
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Lianghui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Lijun Ding
- Center for Reproductive Medicine, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong University, Jinan, China.,Center for Reproductive Medicine, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China.,Center for Reproductive Medicine, Department of Obstetrics and Gynecology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Clinical Center for Stem Cell Research, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
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Diao L, Cai S, Huang C, Li L, Yu S, Wang L, Liu S, Li Y, Zeng Y. New endometrial immune cell-based score (EI-score) for the prediction of implantation success for patients undergoing IVF/ICSI. Placenta 2020; 99:180-188. [PMID: 32829188 DOI: 10.1016/j.placenta.2020.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/18/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022]
Abstract
PROBLEM Limited evidence revealed whether endometrial immunological factors contribute to implantation success in the first-attempted in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients. METHOD The retrospective study was conducted among 139 eligible couples in the derivation cohort and 29 couples in the validation cohort. The expression of endometrial immune cell markers, including CD56 for natural killer cell, CD68 for pan-macrophage, CD163 for M2 macrophage, FOXP3 for regulatory T cell, CD1a for immature dendritic cell, CD83 for mature dendritic cell, CD8 for cytotoxic T cell and CD57 for mature NK and T cells were examined. RESULTS The profiles of endometrial immune cells showed significant difference between the pregnant and implantation failure group in the derivation cohort. Multivariate logistic regression analysis showed that the percentage of CD68+ pan-macrophage and CD163+ M2-macrophage, as well as the transfer strategy are associated with implantation outcomes (P < 0.001, P = 0.029, P = 0.004, respectively). The EI-score was constructed by a nomogram and validated by a clinical decision curve based on CD68+ pan-macrophage, CD163+ M2-macrophage, and the transfer strategy. The performance of the EI-score in the deviation cohort showed a c-index of 0.82 (95% CI 0.74-0.89), and the accuracy rate reached 79.3% in the validation cohort. CONCLUSIONS The endometrial immunological profiles in the mid-secretory phase is associated with implantation outcome in the first IVF/ICSI patients. EI-Score could help clinicians calculate the probability of implantation success via nomogram. Optimal decision point is determined by decision curve analysis and clinical impact curve, to aid in clinical decisions.
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Affiliation(s)
- Lianghui Diao
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518045, PR China; Laboratory for Experimental Feto-Maternal Medicine, Department of Gynecology and Obstetrics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Songchen Cai
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518045, PR China
| | - Chunyu Huang
- Department of Paediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, 999077, Hong Kong, China
| | - Longfei Li
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518045, PR China
| | - Shuyi Yu
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518045, PR China
| | - Linlin Wang
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518045, PR China
| | - Su Liu
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518045, PR China
| | - Yuye Li
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518045, PR China.
| | - Yong Zeng
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518045, PR China.
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Lai ZZ, Ruan LY, Wang Y, Yang HL, Shi JW, Wu JN, Qiu XM, Ha SY, Shen HH, Yang SL, Zheng ZM, Shao J, Ye JF, Li MQ. Changes in subsets of immunocytes in endometrial hyperplasia. Am J Reprod Immunol 2020; 84:e13295. [PMID: 32583503 DOI: 10.1111/aji.13295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Abstract
PROBLEM Endometrial hyperplasia (EH) is characterized by an endometrial gland-to-stroma ratio >1 and is one of the most common gynecological diseases in the world. The role of immunocyte subsets in the development of EH remains unknown. METHODS Patients who underwent dilatation and curettage due to abnormal uterine bleeding were recruited in the present study. Alterations in the numbers of different types of immune cell subsets in the endometrium of patients were analyzed by flow cytometry. RESULTS The present study included 48 patients who were divided into three groups, based on the pathological results: (a) proliferative period (PP, n = 12); (b) simple EH (SEH, n = 30); and (c) complex EH (CEH, n = 6). The results showed that immune cell subpopulations were significantly different between these three groups. Compared with the PP group, the proportion of CD45+ cells and neutrophils and the subtypes of T cells and macrophages were significantly increased in the SEH patients. Compared with the PP and SEH groups, subsets of immunocytes in the CEH group were significantly decreased, including the population of CD45+ cells and the subtypes of T cells and natural killer cells; in contrast, the proportion of macrophages was significantly increased. There were no significant differences between the other cell subsets in each group. CONCLUSION The changes in immune cell subsets may be closely associated with the progression of EH. Although the specific role of different immune cell subsets in the development of the diseases requires further study, the changes in the proportions of immune cell subsets should not be ignored.
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Affiliation(s)
- Zhen-Zhen Lai
- NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China.,Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Lu-Yu Ruan
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Yan Wang
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Hui-Li Yang
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Jia-Wei Shi
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Jiang-Nan Wu
- Clinical Epidemiology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Xue-Min Qiu
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Si-Yao Ha
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Hui-Hui Shen
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Shao-Liang Yang
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Zi-Meng Zheng
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Jun Shao
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Jiang-Feng Ye
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Ming-Qing Li
- NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China.,Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
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70
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Xu Y, Mei J, Diao L, Li Y, Ding L. Chronic endometritis and reproductive failure: Role of syndecan-1. Am J Reprod Immunol 2020; 84:e13255. [PMID: 32329146 DOI: 10.1111/aji.13255] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022] Open
Abstract
Chronic endometritis (CE) is an unusual inflammatory condition characterized by endometrial plasmacyte infiltration. It has a high prevalence in women with reproductive failure. Because of its characteristic localization patterns and molecular functions, syndecan-1 has been identified as a biomarker of plasmacyte, and syndecan-1 immunohistochemistry (IHC) becomes the most dependable diagnostic method for CE. In this review, we discuss the association between CE and reproductive failure, the clinicopathological characterization of CE, the function and expression of syndecan-1, the progress of syndecan-1 IHC in the diagnosis of CE, and the prediction of reproductive outcome.
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Affiliation(s)
- Yanhong Xu
- Center for Reproductive Medicine, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China.,Department of Obstetrics and Gynecology, Center for Reproductive Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Mei
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Lianghui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yuye Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Lijun Ding
- Center for Reproductive Medicine, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China.,Department of Obstetrics and Gynecology, Center for Reproductive Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Clinical Center for Stem Cell Research, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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The excessive presence (percentage or number) of endometrial immune cells in patients with chronic endometritis cannot be associated with reduced endometrial receptivity or recurrent pregnancy failure. Fertil Steril 2020; 113:85-86. [PMID: 32033734 DOI: 10.1016/j.fertnstert.2019.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022]
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