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Gao Y, Xu G, Yang M, Chen K, Wang Y. Risk factors of chronic endometritis in women who have undergone hysteroscopy: a prospective nested case-control study. Sci Rep 2024; 14:18099. [PMID: 39103391 PMCID: PMC11300859 DOI: 10.1038/s41598-024-69095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 07/31/2024] [Indexed: 08/07/2024] Open
Abstract
There is limited research on risk factors for chronic endometritis regarding reproductive history and clinical symptoms. Thus, this nested case-control study identified risk factors for chronic endometritis in women who have undergone hysteroscopy. Endometrial tissue sections were obtained from 502 women with intrauterine disorders who underwent hysteroscopy. Chronic endometritis was diagnosed via CD138 immunostaining. The women were divided into two groups: 271 women without chronic endometritis and 231 women with chronic endometritis. The prevalence of chronic endometritis was 46%. Univariate logistic regression revealed that prolonged menstruation and intermenstrual bleeding were associated with chronic endometritis, and subsequent multivariate logistic regression analyses showed that these were further independently associated. With univariable logistic regression, the gravidity and abortion history were correlated with chronic endometritis; however, no significant correlation was found with the adjusted odds ratio (OR) of 0.74 (95% confidence interval [CI] 0.46-1.19) or 0.76 (95% CI 0.58-1.11), respectively. No significant correlation was found between caesarean section history and the rates of chronic endometritis. No significant difference was found in all other variables between the three groups with > 5, ≤ 5 plasma cells and in a unknown group. Prolonged menstruation and intermenstrual bleeding were risk factors associated with chronic endometritis. Chronic endometritis should be considered and CD138 immunohistochemical examination should be recommended in women with these symptoms.
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Affiliation(s)
- Yun Gao
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou, 31000, China
| | - Gufeng Xu
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou, 31000, China
| | - Min Yang
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou, 31000, China
| | - Kaiting Chen
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou, 31000, China
| | - Yue Wang
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou, 31000, China.
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Guan D, Sun W, Gao M, Chen Z, Ma X. Immunologic insights in recurrent spontaneous abortion: Molecular mechanisms and therapeutic interventions. Biomed Pharmacother 2024; 177:117082. [PMID: 38972152 DOI: 10.1016/j.biopha.2024.117082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024] Open
Abstract
Recurrent spontaneous abortion refers to the occurrence of two or more spontaneous abortions before or during the early stages of pregnancy. The immune system plays a crucial role in the maintenance of pregnancy and embryo implantation. Various immune cells, cytokines, and immune regulatory pathways are involved in the complex immune balance required for a stable pregnancy. Studies suggest that immune abnormalities may be associated with some recurrent spontaneous abortion cases, particularly those involving the dysregulation of immune cell function, autoimmune responses, and placental immunity. In terms of treatment, interventions targeting immune mechanisms are crucial. Various therapeutic approaches, including immunomodulatory drugs, immunoadsorption therapies, and immunocellular therapies, are continually being researched and developed. These approaches aim to restore the immune balance, enhance the success rate of pregnancies, and provide more effective treatment options for patients with recurrent spontaneous abortion.
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Affiliation(s)
- Defeng Guan
- The First Clinical Medical School of Lanzhou University, Lanzhou, China; The First Hospital of Lanzhou University, Lanzhou, China; Gansu key Laboratory of Reproductive Medicine and Embryology, Lanzhou, China
| | - Wenjie Sun
- The First Clinical Medical School of Lanzhou University, Lanzhou, China
| | - Mingxia Gao
- The First Clinical Medical School of Lanzhou University, Lanzhou, China; The First Hospital of Lanzhou University, Lanzhou, China; Gansu key Laboratory of Reproductive Medicine and Embryology, Lanzhou, China
| | - Zhou Chen
- The First Clinical Medical School of Lanzhou University, Lanzhou, China; The First Hospital of Lanzhou University, Lanzhou, China.
| | - Xiaoling Ma
- The First Clinical Medical School of Lanzhou University, Lanzhou, China; The First Hospital of Lanzhou University, Lanzhou, China; Gansu key Laboratory of Reproductive Medicine and Embryology, Lanzhou, China.
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3
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Hue HJ, Choi H, Lee HK, Lee JR, Jee BC, Choo CW, Kim SK. Prevalence and confounders of chronic endometritis diagnosed using CD138 in patients with recurrent implantation failure. Clin Exp Reprod Med 2024; 51:163-169. [PMID: 38263588 PMCID: PMC11140256 DOI: 10.5653/cerm.2023.06170] [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: 06/01/2023] [Revised: 10/16/2023] [Accepted: 11/09/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE This retrospective study aimed to investigate the prevalence of chronic endometritis, diagnosed using CD138 immunohistochemistry, among infertile women and to assess the association between chronic endometritis and recurrent implantation failure (RIF). METHODS In total, 266 patients who underwent hysteroscopy due to infertility between 2019 and 2020 were included in the analysis. Of these, 136 patients with RIF and 130 non-RIF patients were included in the study. CD138 immunohistochemistry test results, blood biomarkers (including natural killer cells, white blood cells, and the lymphocyte-to-neutrophil ratio), and data on pregnancy outcomes were obtained. If the CD138 test yielded a positive result, the patients received antibiotic treatment. RESULTS The overall proportion of CD138-positive patients was 32.7% (87/266). The CD138 positivity rate was not related to the number of cycles with implantation failure. In the RIF patient group, no significant associations were found between CD138 positivity and peripheral blood markers. The clinical pregnancy rates were similar between infertile women treated with antibiotics for chronic endometritis and those without chronic endometritis. CONCLUSION To improve the pregnancy rate in infertile patients, it may be helpful to combine CD138 testing with other laboratory tests and administer antibiotic treatment if the result is positive.
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Affiliation(s)
- Hye Jeong Hue
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyunji Choi
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun Kyoung Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Woo Choo
- Department of Obstetrics and Gynecology, Seoul Maria Fertility Hospital, Seoul, Republic of Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kitaya K, Yasuo T, Yamaguchi T, Morita Y, Hamazaki A, Murayama S, Mihara T, Mihara M. Construction of deep learning-based convolutional neural network model for automatic detection of fluid hysteroscopic endometrial micropolyps in infertile women with chronic endometritis. Eur J Obstet Gynecol Reprod Biol 2024; 297:249-253. [PMID: 38703449 DOI: 10.1016/j.ejogrb.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/19/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE(S) Chronic endometritis (CE) is a localized mucosal inflammatory disorder associated with female infertility of unknown etiology, endometriosis, tubal factors, repeated implantation failure, and recurrent pregnancy loss, along with atypical uterine bleeding and iron deficiency anemia. Diagnosis of CE has traditionally relied on endometrial biopsy and detection of CD138(+) endometrial stromal plasmacytes. To develop a less invasive diagnostic system for CE, we aimed to construct a deep learning-based convolutional neural network (CNN) model for the automatic detection of endometrial micropolyps (EMiP), a fluid hysteroscopy (F-HSC) finding recognized as tiny protrusive lesions that are closely related to this disease. STUDY DESIGN This is an in silico study using archival images of F-HSC performed at an infertility center in a private clinic. A total of 244 infertile women undergoing F-HSC on the days 6-12 of the menstrual cycle between April 2019 and December 2021 with histopathologically-confirmed CE with the aid of immunohistochemistry for CD138 were utilized. RESULTS The archival F-HSC images of 208 women (78 with EMiP and 130 without EMiP) who met the inclusion criteria were finally subjected to analysis. Following preprocessing of the images, half a set was input into a CNN architecture for training, whereas the remaining images were utilized as the test set to evaluate the performance of the model, which was compared with that of the experienced gynecologists. The sensitivity, specificity, accuracy, precision, and F1-score of the CNN model-aided diagnosis were 93.6 %, 92.3 %, 92.8 %, 88.0 %, and 0.907, respectively. The area under the receiver operating characteristic curves of the CNN model-aided diagnosis (0.930) was at a similar level (p > .05) to the value of conventional diagnosis by three experienced gynecologists (0.927, 0.948, and 0.906). CONCLUSION These findings indicate that our deep learning-based CNN is capable of recognizing EMiP in F-HSC images and holds promise for further development of the computer-aided diagnostic system for CE.
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Affiliation(s)
- Kotaro Kitaya
- Infertility Center, Iryouhoujin Kouseikai Mihara Hospital. 6-8 Kamikatsura Miyanogo-cho, Nishikyo-ku, Kyoto 615-8227, Japan; Iryouhoujin Kouseikai Katsura-ekimae Mihara Clinic. 103 Katsura OS Plaza Building, 133 Katsura Minamitatsumi-cho, Nishikyo-ku, Kyoto 615-8074, Japan.
| | - Tadahiro Yasuo
- Department of Obstetrics and Gynecology, Otsu City Hospital. 2-9-9 Motomiya, Otsu 520-0804, Japan
| | - Takeshi Yamaguchi
- Infertility Center, Daigo Watanabe Clinic. 30-15 Daigo Takahata-cho, Fushimi-ku, Kyoto 601-1375, Japan
| | - Yuko Morita
- Infertility Center, Iryouhoujin Kouseikai Mihara Hospital. 6-8 Kamikatsura Miyanogo-cho, Nishikyo-ku, Kyoto 615-8227, Japan
| | - Atsumi Hamazaki
- Infertility Center, Iryouhoujin Kouseikai Mihara Hospital. 6-8 Kamikatsura Miyanogo-cho, Nishikyo-ku, Kyoto 615-8227, Japan
| | - Shinji Murayama
- Infertility Center, Iryouhoujin Kouseikai Mihara Hospital. 6-8 Kamikatsura Miyanogo-cho, Nishikyo-ku, Kyoto 615-8227, Japan
| | - Takako Mihara
- Infertility Center, Iryouhoujin Kouseikai Mihara Hospital. 6-8 Kamikatsura Miyanogo-cho, Nishikyo-ku, Kyoto 615-8227, Japan; Iryouhoujin Kouseikai Katsura-ekimae Mihara Clinic. 103 Katsura OS Plaza Building, 133 Katsura Minamitatsumi-cho, Nishikyo-ku, Kyoto 615-8074, Japan
| | - Masaya Mihara
- Infertility Center, Iryouhoujin Kouseikai Mihara Hospital. 6-8 Kamikatsura Miyanogo-cho, Nishikyo-ku, Kyoto 615-8227, Japan; Iryouhoujin Kouseikai Katsura-ekimae Mihara Clinic. 103 Katsura OS Plaza Building, 133 Katsura Minamitatsumi-cho, Nishikyo-ku, Kyoto 615-8074, Japan
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5
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Hu XX, Liu L, Zhao LJ, Jiang HF, Zhang SY. The timing for embryo transfer after antibiotic therapy for chronic endometritis. Taiwan J Obstet Gynecol 2024; 63:336-340. [PMID: 38802196 DOI: 10.1016/j.tjog.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To explore the optimal timing of embryo transfer after the first round treatment of chronic endometritis (CE) in vitro. MATERIALS AND METHODS A total of 184 patients were recruited from a retrospective analysis of a large university-affiliated reproduction center in 2021. Some people chose to undergo embryo transfer in the same menstrual cycle with the first round of antibiotic treatment (Group 1, n = 29). Others received embryo transfer in the next cycle after the first round of treatment (Group 2, n = 69) or even one cycle later (Group 3,n = 96). RESULTS Patients in Group 1 got significantly lower biochemical pregnancy rate and clinical pregnancy rate and live birth rate than Group 2 (p < 0.05) and also Group 3 (p < 0.05). Then after comparing the influence factors, we found embryo transfer in the next cycle after antibiotic treatment had a higher clinical pregnancy rate than group 1 (OR = 3.2 p < 0.05) and group 3(OR = 2.5, p < 0.05). The live birth rate in group 2 was higher than group 1(OR = 3.5, p < 0.05). CONCLUSION These findings illustrate that embryo transfer in the next menstrual cycle is the optimal time. Embryo transfer in the same menstrual cycle with the first round of treatment reduces the pregnancy rate.
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Affiliation(s)
- Xiao-Xiao Hu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, China
| | - Liu Liu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, China
| | - Li-Juan Zhao
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, China
| | - Hong-Fei Jiang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, China
| | - Song-Ying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, China.
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HogenEsch E, Hojjati R, Komorowski A, Maniar K, Pavone ME, Bakkensen J, Bernardi L. Chronic endometritis: screening, treatment, and pregnancy outcomes in an academic fertility center. J Assist Reprod Genet 2023; 40:2463-2471. [PMID: 37558906 PMCID: PMC10504221 DOI: 10.1007/s10815-023-02902-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE To identify the prevalence of chronic endometritis (CE), compare the efficacy of antibiotic regimens for CE, and examine pregnancy outcomes after treatment for CE among patients in an academic fertility clinic. METHODS In this retrospective cohort study, data from patients who underwent endometrial sampling (ES) for CE evaluation at a single academic institution from 2014 to 2020 were collected and analyzed. Rates of CE were compared by indication for ES including recurrent pregnancy loss (RPL), implantation failure (IF), and recent first-trimester pregnancy loss. Treatment and pregnancy outcomes were also evaluated. RESULTS Six hundred fifty-three individuals underwent ES to evaluate for CE. The overall prevalence of CE was 28.5%; when stratified by indication, the prevalence of CE was 66.2% for recent first-trimester loss, 27.9% for RPL, and 13.1% for IF (p < .001). Of those with CE, 91.9% received antibiotics, most commonly doxycycline (76.0%). CE clearance was not significantly different when doxycycline was compared to all other regimens (71.3% vs. 58.8%, p = .17), and 68.5% of patients cleared CE after one course of antibiotics. Following two antibiotic courses, CE was cleared in 88.3% of patients. Live birth rates (LBRs) were higher for those with cleared CE compared to patients with untreated CE (34.1% vs. 5.6%, p = .014) and similar for those with cleared CE versus those without CE (34.1% vs. 29.3%, p = .297). CONCLUSION CE is common among patients with infertility, particularly those with a recent first-trimester loss. Treatment and clearance of CE were associated with higher LBRs; however, persistent CE was common despite treatment with antibiotics.
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Affiliation(s)
- Elena HogenEsch
- Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA.
| | - Ronus Hojjati
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison Komorowski
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, USA
| | - Kruti Maniar
- Pathology, Northwestern University, Chicago, IL, USA
| | - Mary Ellen Pavone
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, USA
| | - Jennifer Bakkensen
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, USA
| | - Lia Bernardi
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, USA
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7
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Santoro A, Travaglino A, Inzani F, Angelico G, Raffone A, Maruotti GM, Straccia P, Arciuolo D, Castri F, D'Alessandris N, Scaglione G, Valente M, Cianfrini F, Masciullo V, Zannoni GF. The Role of Plasma Cells as a Marker of Chronic Endometritis: A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:1714. [PMID: 37371809 DOI: 10.3390/biomedicines11061714] [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: 05/09/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic endometritis (CE) is the persistent inflammation of the endometrial lining associated with infertility and various forms of reproductive failures. The diagnosis of CE is based on the histological evidence of stromal plasma cells; however, standardized methods to assess plasma cells are still lacking. In the present paper, we aimed to determine the most appropriate plasma cell threshold to diagnose CE based on pregnancy outcomes. Three electronic databases were searched from their inception to February 2022 for all studies comparing pregnancy outcomes between patients with CE and patients without CE. The relative risk (RR) of pregnancy, miscarriage, and/or live birth rates were calculated and pooled based on the plasma cell threshold adopted. A p-value < 0.05 was considered significant. Nine studies adopting different thresholds (1 to 50 plasma cells/10 HPF) were included. In the meta-analysis, we only found a significant association between miscarriage rate and a plasma cell count ≥ 5/10 HPF (RR = 2.4; p = 0.007). Among studies not suitable for meta-analysis, CE showed an association with worsened pregnancy only when high thresholds (10 and 50/10 HPF) were adopted. In conclusion, our study suggests that the presence of plasma cells at low levels (<5/10 HPF) may not predict worsened pregnancy outcomes. Based on these findings, a threshold of ≥5 plasma cells/10 HPF may be more appropriate to diagnose CE.
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Affiliation(s)
- Angela Santoro
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonio Travaglino
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Frediano Inzani
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Italy
| | - Giuseppe Angelico
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Public Health, University of Naples Federico II, 80138 Naples, Italy
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Public Health, University of Naples Federico II, 80138 Naples, Italy
| | - Patrizia Straccia
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Damiano Arciuolo
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Federica Castri
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Nicoletta D'Alessandris
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giulia Scaglione
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Michele Valente
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Federica Cianfrini
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Valeria Masciullo
- Division of Gynecologic Surgery, Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Gian Franco Zannoni
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy
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8
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Turesheva A, Aimagambetova G, Ukybassova T, Marat A, Kanabekova P, Kaldygulova L, Amanzholkyzy A, Ryzhkova S, Nogay A, Khamidullina Z, Ilmaliyeva A, Almawi WY, Atageldiyeva K. Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box. J Clin Med 2023; 12:4074. [PMID: 37373766 DOI: 10.3390/jcm12124074] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Recurrent pregnancy loss is a complex health challenge with no universally accepted definition. Inconsistency in definitions involves not only the number of spontaneous abortions (two or three) that are accepted for recurrent pregnancy loss but the types of pregnancy and gestational age at miscarriage. Due to the heterogeneity of definitions and criteria applied by international guidelines for recurrent pregnancy loss, the true incidence of recurrent miscarriage, which is reported to range from 1% to 5%, is difficult to estimate. Moreover, the exact etiology of recurrent pregnancy loss remains questionable; thus, it is considered a polyetiological and multifactorial condition with many modifiable and non-modifiable factors involved. Even after thoroughly evaluating recurrent pregnancy loss etiology and risk factors, up to 75% of cases remain unexplained. This review aimed to summarize and critically analyze accumulated knowledge on the etiology, risk factors, relevant diagnostic options, and management approach to recurrent pregnancy loss. The relevance of various factors and their proposed roles in recurrent pregnancy loss pathogenesis remains a matter of discussion. The diagnostic approach and the management largely depend on the etiology and risk factors taken into consideration by a healthcare professional as a cause of recurrent miscarriage for a particular woman or couple. Underestimation of social and health consequences of recurrent pregnancy loss leads to compromised reproductive health and psychological well-being of women after miscarriage. Studies on etiology and risk factors for recurrent pregnancy loss, especially idiopathic, should be continued. The existing international guidelines require updates to assist clinical practice.
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Affiliation(s)
- Akbayan Turesheva
- Department of Normal Physiology, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | | | - Talshyn Ukybassova
- Clinical Academic Department of Women's Health, CF "University Medical Center", Astana 010000, Kazakhstan
| | - Aizada Marat
- Department of Obstetrics and Gynecology #1, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Perizat Kanabekova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Lyazzat Kaldygulova
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Ainur Amanzholkyzy
- Department of Normal Physiology, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Svetlana Ryzhkova
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030000, Kazakhstan
| | - Anastassiya Nogay
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Zaituna Khamidullina
- Department of Obstetrics and Gynecology #1, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Aktoty Ilmaliyeva
- Department of Medicine #3, NJSC "Astana Medical University", Astana 010000, Kazakhstan
| | - Wassim Y Almawi
- Faculte' des Sciences de Tunis, Universite' de Tunis El Manar, Tunis 5000, Tunisia
| | - Kuralay Atageldiyeva
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Clinical Academic Department of Internal Medicine, CF "University Medical Center", Astana 010000, Kazakhstan
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9
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Tian Y, Zeng Q, Cheng Y, Wang XH, Cao D, Yeung WSB, Liu Q, Duan YG, Yao YQ. Follicular helper T lymphocytes in the endometria of patients with reproductive failure: Association with pregnancy outcomes and inflammatory status of the endometria. Am J Reprod Immunol 2023:e13708. [PMID: 37095737 DOI: 10.1111/aji.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023] Open
Abstract
PROBLEM The phenotypes and functions of B and CD4+ T-helper cell subsets during chronic inflammation of the endometria remain largely unexplored. This study aimed to investigate the characteristics and functions of follicular helper T (Tfh) cells to understand the pathological mechanisms of chronic endometritis (CE). METHOD OF STUDY Eighty patients who underwent hysteroscopic and histopathological examinations for CE were divided into three groups-those with positive results for hysteroscopy and CD138 staining (DP), negative results for hysteroscopy but positive CD138 staining (SP), and negative results for hysteroscopy and CD138 staining (DN). The phenotypes of B cells and CD4+ T-cell subsets were analyzed using flow cytometry. RESULTS CD38+ and CD138+ cells were mainly expressed in the non-leukocyte population of the endometria, and the endometrial CD19+ CD138+ B cells were fewer than the CD3+ CD138+ T cells. The percentage of Tfh cells increased with chronic inflammation in the endometria. Additionally, the elevated percentage of Tfh cells correlated with the number of miscarriages. CONCLUSIONS CD4+ T cells, particularly Tfh cells, may be critical in chronic endometrial inflammation and affect its microenvironment, thereby regulating endometrial receptivity, compared to B cells.
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Affiliation(s)
- Ye Tian
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, Chinese PLA General Hospital, Beijing, China
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, the University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Qunxiong Zeng
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, the University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Yanfei Cheng
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, the University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Xiao-Hui Wang
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, the University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Dandan Cao
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, the University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - William Shu-Biu Yeung
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, the University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Qingzhi Liu
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, the University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Yong-Gang Duan
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, the University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Yuan-Qing Yao
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, Chinese PLA General Hospital, Beijing, China
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, the University of Hong Kong - Shenzhen Hospital, Shenzhen, China
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10
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Goto T, Goto S, Ozawa F, Yoshihara H, Kitaori T, Komura M, Takahashi S, Ozaki Y, Sugiura-Ogasawara M. The association between chronic deciduitis and recurrent pregnancy loss. J Reprod Immunol 2023; 156:103824. [PMID: 36773493 DOI: 10.1016/j.jri.2023.103824] [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: 10/06/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Chronic deciduitis (CD) is defined as the presence of lymphocytes or plasma cells in decidual tissue. CD suggests the presence of chronic endometritis (CE) which is associated with recurrent pregnancy loss (RPL). In this study, we examined the role CD plays in RPL patients with aneuploid and euploid miscarriage. The frequency of CD in 49 RPL patients (22 euploid and 27 aneuploid miscarriages) and 17 control women was assessed and the subsequent live birth rate (LBR) in the presence and absence of CD were compared. When only one CD138-positive endometrial stromal plasma cell (ESPC) was found per high-power field (HPF), we diagnosed small-positive CD (Grade 1). When a cluster of two or more CD138-positive ESPCs was found per HPF, we diagnosed it as CD Grade 2. The prevalence of Grade 1 was 18.2% (4/22) in patients with euploid miscarriage, 37.0% (10/27) in patients with aneuploid miscarriage and 23.5% (4/17) in control women. The prevalence of Grade 2 was 45.5% (10/22) in patients with euploid miscarriage, 55.6% (15/27) in patients with aneuploid miscarriage and 23.5% (4/17) in control women. There was a significant difference in the prevalence of CD (p = 0.015). The LBR of patients with CD was similar to that of patients without CD. CD was associated with RPL, especially in patients with aneuploid miscarriage. However, since there was no difference in the LBR of patients with or without CD in the next pregnancy, it was unclear whether CD was a contributing cause of RPL.
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Affiliation(s)
- Takato Goto
- Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Shinobu Goto
- Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
| | - Fumiko Ozawa
- Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hiroyuki Yoshihara
- Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Tamao Kitaori
- Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Masayuki Komura
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Satoru Takahashi
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Yasuhiko Ozaki
- Department of Obstetrics and Gynecology, Nagoya City University West Medical Center, Nagoya 462-8508, Japan
| | - Mayumi Sugiura-Ogasawara
- Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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11
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Kitaya K, Yasuo T. Commonalities and Disparities between Endometriosis and Chronic Endometritis: Therapeutic Potential of Novel Antibiotic Treatment Strategy against Ectopic Endometrium. Int J Mol Sci 2023; 24:ijms24032059. [PMID: 36768381 PMCID: PMC9916512 DOI: 10.3390/ijms24032059] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Chronic endometritis (CE) is a local mucosal inflammatory disorder of the uterine lining, which is histopathologically recognized as the unusual infiltration of CD138(+) plasmacytes into the endometrial stromal compartment. Accumulating body of research documented that CE is associated with female infertility and several obstetric/neonatal complications. The major cause of CE is thought to be intrauterine infection represented by common bacteria (Escherichia coli, Enterococcus faecalis, Streptococcus, and Staphylococcus), Mycoplasma/Ureaplasma, and Mycobacterium. Additionally, local dysbiosis in the female reproductive tract may be involved in the onset and development of CE. Antibiotic treatments against these microorganisms are effective in the elimination of endometrial stromal plasmacytes in the affected patients. Meanwhile, endometriosis is a common female reproductive tract disease characterized by endometriotic tissues (ectopic endometrium) growing outside the uterus and potentially causes chronic pelvic symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria), infertility, and ovarian cancers. Endometriosis involves endocrinological, genetic, and epigenetic factors in its etiology and pathogenesis. Recent studies focus on immunological, inflammatory, and infectious aspects of endometriosis and demonstrate several common characteristics between endometriosis and CE. This review aimed to better understand the immunological and microbial backgrounds underlying endometriosis and CE and look into the therapeutic potential of the novel antibiotic treatment strategy against endometriosis in light of endometrial infectious disease.
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Affiliation(s)
- Kotaro Kitaya
- Infertility Center, Kouseikai Mihara Hospital/Katsura Mihara Clinic, 6-8, Kamikatsura Miyanogo-cho, Nishikyo-ku, Kyoto 615-8227, Japan
- Correspondence: ; Tel.: +81-75-392-3111
| | - Tadahiro Yasuo
- Department of Obstetrics and Gynecology, Otsu City Hospital, Otsu 520-0804, Japan
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12
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Silencing of circ_0007299 suppresses proliferation, migration, and invasiveness and promotes apoptosis of ectopic endometrial stromal cells in endometriosis via miR-424-5p-dependent modulation of CREB1. Arch Gynecol Obstet 2023; 307:149-161. [PMID: 35708784 DOI: 10.1007/s00404-022-06650-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The abnormality of endometrial stromal cells (ESCs) can contribute to endometriosis pathogenesis. Circular RNAs (circRNAs) possess critical roles in endometriosis pathogenesis. Here, we defined the activity and mechanism of human circ_0007299 in the regulation of ectopic ESCs in vitro. METHODS Circ_0007299, miR-424-5p and cAMP response element-binding protein 1 (CREB1) were quantified by qRT-PCR or immunoblotting. Cell viability, proliferation, apoptosis, invasion and motility were gauged by CCK-8, 5-Ethynyl-2'-Deoxyuridine (EdU), flow cytometry, transwell, and wound-healing assays, respectively. Dual-luciferase reporter and RNA immunoprecipitation (RIP) assays were used to verify the direct relationship between miR-424-5p and circ_0007299 or CREB1. RESULTS Our data showed that circ_0007299 was upregulated in human ectopic endometrium tissues and ectopic ESCs. Silencing endogenous circ_0007299 impeded the proliferation, invasiveness, and motility and enhanced apoptosis of ectopic ESCs. Mechanistically, circ_0007299 regulated miR-424-5p expression. Moreover, circ_0007299 silencing impeded the proliferation, invasiveness, and motility and enhanced apoptosis of ectopic ESCs via its regulation on miR-424-5p. CREB1 was identified as a direct miR-424-5p target, and miR-424-5p overexpression suppressed ectopic ESC proliferation, migration, and invasiveness and promoted apoptosis by downregulating CREB1. Furthermore, circ_0007299 positively modulated CREB1 expression through miR-424-5p competition. CONCLUSION Our findings establish that circ_0007299 silencing impedes the proliferation, invasiveness, and motility and promotes apoptosis of ectopic ESCs at least in part via miR-424-5p-dependent modulation of CREB1.
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13
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Yasuo T, Kitaya K. Challenges in Clinical Diagnosis and Management of Chronic Endometritis. Diagnostics (Basel) 2022; 12:2711. [PMID: 36359553 PMCID: PMC9689541 DOI: 10.3390/diagnostics12112711] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 09/29/2023] Open
Abstract
Chronic endometritis (CE) is a local mucosal infectious and inflammatory disorder characterized by unusual filtration of CD138(+) endometrial stromal plasmacytes. CE is attracting attention due to its potential association with infertility of unknown etiology, repeated implantation failure, recurrent pregnancy loss, and several maternal/neonatal complications. Due to the variance in study design among researchers, universal diagnostic criteria remain to be established for the clinical diagnosis and management of CE. This review article aims to summarize current knowledge and provide insights into unsolved questions on CE to establish clinical guidelines for the disease from the viewpoint of human reproduction.
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Affiliation(s)
- Tadahiro Yasuo
- Department of Obstetrics and Gynecology, Otsu City Hospital, Otsu 520-0804, Japan
| | - Kotaro Kitaya
- Infertility Center, Kouseikai Mihara Hospital/Katsura Mihara Clinic, 6–8 Kamikatsura Miyanogo-cho, Nishikyo-ku, Kyoto 615-8227, Japan
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14
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Cicinelli E, McQueen DB, Huepfel B, Vitagliano A, Moreno I, Simon C, Pirtea P, Scott RT, Bellavia M, de Ziegler D. Should patients be screened for chronic endometritis before assisted reproductive technology? Fertil Steril 2022; 118:639-652. [PMID: 36182261 DOI: 10.1016/j.fertnstert.2022.08.846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Ettore Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Bari, Italy
| | - Dana B McQueen
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Chicago, Chicago, Ilinois
| | - Bridget Huepfel
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Chicago, Chicago, Ilinois
| | - Amerigo Vitagliano
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | - Inmaculada Moreno
- Carlos Simon Foundation, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Carlos Simon
- Carlos Simon Foundation, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, INCLIVA, Valencia, Spain; Department of Obstetrics and Gynecology BIDMC, Harvard University, Boston, Massachusetts
| | - Paul Pirtea
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, Hospital Foch, Suresnes, France.
| | - Richard T Scott
- IVIRMA New Jersey, Basking Ridge, New Jersey; Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Marina Bellavia
- Direttore Sanitario FMH Ginecologia - Ostetricia ed Procreazione Medico Assistita
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15
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Timing of endometrial biopsy: Are we one step closer to the definition of chronic endometritis? Fertil Steril 2022; 118:795-796. [PMID: 36109251 DOI: 10.1016/j.fertnstert.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 01/13/2023]
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16
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McQueen DB, Maniar KP, Hutchinson A, Confino R, Bernardi L, Pavone ME. Retained pregnancy tissue after miscarriage is associated with high rate of chronic endometritis. J OBSTET GYNAECOL 2022; 42:3101-3105. [PMID: 35920342 DOI: 10.1080/01443615.2022.2100693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The objective of this study was to evaluate prevalence of chronic endometritis in a cohort of patients with retained pregnancy tissue (RPT) following miscarriage, with and without a history of recurrent pregnancy loss (RPL). In a cohort of our single academic fertility centre, we evaluated women with unexplained RPL (two or more losses) without evidence of RPT and women undergoing hysteroscopic resection of RPT following miscarriage. Endometrial samples underwent staining with H and E and CD138. A pathologist blinded to patient history recorded the number of plasma cells per 10 high power fields (HPF) and the presence or absence of endometrial stromal changes. Our main outcome measure was to measure the prevalence of chronic endometritis. Endometrial samples from 50 women with RPT following miscarriage and 50 women with unexplained RPL without evidence of RPT were reviewed. The prevalence of chronic endometritis was significantly higher in the RPT cohort (62% versus 30%). A multivariable regression demonstrated significantly higher odds of chronic endometritis in the RPT cohort, aOR 7.3 (95% CI 2.1, 25.5). We conclude that women with RPT following pregnancy loss have a high rate of chronic endometritis, suggesting that RPT is a risk factor for this disorder. Impact StatementWhat is already known on this subject? Known risk factors for chronic endometritis include a history of pelvic inflammatory disease, intrauterine polyps and fibroids. The aetiology for increased chronic endometritis among women with RPL is unknown.What do the results of this study add? The prevalence of chronic endometritis is significantly higher among women with retained pregnancy tissue (RPT) following miscarriage compared to women with RPL. These data presented suggest that RPT is associated with chronic endometritis among women with a history of miscarriage.What are the implications of these findings for clinical practice and/or further research? We suggest a pathologic evaluation for chronic endometritis be performed on all patients who undergo hysteroscopic resection of RPT following miscarriage. Our findings also suggest that a uterine cavity evaluation with hysteroscopy to evaluate for RPT may be reasonable in women with a history of miscarriage who are found to have chronic endometritis on endometrial biopsy. Further research is needed to determine if resection of retained tissue is sufficient to treat RPOC associated chronic endometritis, or if additional antibiotic treatment is necessary.
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Affiliation(s)
- Dana B McQueen
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Kruti P Maniar
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anne Hutchinson
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rafael Confino
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lia Bernardi
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Duan H, Li X, Hao Y, Shi J, Cai H. Risk of spontaneous abortion after antibiotic therapy for chronic endometritis before in vitro fertilization and intracytoplasmic sperm injection stimulation. Fertil Steril 2022; 118:337-346. [PMID: 35691723 DOI: 10.1016/j.fertnstert.2022.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether cured chronic endometritis (CE) from antibiotic treatment would be associated with a higher risk of spontaneous abortion in the following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. DESIGN Prospective cohort study. SETTING Tertiary reproductive medicine center. PATIENT(S) Patients with infertility who underwent a routine hysteroscopy underwent an IVF/ICSI stimulation between January 1, 2019, and December 31, 2020. Women with CE (N = 338) underwent antibiotic therapy, and the assisted reproductive outcomes were then compared with women without CE (N = 7,962). INTERVENTION(S) Chronic endometritis was diagnosed through hysteroscopy and confirmed by histology and immunohistochemistry for CD138. MAIN OUTCOME MEASURE(S) Spontaneous abortion rate after the initial embryo transfer. RESULT(S) A total of 7,218 patients underwent embryo transfer, with 330 in the cured CE group and 6,888 in the non-CE group. Women with cured CE had a higher rate of spontaneous abortion than did those without CE (11.8% vs. 9.2%; crude odds ratio [OR], 1.32 [0.94, 1.86]), and this difference was statistically significant after adjusting for confounding variables (adjusted OR, 1.49 [1.01, 2.19]). The live birth rate was 43.9% in the cured CE group and 50.5% in the non-CE group (crude OR, 0.77 [0.62, 0.96]; adjusted OR, 0.73 [0.59, 0.92]). The incidence of clinical pregnancy did not differ significantly between the 2 groups (56.1% vs. 60.0%; crude OR, 0.85 [0.68, 1.06]; adjusted OR, 0.83 [0.66, 1.03]). Sensitivity analyses stratified by initial fresh- or frozen-thawed embryo transfer cycles resulted in similar results. CONCLUSION(S) Chronic endometritis cured with antibiotic therapy was associated with an increased risk of spontaneous abortion among women undergoing IVF/ICSI treatment. The interpretation of the findings is limited by a potential confounding bias.
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Affiliation(s)
- Haixia Duan
- Department of Hysteroscopic Centre, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Xiaojuan Li
- Department of Hysteroscopic Centre, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Yuan Hao
- Department of Hysteroscopic Centre, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Juanzi Shi
- Reproductive Medicine Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - He Cai
- Reproductive Medicine Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China.
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18
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Peuranpää P, Holster T, Saqib S, Kalliala I, Tiitinen A, Salonen A, Hautamäki H. Female reproductive tract microbiota and recurrent pregnancy loss: a nested case-control study. Reprod Biomed Online 2022; 45:1021-1031. [DOI: 10.1016/j.rbmo.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
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19
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Herlihy NS, Klimczak AM, Titus S, Scott C, Hanson BM, Kim JK, Seli E, Scott RT. The role of endometrial staining for CD138 as a marker of chronic endometritis in predicting live birth. J Assist Reprod Genet 2022; 39:473-479. [PMID: 35064433 PMCID: PMC8956753 DOI: 10.1007/s10815-021-02374-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Chronic endometritis (CE) is diagnosed via endometrial biopsy and staining for plasma cells. A threshold plasma cell count that identifies CE and predicts pregnancy outcomes has not been established, and the prevalence of plasma cells in the general infertile population is unknown. The purpose of this study was to determine the prevalence of plasma cells in the general infertile population and whether a threshold exists which predicts live birth. METHODS Endometrial samples were obtained prospectively from 80 women undergoing IVF, embedded in paraffin, and stained for plasma cells using mouse mono-clonal antibody for CD138. Slides were reviewed at 20× magnification and 10 random images captured. Three reviewers graded each image for plasma cells. Participants underwent single, euploid, and frozen blastocyst transfer. RESULTS Forty-nine percent of samples had ≥1 plasma cell across 10 HPFs, 11% had ≥5 cells across 10 HPFs, and 4% had ≥10 cells across 10 HPFs. There was no difference in prevalence between those who did and did not achieve live birth. Using thresholds of 1, 5, and 10 plasma cells per 10 HPFs, there were no differences in implantation, clinical pregnancy, clinical pregnancy loss, or live birth rates between patients with and without CE. CONCLUSION Endometrial plasma cells are present in half the general infertile population and do not predict implantation, clinical pregnancy, clinical pregnancy loss, or live birth rates at low levels.
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Affiliation(s)
- N. S. Herlihy
- IVI/RMA New Jersey, Basking Ridge, NJ USA ,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - A. M. Klimczak
- IVI/RMA New Jersey, Basking Ridge, NJ USA ,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - S. Titus
- Foundation for Embryonic Competence, Basking Ridge, NJ USA
| | - C. Scott
- IVI/RMA New Jersey, Basking Ridge, NJ USA
| | - B. M. Hanson
- IVI/RMA New Jersey, Basking Ridge, NJ USA ,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - J. K. Kim
- IVI/RMA New Jersey, Basking Ridge, NJ USA ,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - E. Seli
- IVI/RMA New Jersey, Basking Ridge, NJ USA ,Yale Medical School, New Haven, CT USA
| | - R. T. Scott
- IVI/RMA New Jersey, Basking Ridge, NJ USA ,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
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20
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Kabodmehri R, Etezadi A, Sharami SH, Ghanaei MM, Hosseinzadeh F, Heirati SFD, Pourhabibi Z. The association between chronic endometritis and uterine fibroids. J Family Med Prim Care 2022; 11:653-659. [PMID: 35360819 PMCID: PMC8963633 DOI: 10.4103/jfmpc.jfmpc_1470_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/01/2021] [Accepted: 11/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Some studies reported the association between fibroids with uterine inflammation. By considering this hypothesis, the formation and recurrence of uterine fibroids can be prevented by diagnosis and treatment of inflammation, and complications and costs can be reduced. This study aimed to evaluate the association between chronic endometritis and uterine fibroids in non-menopausal women. Materials and Methods: This prospective case-control study was performed on non-menopausal women referred to Al-Zahra Hospital in Rasht during April 2019-April 2020. Non- menopausal women of reproductive age (20-55 years old) with abnormal uterine bleeding who were candidates for hysteroscopy based on medical history and ultrasound reports were included in this study. The case group with fibroids were divided into two groups of intramural and subserosal myoma group and submucosal group based on the location of fibroids. The control group was patients with abnormal uterine bleeding complaints and no uterine fibroid. Endometrial specimens were examined by a pathologist for histological and immunochemistry assessments. In interpreting the results of endometrial biopsy, a positive result was indicated by the presence of one or more plasma cells per 10 high power field. Data were gathered by a form including age, parity, history of recurrent miscarriage, patient’s complaint (abnormal uterine bleeding), hysteroscopic results (submucosal myoma-polyp-normal), uterine histology (polyp, endometritis, and hyperplasia) and prevalence of chronic endometritis based on plasma cell in the biopsy. Data were analyzed by SPSS software version 21. Data were reported by descriptive statistics including number, percent, mean and standard deviation. The normality of quantitative data was assessed by the Kolmogorov- Smirnov test. Mann-Whitney U test, Chi-square and Fisher exact tests were used to compare groups and logistic regression was used to control the effect of confounders. Results: The incidence of chronic endometritis was 39% (38 out of 97) and a higher incidence of chronic endometritis was noted in the case group than the control group (46% vs. 31%), No significant difference was observed between the two groups (P > 0.05). However, the incidence of chronic endometritis in women with submucosal myoma was higher than the intramural and subserosal groups (64% vs. 37%) (P = 0.04). To control the effect of age on the rate of chronic endometritis in both groups, no significant effect was observed in logistic regression. Conclusions: The results showed the overall incidence of chronic endometritis was higher than previous studies and also the incidence was higher and more significant in women with submucosal myoma than in the intramural and subserosal group. As in this study, authors assessed the association between chronic endometritis and uterine fibroids, further studies assessing the cause and effect relationships are recommended.
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Affiliation(s)
- Roya Kabodmehri
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-zahra Hospital, School of Medicine, Rasht, Iran
| | - Atoosa Etezadi
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-zahra Hospital, School of Medicine, Rasht, Iran
| | - Seyedeh Hajar Sharami
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-zahra Hospital, School of Medicine, Rasht, Iran
| | - Mandana Mansour Ghanaei
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-zahra Hospital, School of Medicine, Rasht, Iran
| | - Fatemeh Hosseinzadeh
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-zahra Hospital, School of Medicine, Rasht, Iran
| | | | - Zahra Pourhabibi
- Vice-Chancellorship of Research and Technology, Guilan University of Medical Science, Rasht, Iran
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21
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Khan KN, Fujishita A, Ogawa K, Koshiba A, Mori T, Itoh K, Nakashima M, Kitawaki J. Occurrence of chronic endometritis in different types of human adenomyosis. Reprod Med Biol 2022; 21:e12421. [PMID: 35386364 PMCID: PMC8967303 DOI: 10.1002/rmb2.12421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 02/02/2023] Open
Abstract
Purpose Human adenomyosis has an adverse effect on female fertility. Exact mechanistic basis is still unclear. We investigated the occurrence of chronic endometritis (CE) in different types of human adenomyosis. Methods This is a prospective non-randomized observational study enrolling patients with focal (n = 30), diffuse (n = 26), intrinsic (n = 23), and extrinsic (n = 10) adenomyosis. Endometrial biopsy samples were collected from hysterectomy specimens. Immunohistochemical analysis was performed using antibody against CD68 (Mφ marker) with biopsy samples of intrinsic/extrinsic adenomyosis and CD138 (Syndecan-1), a marker of plasma cells, in all biopsy samples. Results In GnRHa-untreated groups, a higher trend in the occurrence of CE, as characterized by infiltration of ≥1 plasma cells in endometrial stroma, was found in women with focal (58.8%, p = 0.0849) and diffuse adenomyosis (60.0%, p = 0.0841) comparing to control women (10.0%). In women with focal adenomyosis, ipsilateral side showed a significantly higher occurrence of CE (58.8%) than on the contralateral side (11.7%) (p = 0.043). Tissue infiltration of macrophages in endometria was significantly higher in intrinsic than in extrinsic adenomyosis (p = 0.03) without showing any significant difference in the occurrence of CE between these two variants of adenomyosis. Conclusion A variable occurrence of CE in different types of adenomyosis may be involved in adverse reproductive outcome.
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Affiliation(s)
- Khaleque N. Khan
- Department of Obstetrics and GynecologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Akira Fujishita
- Department of GynecologySaiseikai Nagasaki HospitalNagasakiJapan
| | - Kanae Ogawa
- Department of Obstetrics and GynecologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Akemi Koshiba
- Department of Obstetrics and GynecologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Taisuke Mori
- Department of Obstetrics and GynecologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Kyoko Itoh
- Department of Pathology and Applied NeurobiologyKyoto Prefectural University of MedicineKyotoJapan
| | - Masahiro Nakashima
- Department of Molecular and Diagnostic PathologyAtomic Bomb Disease InstituteNagasaki University School of MedicineNagasakiJapan
| | - Jo Kitawaki
- Department of Obstetrics and GynecologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
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22
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Shen M, O’Donnell E, Leon G, Kisovar A, Melo P, Zondervan K, Granne I, Southcombe J. The role of endometrial B cells in normal endometrium and benign female reproductive pathologies: a systematic review. Hum Reprod Open 2021; 2022:hoab043. [PMID: 35146127 PMCID: PMC8825379 DOI: 10.1093/hropen/hoab043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/02/2021] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION What are the similarities and differences in endometrial B cells in the normal human endometrium and benign reproductive pathologies? SUMMARY ANSWER Endometrial B cells typically constitute <5% of total endometrial CD45+ lymphocytes, and no more than 2% of total cells in the normal endometrium, and while their relative abundance and phenotypes vary in benign gynaecological conditions, current evidence is inconsistent. WHAT IS KNOWN ALREADY B cells are vitally important in the mucosal immune environment and have been extensively characterized in secondary lymphoid organs and tertiary lymphoid structures (TLSs), with the associated microenvironment germinal centre. However, in the endometrium, B cells are largely overlooked, despite the crucial link between autoimmunity and reproductive pathologies and the fact that B cells are present in normal endometrium and benign female reproductive pathologies, scattered or in the form of lymphoid aggregates (LAs). A comprehensive summary of current data investigating B cells will facilitate our understanding of endometrial B cells in the endometrial mucosal immune environment. STUDY DESIGN SIZE DURATION This systematic review retrieved relevant studies from four databases (MEDLINE, EMBASE, Web of Science Core Collection and CINAHL) from database inception until November 2021. PARTICIPANTS/MATERIALS SETTING METHODS The search strategy combined the use of subject headings and relevant text words related to 'endometrium', 'B cells' and B-cell derivatives, such as 'antibody' and 'immunoglobulin'. Non-benign diseases were excluded using cancer-related free-text terms, and searches were limited to the English language and human subjects. Only peer-reviewed research papers were included. Each paper was graded as 'Good', 'Fair' or 'Poor' quality based on the NEWCASTLE-OTTAWA quality assessment scale. Only 'Good' quality papers were included. MAIN RESULTS AND THE ROLE OF CHANCE Twenty-seven studies met the selection criteria and were included in this review: 10 cross-sectional studies investigated B cells in the normal endometrium; and 17 case-control studies compared the characteristics of endometrial B cells in control and benign female reproductive pathologies including endometritis, endometriosis, infertility, abnormal uterine bleeding, endometrial polyps and uterine fibroids. In all studies, B cells were present in the endometrium, scattered or in the form of LAs. CD20+ B cells were more abundant in patients with endometritis, but the data were inconsistent as to whether B-cell numbers were increased in endometriosis and patients with reproductive pathologies. LIMITATIONS REASONS FOR CAUTION Although only 'good' quality papers were included in this systematic review, there were variations in patients' age, diagnostic criteria for different diseases and sample collection time among included studies. Additionally, a large number of the included studies only used immunohistochemistry as the identification method for endometrial B cells, which may fail to provide an accurate representation of the numbers of endometrial B cells. WIDER IMPLICATIONS OF THE FINDINGS Histological studies found that endometrial B cells are either scattered or surrounded by T cells in LAs: the latter structure seems to be under hormonal control throughout the menstrual cycle and resembles TLSs that have been observed in other tissues. Further characterization of endometrial B cells and LAs could offer insights to endometrial B-cell function, particularly in the context of autoimmune-associated pathologies, such as endometriosis. Additionally, clinicians should be aware of the limited value of diagnosing plasma cell infiltration using only CD138. STUDY FUNDING/COMPETING INTERESTS This study was funded by Finox Biotech. The authors have no conflicts of interest to declare. PROSPERO REGISTRATION NUMBER This systematic review was registered in PROSPERO in January 2020 (PROSPERO ID: CRD42020152915).
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Affiliation(s)
- Mengni Shen
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Elizabeth O’Donnell
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Gabriela Leon
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Ana Kisovar
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Pedro Melo
- Tommy’s National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Krina Zondervan
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Ingrid Granne
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Jennifer Southcombe
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
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23
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Chronische Endometritis bei rezidivierendem Abortgeschehen. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1605-8209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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24
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Herlihy NS, Franasiak JM. Lending clarity via specificity to the diagnosis of chronic endometritis. Fertil Steril 2021; 116:680-681. [PMID: 34330425 DOI: 10.1016/j.fertnstert.2021.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nola S Herlihy
- IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason M Franasiak
- IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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