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Kapetanios V, Lampraki M, Georgoulias G, Kasdaglis S, Kliafas S, Gkavra N, Xountasi M, Tsilivakos V, Leventopoulos M. Correlation between hysteroscopic features and specific microbial species in women with chronic endometritis. Heliyon 2024; 10:e30259. [PMID: 38711647 PMCID: PMC11070820 DOI: 10.1016/j.heliyon.2024.e30259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
Objective and rationale Chronic endometritis (CE) has recently been associated with unexplained infertility and recurrent miscarriages. The current gold standard for CE detection is histopathological examination. However, office hysteroscopy and endometrial cultures are also significant, due to the possible link between CE and various microorganisms. Bacterial colonization of the endometrium has been associated with reduced success rates of in vitro fertilisation embryo transfer. Few studies have tried to correlate CE hysteroscopy findings with pathogenic microorganisms. This prospective cohort study sought to establish whether hysteroscopic diagnostic lesions correlate with specific microbial species. Methods The study encompassed women undergoing diagnostic tests for a range of subfertility health issues. 189 women completed the standard office diagnostic hysteroscopy (DH). 181 had also endometrial samples taken for microbial culture investigation. Correlation analysis (χ2 and Fisher's exact test) between hysteroscopic findings suggestive of CE and endometrial cultures was carried out. Logistic regression models were also fitted to measure whether a positive endometrial culture could affect CE conditions. Results A significant association of E. coli was observed between the hysteroscopically characterized CE + group with focal hyperplasia, when compared to the non-CE group. Logistic regression analysis revealed that women positive for E. coli were 4.423 times more likely to have focal endometrial hyperplasia. No other significant correlations were identified between DH and positive endometrial cultures. Conclusions The presence of E. coli in the endometrium was significantly correlated with focal hyperplasia findings from hysteroscopy, emphasizing the importance of microbial cultures in the diagnosis and targeted treatment of CE in women with subfertility.
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Affiliation(s)
| | - Maria Lampraki
- Department of Gynecology, Locus Medicus S.A., Athens, Greece
| | | | | | - Stylianos Kliafas
- School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Greece
| | - Nikolaos Gkavra
- School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Greece
| | - Maria Xountasi
- Department of Cellular Biology and Immunology, Locus Medicus S.A., Athens, Greece
| | - Vassilis Tsilivakos
- Department of Cellular Biology and Immunology, Locus Medicus S.A., Athens, Greece
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Vitagliano A, Laganà AS, De Ziegler D, Cicinelli R, Santarsiero CM, Buzzaccarini G, Chiantera V, Cicinelli E, Marinaccio M. Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome-A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12092250. [PMID: 36140651 PMCID: PMC9498271 DOI: 10.3390/diagnostics12092250] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 01/10/2023] Open
Abstract
This systematic review and meta-analysis aims to evaluate the impact of chronic endometritis (CE) and its therapy on in vitro fertilization (IVF) outcome. Additionally, we aim to investigate whether various degrees of CE severity may exert a different effect on IVF outcome. Ongoing-pregnancy rate/live-birth-rate (OPR/LBR), clinical-pregnancy rate (CPR), and miscarriage rate (MR) were calculated. A total number of 4145 patients (from ten studies) were included. Women with CE had lower OPR/LBR (OR 1.97, p = 0.02) and CPR (OR 2.28, p = 0.002) compared to those without CE. CE cure increased OPR/LBR (OR 5.33, p < 0.0001) and CPR (OR 3.64, p = 0.0001). IVF outcome was comparable between women with cured CE and those without CE (OPR/LBR, CPR and MR: p = ns). Women with severe CE had lower OPR/LBR (OR 0.43, p = 0.003) and CPR (OR 0.40, p = 0.0007) compared to those mild CE. Mild CE showed no influence on the IVF outcome as compared to women without CE (OPR/LBR, CPR and MR: p = ns). Based on this data analysis, CE significantly reduces OPR/LBR and CPR in women undergoing IVF. Importantly, CE resolution after antibiotic therapy may improves IVF outcome, leading to similar OPR/LBR and CPR as compared to unaffected patients. The negative effects of CE on IVF outcome may be restricted to severe disease, whereas mild CE may have no influence on IVF success.
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Affiliation(s)
- Amerigo Vitagliano
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
- Correspondence:
| | - Dominique De Ziegler
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital Foch, Faculté de Médecine Paris Ouest (UVSQ), 92150 Suresnes, France
| | - Rossana Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Carla Mariaflavia Santarsiero
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Giovanni Buzzaccarini
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35128 Padua, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Marco Marinaccio
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
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Cicinelli E, Haimovich S, De Ziegler D, Raz N, Ben-Tzur D, Andrisani A, Ambrosini G, Picardi N, Cataldo V, Balzani M, Cicinelli R, Noventa M, Marin L, Greco P, Resta L, Saccardi C, Buzzaccarini G, Vitagliano A. MUM-1 immunohistochemistry has high accuracy and reliability in the diagnosis of chronic endometritis: a multi-centre comparative study with CD-138 immunostaining. J Assist Reprod Genet 2022; 39:219-226. [PMID: 34791588 PMCID: PMC8866577 DOI: 10.1007/s10815-021-02356-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/10/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The current gold standard for chronic endometritis (CE) diagnosis is immunohistochemistry (IHC) for CD-138. However, IHC for CD-138 is not exempt from diagnostic limitations. The aim of our study was to evaluate the reliability and accuracy of MUM-1 IHC, as compared with CD-138. METHODS This is a multi-centre, retrospective, observational study, which included three tertiary hysteroscopic centres in university teaching hospitals. One hundred ninety-three consecutive women of reproductive age were referred to our hysteroscopy services due to infertility, recurrent miscarriage, abnormal uterine bleeding, endometrial polyps or myomas. All women underwent hysteroscopy plus endometrial biopsy. Endometrial samples were analysed through histology, CD138 and MUM-1 IHC. The primary outcome was to evaluate the diagnostic accuracy of MUM-1 IHC for CE, as compared with CD-138 IHC. RESULTS Sensitivity and specificity of CD-138 and MUM-1 IHC were respectively 89.13%, 79.59% versus 93.48% and 85.03%. The overall diagnostic accuracy of MUM-1 and CD-138 IHC were similar (AUC = 0.893 vs AUC = 0.844). The intercorrelation coefficient for single measurements was high between the two techniques (ICC = 0.831, 0.761-0.881 95%CI). However, among CE positive women, MUM-1 allowed the identification of higher number of plasma cells/hpf than CD-138 (6.50 [SD 4.80] vs 5.05 [SD 3.37]; p = 0.017). Additionally, MUM-1 showed a higher inter-observer agreement as compared to CD-138. CONCLUSION IHC for MUM-1 and CD-138 showed a similar accuracy for detecting endometrial stromal plasma cells. Notably, MUM-1 showed higher reliability in the paired comparison of the individual samples than CD-138. Thus, MUM-1 may represent a novel, promising add-on technique for the diagnosis of CE.
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Affiliation(s)
- Ettore Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), 2nd Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Sergio Haimovich
- Department of Obstetrics and Gynecology, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera. The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Hadera, Israel
| | - Dominique De Ziegler
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Nili Raz
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera. The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Hadera, Israel
| | - Dana Ben-Tzur
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera. The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Hadera, Israel
| | - Alessandra Andrisani
- Department of Women's and Children's Health, University of Padua, via Nicolò Giustiniani 3, 35128, Padua, Italy
| | - Guido Ambrosini
- Department of Women's and Children's Health, University of Padua, via Nicolò Giustiniani 3, 35128, Padua, Italy
| | - Nico Picardi
- Department of Biomedical and Human Oncological Science (DIMO), 2nd Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Viviana Cataldo
- Department of Biomedical and Human Oncological Science (DIMO), 2nd Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Marco Balzani
- Department of Biomedical and Human Oncological Science (DIMO), 2nd Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Rossana Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), 2nd Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Marco Noventa
- Department of Women's and Children's Health, University of Padua, via Nicolò Giustiniani 3, 35128, Padua, Italy
| | - Loris Marin
- Department of Women's and Children's Health, University of Padua, via Nicolò Giustiniani 3, 35128, Padua, Italy
| | - Pantaleo Greco
- Section of Gynecology and Obstetrics, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Leonardo Resta
- Institute of Pathology, Faculty of Medicinecs, University of Bari, Bari, Italy
| | - Carlo Saccardi
- Department of Women's and Children's Health, University of Padua, via Nicolò Giustiniani 3, 35128, Padua, Italy
| | - Giovanni Buzzaccarini
- Department of Women's and Children's Health, University of Padua, via Nicolò Giustiniani 3, 35128, Padua, Italy.
| | - Amerigo Vitagliano
- Department of Women's and Children's Health, University of Padua, via Nicolò Giustiniani 3, 35128, Padua, Italy
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Vitagliano A, Cialdella M, Cicinelli R, Santarsiero CM, Greco P, Buzzaccarini G, Noventa M, Cicinelli E. Association between Endometrial Polyps and Chronic Endometritis: Is It Time for a Paradigm Shift in the Pathophysiology of Endometrial Polyps in Pre-Menopausal Women? Results of a Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:2182. [PMID: 34943419 PMCID: PMC8700534 DOI: 10.3390/diagnostics11122182] [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: 10/30/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic endometritis (CE) and endometrial polyps (EPs) are common conditions in reproductive age women. CE is an infectious disorder of the endometrium characterized by signs of chronic inflammation at hysteroscopic and histological analyses. EPs are abnormal endometrial growths containing glands, stroma and blood vessels projecting from the lining of the uterus. During the last years, different authors have investigated the correlation between CE and EPs, with controversial results. The aim of this study was to summarize available evidence on the potential correlation between CE and EPs. DESIGN Systematic literature review and meta-analysis. METHODS Observational-studies were identified by searching electronic databases from their inception to September 2021. Only studies on pre-menopausal women were included. Statistical analysis was performed using MedCalc 16.4.3 (Ostend, Belgium) and Review Manager version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration). The summary measures were reported as pooled proportion or odds ratio (OR) with 95% confidence interval (CI). The primary outcome was to evaluate the prevalence of CE in women with EPs. The secondary outcome was to determine the prevalence of CD-138-positive EPs among EPs. Tertiary outcomes were to compare the prevalence of CE in women with EPs versus women with a non-polypoid endometrium and to compare the prevalence of CE in women with a single EP versus women with multiple EPs. RESULTS Eight observational studies (n = 3225 patients) were included in quantitative synthesis. Pooled prevalence of CE among women with EPs was 51.35% (95% CI, 27.24-75.13%). Pooled proportion of CD-138-positive EPs among EPs was 70.73% (95% CI, 55.73-83.68%). Women with EPs showed higher prevalence of CE compared to women without EPs (OR 3.07, 95% CI 1.59-5.95). Women with ≥3 EPs had higher prevalence of CE then women with a single EP (OR 3.43, 95% CI 1.83-6.46). CONCLUSIONS In pre-menopausal women, CE and EPs may have a dependent relationship and may represent two consequent steps of a common pathological process.
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Affiliation(s)
- Amerigo Vitagliano
- Department of Women and Children’s Health, University of Padua, 35128 Padua, Italy; (G.B.); (M.N.)
| | - Mariangela Cialdella
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70124 Bari, Italy; (M.C.); (R.C.); (C.M.S.); (E.C.)
| | - Rossana Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70124 Bari, Italy; (M.C.); (R.C.); (C.M.S.); (E.C.)
| | - Carla Mariaflavia Santarsiero
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70124 Bari, Italy; (M.C.); (R.C.); (C.M.S.); (E.C.)
| | - Pantaleo Greco
- Department of Translational and for Romagna Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Giovanni Buzzaccarini
- Department of Women and Children’s Health, University of Padua, 35128 Padua, Italy; (G.B.); (M.N.)
| | - Marco Noventa
- Department of Women and Children’s Health, University of Padua, 35128 Padua, Italy; (G.B.); (M.N.)
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70124 Bari, Italy; (M.C.); (R.C.); (C.M.S.); (E.C.)
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