1
|
Zhang H, Wu L, Liao T, Wang R, Zhu H, Lin L, Wang W, Huang W. Clinical utility of office hysteroscopy following failed in vitro fertilization-embryo transfer: A retrospective cohort study. Int J Gynaecol Obstet 2024; 166:1345-1350. [PMID: 38578147 DOI: 10.1002/ijgo.15522] [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: 07/13/2023] [Revised: 03/01/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Despite its widespread use, in vitro fertilization (IVF) outcomes are challenged by implantation failure, largely due to factors such as embryo quality and endometrial receptivity. In this study, we investigated the clinical effect of office hysteroscopy (OH) on the subsequent frozen-thawed embryo transfer (FET) in infertile women who experienced a failed IVF-embryo transfer (IVF-ET) cycle. METHODS We included 577 infertile women who underwent OH because of a history of failed ET between October 2019 and September 2021. During OH, visible endometrial polyps (EPs) were diagnosed and removed by curette or biopsy forceps; chronic endometritis (CE) was diagnosed by histopathology and immunohistochemistry and treated with oral doxycycline (0.2 g/d) for 14 days. According to the hysteroscopic findings and endometrial pathology with immunohistochemistry, patients were divided into three groups: group A (n = 161) had CE with or without EPs, group B (n = 156) had EPs only, and group C (n = 260) had no CE or EPs. RESULTS In the following FET cycle, the implantation rates were 47%, 51%, and 45% (P = 0.411); the clinical pregnancy rates were 56%, 62%, and 55% (P = 0.436); the live birth rates were 45%, 51%, and 42% (P = 0.205); and the miscarriage rates were 18%, 16%, and 22% (P = 0.497) in groups A, B, and C, respectively. There were no significant differences among groups (P > 0.05). CONCLUSION OH is helpful for diagnosis and treatment of abnormal intrauterine environment in women with a failed IVF cycle and further improves their pregnancy outcome in the following FET.
Collapse
Affiliation(s)
- Hanyun Zhang
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
| | - Lukanxuan Wu
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
| | - Tianji Liao
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
| | - Ruiying Wang
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
| | - Huili Zhu
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
| | - Lijun Lin
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
| | - Wei Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
- Department of Pathology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Wei Huang
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Tehrani HG, Rezaei M, Mehrabian F, Naghshineh E, Moghoofei M. Viral Infection in Endometritis: Is There an Important Role or Not? Am J Reprod Immunol 2024; 92:e13930. [PMID: 39302213 DOI: 10.1111/aji.13930] [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: 05/31/2024] [Revised: 08/06/2024] [Accepted: 08/30/2024] [Indexed: 09/22/2024] Open
Abstract
Chronic endometritis (CE) is a frequent pathological condition that is defined as localized inflammation in the endometrium. Some adverse fertility consequences such as recurrent miscarriage and failure of implantation are associated with chronic endometritis. On the one hand, inflammation plays an important role in the pathogenesis of endometritis, and on the other hand, the role of viral infections in inducing inflammation can make this review strongly attractive and practical. We set out to provide an overview of viral infections as a potential etiology of CE pathophysiology through the alteration of an endometrial microenvironment and its association with infertility. To the best of our knowledge, this is the first review to demonstrate the role of viral infection in chronic endometritis, and whether or not infection ultimately plays a role..
Collapse
Affiliation(s)
- Hatav Ghasemi Tehrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Rezaei
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ferdous Mehrabian
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Naghshineh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Moghoofei
- Infectious Diseases Research Center, Health Research Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
3
|
Huang J, You X, Zhao Z, Jiang X, Qu D. Chronic endometritis multiplies the recurrence risk of endometrial polyps after transcervical resection of endometrial polyps: a prospective study. BMC Womens Health 2024; 24:372. [PMID: 38918774 PMCID: PMC11201338 DOI: 10.1186/s12905-024-03221-w] [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: 04/22/2024] [Accepted: 06/21/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND To investigate the impact of chronic endometritis (CE) on the recurrence of endometrial polyps (EPs) in premenopausal women after transcervical resection of endometrial polyps (TCRP). METHODS This prospective study enrolled 507 women who underwent TCRP between January 1, 2022 and December 31, 2022. The patients were divided into a CE group (n = 133) and non-CE group (n = 374) based on the expression of CD138 in the endometrium. The EP recurrence rate at 1 year after TCRP was compared between the CE and non-CE groups and between groups with mild CE and severe CE. The impact of CD138 expression by resected EPs on EP recurrence also was investigated. RESULTS The EP recurrence rate at 1 year post-TCRP was higher in the CE group than in the non-CE group (25.6% vs. 10.4%) and also higher in the severe CE group than in the mild CE group (34.5% vs. 18.7%). Additionally, the EP recurrence rate was higher among patients with CD138-expressing EPs than among those with EPs lacking CD138 expression (30.5% vs. 6.5%). The odds ratio (OR) for EP recurrence in the CE cohort compared with the non-CE cohort was 3.10 (95% confidence interval [CI] 1.84-5.23) after adjustment for EP number and precautions against EP recurrence. The ORs for EP recurrence in patients with mild CE and severe CE were 2.21 (95%CI 1.11-4.40) and 4.32 (95%CI 2.26-8.26), respectively. Similarly, the OR for EP recurrence in cases with CD138-expressing EPs relative to cases with EPs lacking CD138 expression was 6.22 (95%CI 3.59-10.80) after adjustment for EP number and precautions against EP recurrence. CONCLUSIONS CE multiplied the recurrence rate of EPs in premenopausal women after TCRP, and this effect positively correlated with CE severity. CD138 expression by EPs also was associated with a higher risk for EP recurrence.
Collapse
Affiliation(s)
- Jing Huang
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No 63, Wenhua Road, Nanchong, 637000, China
- Non-invasive and Micro-invasive Laboratory of Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Xiao You
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No 63, Wenhua Road, Nanchong, 637000, China
- Non-invasive and Micro-invasive Laboratory of Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Zijun Zhao
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No 63, Wenhua Road, Nanchong, 637000, China
- Non-invasive and Micro-invasive Laboratory of Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Xiaorui Jiang
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No 63, Wenhua Road, Nanchong, 637000, China
- Non-invasive and Micro-invasive Laboratory of Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Dacheng Qu
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No 63, Wenhua Road, Nanchong, 637000, China.
- Non-invasive and Micro-invasive Laboratory of Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
| |
Collapse
|
4
|
Cuadrado-Torroglosa I, García-Velasco JA, Alecsandru D. The Impacts of Inflammatory and Autoimmune Conditions on the Endometrium and Reproductive Outcomes. J Clin Med 2024; 13:3724. [PMID: 38999290 PMCID: PMC11242609 DOI: 10.3390/jcm13133724] [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: 05/23/2024] [Revised: 06/17/2024] [Accepted: 06/23/2024] [Indexed: 07/14/2024] Open
Abstract
Background: A healthy pregnancy begins with an adequate endometrial state, even before the arrival of a blastocyst. Proper endometrial priming and the development of a tolerogenic decidua are key steps in creating the perfect environment for implantation and pregnancy. In these processes, the involvement of the maternal immune system seems to be of great relevance, modulating the different decidual immune populations to prepare the endometrium for a potential pregnancy. However, certain local pathologies of an inflammatory and autoimmune nature appear to have a direct impact on these phenomena, thus altering patients' reproductive outcomes. Methods: This literature review analyzes original articles, reviews, systematic reviews, and meta-analyses published between 1990 and 2024, concerning the impact of different inflammatory and autoimmune conditions on endometrial status and fertility. The included papers were obtained from Medline (Pubmed) and the Cochrane library. Results: There is evidence that endometriosis, adenomyosis, and chronic endometritis, through the promotion of a chronic inflammatory environment, are capable of altering endometrial immune populations, and, thus, processes essential for early pregnancy. Among other effects, these conditions have been linked to impaired decidualization, alterations in progesterone responsiveness, and hindered placentation. Similarly, antiphospholipid syndrome (APS), thyroid dysfunction, diabetes, and other pathologies related to glucose and gluten metabolism, due to their autoimmune nature, also appear to have a local impact on the uterine environment, affecting reproductive success through different mechanisms, including altered hormonal response and, again, impaired decidualization. Conclusions: The management of inflammatory and autoimmune diseases in assisted reproduction patients is gaining importance due to their direct impact on the endometrium. It is necessary to follow current expert recommendations and established therapeutic approaches in order to improve patients' prospects, ranging from antibiotic treatment in chronic endometritis to heparin and aspirin in APS, as well as hormonal treatments for endometriosis/adenomyosis or a gluten-free diet in celiac disease. All of them and the rest of the therapeutic perspectives, both current and under investigation, are presented throughout this work, assessing the possible improvements for reproductive outcomes.
Collapse
Affiliation(s)
- Isabel Cuadrado-Torroglosa
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106, Torre A, Planta 1a, 46026 Valencia, Spain; (I.C.-T.); (J.A.G.-V.)
| | - Juan A. García-Velasco
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106, Torre A, Planta 1a, 46026 Valencia, Spain; (I.C.-T.); (J.A.G.-V.)
- IVIRMA Global Research Alliance, IVIRMA Madrid, Av. del Talgo, 68, 28023 Madrid, Spain
- Department of Obstetrics and Gynaecology, Rey Juan Carlos University, Av. de Atenas, s/n, 28922 Alcorcón, Spain
| | - Diana Alecsandru
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Avenida Fernando Abril Martorell, 106, Torre A, Planta 1a, 46026 Valencia, Spain; (I.C.-T.); (J.A.G.-V.)
- IVIRMA Global Research Alliance, IVIRMA Madrid, Av. del Talgo, 68, 28023 Madrid, Spain
| |
Collapse
|
5
|
Zhang H, Qiu H, Liu Z, Yu S, Chen C, Zeng Y, Li Y. Endometrial preparation protocols did not impact pregnancy outcomes of patients with cured chronic endometritis. Reprod Biomed Online 2024; 48:103753. [PMID: 38520803 DOI: 10.1016/j.rbmo.2023.103753] [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: 08/14/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 03/25/2024]
Abstract
RESEARCH QUESTION Do endometrial preparation protocols have an effect on pregnancy outcomes in patients with cured chronic endometritis? DESIGN A retrospective study was conducted on 3721 infertile patients from December 2018 to August 2020. Endometrial tissues obtained during the proliferative phase were immunostained for CD138. The presence of CD138-positive cells within the stromal cells indicated chronic endometritis. All patients diagnosed with chronic endometritis received oral antibiotics. Patients underwent endometrial preparation and frozen embryo transfer once chronic endometritis was cured. This study compared various endometrial preparation protocols to assess their effects on pregnancy outcomes. Additionally, it aimed to investigate differences in pregnancy outcomes between patients without chronic endometritis and patients with cured chronic endometritis while following the same endometrial preparation protocol. RESULTS Almost no differences in pregnancy outcomes were observed between natural cycle, hormone replacement therapy (HRT) and gonadotrophin-releasing hormone agonist-HRT (GnRH agonist-HRT) protocols in patients without chronic endometritis and patients with cured chronic endometritis. The only notable difference was that, among women without chronic endometritis, the early miscarriage rate was higher for the GnRH agonist-HRT protocol (25.8%) compared with the natural cycle (17.4%) and HRT (17.7%) protocols (P = 0.025). However, this difference was not significant after adjusting for confounders (adjusted OR 1.383, 95% CI 0.931-2.055). The live birth rate, clinical pregnancy rate, early miscarriage rate, ectopic pregnancy rate and ongoing pregnancy rate did not differ significantly (P > 0.05) between patients without chronic endometritis and patients with cured chronic endometritis who underwent natural cycle, HRT and GnRH agonist-HRT protocols. CONCLUSION Endometrial preparation protocols had no impact on pregnancy outcomes in patients with cured chronic endometritis.
Collapse
Affiliation(s)
- Hongzhan Zhang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Guangdong Province, People's Republic of China; Guangdong Engineering Technology Research Centre of Reproductive Immunology for Peri-implantation, Guangdong Province, People's Republic of China
| | - Han Qiu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Guangdong Province, People's Republic of China; Guangdong Engineering Technology Research Centre of Reproductive Immunology for Peri-implantation, Guangdong Province, People's Republic of China
| | - Zhiqiang Liu
- Guangdong Engineering Technology Research Centre of Reproductive Immunology for Peri-implantation, Guangdong Province, People's Republic of China
| | - Shuyi Yu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Guangdong Province, People's Republic of China; Guangdong Engineering Technology Research Centre of Reproductive Immunology for Peri-implantation, Guangdong Province, People's Republic of China
| | - Cong Chen
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Guangdong Province, People's Republic of China; Guangdong Engineering Technology Research Centre of Reproductive Immunology for Peri-implantation, Guangdong Province, People's Republic of China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Guangdong Province, People's Republic of China; Guangdong Engineering Technology Research Centre of Reproductive Immunology for Peri-implantation, Guangdong Province, People's Republic of China
| | - Yuye Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Guangdong Province, People's Republic of China; Guangdong Engineering Technology Research Centre of Reproductive Immunology for Peri-implantation, Guangdong Province, People's Republic of China.
| |
Collapse
|
6
|
Piibor J, Waldmann A, Prasadani M, Kavak A, Andronowska A, Klein C, Kodithuwakku S, Fazeli A. Investigation of Uterine Fluid Extracellular Vesicles' Proteomic Profiles Provides Novel Diagnostic Biomarkers of Bovine Endometritis. Biomolecules 2024; 14:626. [PMID: 38927030 PMCID: PMC11202259 DOI: 10.3390/biom14060626] [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: 04/24/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Cow uterine infections pose a challenge in dairy farming, resulting in reproductive disorders. Uterine fluid extracellular vesicles (UF-EVs) play a key role in cell-to-cell communication in the uterus, potentially holding the signs of aetiology for endometritis. We used mass spectrometry-based quantitative shotgun proteomics to compare UF-EV proteomic profiles in healthy cows (H), cows with subclinical (SE) or clinical endometritis (CLE) sampled at 28-35 days postpartum. Functional analysis was performed on embryo cultures with the exposure to different EV types. A total of 248 UF-EV proteins exhibited differential enrichment between the groups. Interestingly, in SE, EV protein signature suggests a slight suppression of inflammatory response compared to CLE-UF-EVs, clustering closer with healthy cows' profile. Furthermore, CLE-UF-EVs proteomic profile highlighted pathways associated with cell apoptosis and active inflammation aimed at pathogen elimination. In SE-UF-EVs, the regulation of normal physiological status was aberrant, showing cell damage and endometrial repair at the same time. Serine peptidase HtrA1 (HTRA1) emerged as a potential biomarker for SE. Supplementation of CLE- and SE-derived UF-EVs reduced the embryo developmental rates and quality. Therefore, further research is warranted to elucidate the precise aetiology of SE in cattle, and HTRA1 should be further explored as a potential diagnostic biomarker.
Collapse
Affiliation(s)
- Johanna Piibor
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (J.P.); (A.W.); (M.P.); (A.K.); (S.K.)
| | - Andres Waldmann
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (J.P.); (A.W.); (M.P.); (A.K.); (S.K.)
- Faculty of Veterinary Medicine, Latvia University of Life Sciences and Technologies, LV-3004 Jelgava, Latvia
| | - Madhusha Prasadani
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (J.P.); (A.W.); (M.P.); (A.K.); (S.K.)
| | - Ants Kavak
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (J.P.); (A.W.); (M.P.); (A.K.); (S.K.)
| | - Aneta Andronowska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Juliana Tuwima 10, 10-748 Olsztyn, Poland;
| | - Claudia Klein
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Höltystr. 10, 31535 Neustadt, Germany;
| | - Suranga Kodithuwakku
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (J.P.); (A.W.); (M.P.); (A.K.); (S.K.)
- Department of Animal Sciences, Faculty of Agriculture, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Alireza Fazeli
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (J.P.); (A.W.); (M.P.); (A.K.); (S.K.)
- Department of Pathophysiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila St. 14b, 50411 Tartu, Estonia
- Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Level 4, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
| |
Collapse
|
7
|
Li JW, Xv H, Wan RT. Bibliometric analysis of the global trends in immune-related recurrent pregnancy loss research over the last two decades. J Obstet Gynaecol Res 2024; 50:828-841. [PMID: 38467350 DOI: 10.1111/jog.15907] [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: 10/23/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024]
Abstract
PROBLEM A comprehensive analysis was conducted to explore the scientific output on immune-related recurrent pregnancy loss (RPL) and its key aspects. Despite the lack of clear explanations for most RPL cases, immune factors were found to play a significant role. METHOD OF STUDY The study utilized a bibliometric approach, searching the Web of Science Core Collection database for relevant literature published between 2004 and 2023. RESULTS The collected dataset consisted of 2228 articles and reviews, revealing a consistent increase in publications and citations over the past two decades. The analysis identified the United States and China as the most productive countries in terms of RPL research. Among the institutions, Fudan University in China emerged as the top contributor, followed by Shanghai Jiaotong University. Kwak-kim J was the most prolific author, while Christiansen Ob had the highest number of co-citations. The top 25 co-cited references on diagnosis, treatment, and mechanisms formed the foundation of knowledge in this field. By examining keyword co-occurrence and co-citations, the study found that antiphospholipid syndrome and natural killer cells were the primary areas of focus in immune-related RPL research. Additionally, three emerging hotspots were identified: chronic endometritis, inflammation, and decidual macrophages. These aspects demonstrated increasing interest and research activity within the field of immune-related RPL. CONCLUSIONS Overall, this comprehensive bibliometric analysis provided valuable insights into the patterns, frontiers, and focal points of global scientific output related to immune-related RPL.
Collapse
Affiliation(s)
- Jing-Wei Li
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - Honglin Xv
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - Ren-Tao Wan
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Guo J, Chang Y, Zeng Z, Liu H, Liang X, Zeng H, Peng J. Chronic endometritis incidence in infertile women with and without polycystic ovary syndrome: a propensity score matched study. BMC Womens Health 2023; 23:628. [PMID: 38012612 PMCID: PMC10683087 DOI: 10.1186/s12905-023-02759-5] [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: 08/14/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is known to be associated with chronic low-grade inflammation and endometrial dysfunction. Chronic endometritis (CE) is a type of local inflammation that can contribute to endometrial dysfunction in infertile women. Some clinicians recommend screening for CE in women at high risk, such as those with endometrial polyps. However, it is still uncertain whether there is a relationship between PCOS and CE, as well as whether women with PCOS require enhanced screening for CE. This study was to assess the incidence of CE among infertile women with PCOS by hysteroscopy combined with histopathology CD138 immunohistochemical staining of endometrium. METHODS A total of 205 patients in the PCOS group and 4021 patients in the non-PCOS group from July 2017 to August 2022 were included in this retrospective study. After nearest-neighbor 1:4 propensity score matching (PSM), 189 PCOS patients were matched with 697 non-PCOS patients. Basic information was recorded. The CE incidence was compared. The risk factors affecting CE incidence were also analyzed. RESULTS No significantly higher CE incidence in infertile women with PCOS were found either in total analysis or after PSM (P = 0.969; P = 0.697; respectively). Similar results were discovered in the subgroup of Body Mass Index (BMI) (P = 0.301; P = 0.671; P = 0.427; respectively) as well as the four PCOS phenotypes (P = 0.157). Intriguingly, the incidence of CE increased as BMI increased in the PCOS group, even though no significant differences were found (P = 0.263). Multivariate logistic regression showed that age, infertility duration, infertility type, PCOS, and obesity were not the independent risk factors affecting CE incidence. CONCLUSION The incidence of CE in PCOS patients did not significantly increase compared to non-PCOS patients. Similarly, no significant differences in the incidence of CE were observed among different PCOS phenotypes. The current evidence does not substantiate the need for widespread CE screening among PCOS women, potentially mitigating the undue financial and emotional strain associated with such screenings.
Collapse
Affiliation(s)
- Jiayi Guo
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
- GuangDong Engineering Technology Research Center of Fertility Preservation, Guangzhou, 510655, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Yajie Chang
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
- GuangDong Engineering Technology Research Center of Fertility Preservation, Guangzhou, 510655, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Zhi Zeng
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
- GuangDong Engineering Technology Research Center of Fertility Preservation, Guangzhou, 510655, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Huijun Liu
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
- GuangDong Engineering Technology Research Center of Fertility Preservation, Guangzhou, 510655, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Xiaoyan Liang
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
- GuangDong Engineering Technology Research Center of Fertility Preservation, Guangzhou, 510655, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Haitao Zeng
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
- GuangDong Engineering Technology Research Center of Fertility Preservation, Guangzhou, 510655, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Jintao Peng
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China.
- GuangDong Engineering Technology Research Center of Fertility Preservation, Guangzhou, 510655, Guangdong, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China.
| |
Collapse
|
10
|
Fan Y, Shi C, Huang N, Fang F, Tian L, Wang J. Recurrent Implantation Failure: Bioinformatic Discovery of Biomarkers and Identification of Metabolic Subtypes. Int J Mol Sci 2023; 24:13488. [PMID: 37686293 PMCID: PMC10487894 DOI: 10.3390/ijms241713488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
Recurrent implantation failure (RIF) is a challenging scenario from different standpoints. This study aimed to investigate its correlation with the endometrial metabolic characteristics. Transcriptomics data of 70 RIF and 99 normal endometrium tissues were retrieved from the Gene Expression Omnibus database. Common differentially expressed metabolism-related genes were extracted and various enrichment analyses were applied. Then, RIF was classified using a consensus clustering approach. Three machine learning methods were employed for screening key genes, and they were validated through the RT-qPCR experiment in the endometrium of 10 RIF and 10 healthy individuals. Receiver operator characteristic (ROC) curves were generated and validated by 20 RIF and 20 healthy individuals from Peking University People's Hospital. We uncovered 109 RIF-related metabolic genes and proposed a novel two-subtype RIF classification according to their metabolic features. Eight characteristic genes (SRD5A1, POLR3E, PPA2, PAPSS1, PRUNE, CA12, PDE6D, and RBKS) were identified, and the area under curve (AUC) was 0.902 and the external validated AUC was 0.867. Higher immune cell infiltration levels were found in RIF patients and a metabolism-related regulatory network was constructed. Our work has explored the metabolic and immune characteristics of RIF, which paves a new road to future investigation of the related pathogenic mechanisms.
Collapse
Affiliation(s)
- Yuan Fan
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China; (Y.F.); (C.S.); (N.H.); (F.F.)
- Reproductive Medical Center, Peking University People’s Hospital, Beijing 100044, China
| | - Cheng Shi
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China; (Y.F.); (C.S.); (N.H.); (F.F.)
- Reproductive Medical Center, Peking University People’s Hospital, Beijing 100044, China
| | - Nannan Huang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China; (Y.F.); (C.S.); (N.H.); (F.F.)
- Reproductive Medical Center, Peking University People’s Hospital, Beijing 100044, China
| | - Fang Fang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China; (Y.F.); (C.S.); (N.H.); (F.F.)
- Reproductive Medical Center, Peking University People’s Hospital, Beijing 100044, China
| | - Li Tian
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China; (Y.F.); (C.S.); (N.H.); (F.F.)
- Reproductive Medical Center, Peking University People’s Hospital, Beijing 100044, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China; (Y.F.); (C.S.); (N.H.); (F.F.)
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Qiao X, Wu L, Liu D, Pei T, Huang W. Existence of chronic endometritis and its influence on pregnancy outcomes in infertile women with minimal/mild endometriosis. Int J Gynaecol Obstet 2023; 160:628-634. [PMID: 35780459 DOI: 10.1002/ijgo.14326] [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: 03/21/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE This study aimed to evaluate the prevalence of chronic endometritis (CE) in women with minimal/mild endometriosis and to analyze whether CE affects their pregnancy outcomes. METHODS This retrospective study included 201 infertile women who were diagnosed with minimal/mild endometriosis after undergoing hysteroscopy combined with laparoscopy from January 2016 to December 2018. Immunohistochemistry was used to detect CD138 and CD38, which are specific markers of plasma cells in the endometrial stroma to diagnose CE. Subsequently, we investigated the prevalence of CE and the effects of CE on spontaneous cumulative pregnancy rate, live birth rate, and miscarriage rate within 24 months after surgery. RESULTS The prevalence of CE in infertile women with minimal/mild endometriosis was 24.38%. Patients diagnosed with CE showed a significantly lower cumulative pregnancy rate and live birth rate compared with women without CE (46.51% vs. 71.13% [P = 0.004]; 44.19% vs. 63.38% [P = 0.025]). However, the rate of miscarriage in women with CE was also lower than in women without CE (0 vs. 7.04%, P = 0.074). CONCLUSION Since CE had an adverse effect on cumulative pregnancy rate and live birth rate in infertile women with minimal/mild endometriosis, we suggested that diagnosis and treatment of CE may improve their pregnancy outcomes.
Collapse
Affiliation(s)
- Xinyu Qiao
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China.,NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
| | - Lukanxuan Wu
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China.,NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
| | - Dong Liu
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
| | - Tianjiao Pei
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
| | - Wei Huang
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China.,NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Fujii S, Oguchi T. Age- and endometrial microbiota-related delay in development of endometrial receptivity. Reprod Med Biol 2023; 22:e12523. [PMID: 37383030 PMCID: PMC10298046 DOI: 10.1002/rmb2.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
Purpose We evaluated factors affecting the development of endometrial receptivity according to age and changes in the endometrial microbiota. Methods We recruited patients with infertility who underwent transcriptomic analyses of endometrial receptivity and the endometrial microbiome prior to frozen embryo transfer. An endometrial biopsy was performed 108 h after initial progesterone administration. Results In 185 tests from 185 eligible patients, the results of endometrial receptivity analysis were receptive in 111 (60.0%) patients and pre-receptive in 74 (40.0%) patients. Compared with receptive patients, pre-receptive patients had significantly older ages (36.0 ± 0.5 vs. 38.2 ± 0.5, p = 0.0021), a smaller proportion of normal Lactobacillus-dominant microbiota (27.9% vs. 12.2%), and a greater proportion of microbiota with ultralow biomass (22.5% vs. 41.9%) (p = 0.0074). Patient age (adjusted odds ratio: 1.08, 95% confidence interval: 1.01-1.16, p = 0.0351) and a microbiome with ultralow biomass (adjusted odds ratio: 3.82, 95% confidence interval: 1.49-9.82, p = 0.0039) were independent predictive factors for pre-receptive endometrium. Conclusions Older age was accompanied by a decrease in Lactobacillus-dominant microbiota; aging and endometrial microbiota with ultralow biomass were significantly associated with pre-receptive endometrium. Our findings suggest that the quantity (rather than proportion) of Lactobacillus in the endometrium is important in the development of endometrial receptivity.
Collapse
|
15
|
Ali S, Majid S, Ali MN, Banday MZ, Taing S, Wani S, Almuqbil M, Alshehri S, Shamim K, Rehman MU. Immunogenetic Role of IL17A Polymorphism in the Pathogenesis of Recurrent Miscarriage. J Clin Med 2022; 11:jcm11247448. [PMID: 36556060 PMCID: PMC9785316 DOI: 10.3390/jcm11247448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Interleukin-17A (IL17A) is a proinflammatory cytokine and is assumed to play an important role in fetal rejection. In order to evaluate the potential role of IL17A polymorphism in the pathogenesis of recurrent miscarriage (RM), serum IL17A levels were estimated by ELISA. Single-nucleotide polymorphism was assessed by polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP) using gene-specific primers and the EcoNI restriction enzyme. Serum IL17A levels were nonsignificantly (p > 0.5) low in RM patients compared with the control group. IL17A gene amplification by PCR yielded the undigested product of 815 bp, and its digestion with EcoNI enzyme produced 815, 529, 286, and 270 bp fragments for the GG genotype; 529, 286, and 270 bp fragments for the GA genotype; and 529 and 286 bp fragments for the AA genotype. The genotype frequency between the RM and control groups exhibited a significant difference (p = 0.001), whereas no significant difference was observed between allele frequencies in the two groups (p = 0.0954). These data suggest that the IL17A gene polymorphism exhibits no significant effect on IL17A gene expression. However, it significantly decreases and increases RM risk in the homozygous and recessive models, suggesting its potential pregnancy-protecting and -harming roles in the AA and GA + GG genotypes, respectively.
Collapse
Affiliation(s)
- Shafat Ali
- Cytogenetics and Molecular Biology Laboratory, Centre of Research for Development, University of Kashmir, Srinagar 190006, J&K, India
- Department of Biochemistry, Government Medical College, Srinagar 190010, J&K, India
- Multidisciplinary Research Unit, Government Medical College, Srinagar 190010, J&K, India
- Department of Obstetrics and Gynaecology, Government Medical College-Associated Lalla Ded Hospital, Srinagar 190008, J&K, India
| | - Sabhiya Majid
- Department of Biochemistry, Government Medical College, Srinagar 190010, J&K, India
- Multidisciplinary Research Unit, Government Medical College, Srinagar 190010, J&K, India
- Correspondence: (S.M.); (M.N.A.); (M.U.R.)
| | - Md. Niamat Ali
- Cytogenetics and Molecular Biology Laboratory, Centre of Research for Development, University of Kashmir, Srinagar 190006, J&K, India
- Correspondence: (S.M.); (M.N.A.); (M.U.R.)
| | - Mujeeb Zafar Banday
- Department of Biochemistry, Government Medical College, Srinagar 190010, J&K, India
| | - Shahnaz Taing
- Department of Obstetrics and Gynaecology, Government Medical College-Associated Lalla Ded Hospital, Srinagar 190008, J&K, India
| | - Saima Wani
- Department of Obstetrics and Gynaecology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar 190011, J&K, India
| | - Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Kashif Shamim
- National Centre for Natural Products Research, University of Mississippi, Oxford, MS 38677, USA
| | - Muneeb U. Rehman
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Correspondence: (S.M.); (M.N.A.); (M.U.R.)
| |
Collapse
|
16
|
Abstract
Recurrent implantation failure (RIF) is a major limiting factor in the success rates of in-vitro fertilisation despite the remarkable clinical and technological advancement made at improving assisted reproductive technology. The primary purpose of the endometrium is to provide a receptive site for the implantation of the blastocyst and support its growth and subsequent development. Endometrial pathologies such as endometrial polyps, adenomyosis, Asherman's syndrome, chronic endometritis, and congenital Müllerian ducts defect negatively influence the integrity and receptivity of the endometrium, as well as the implantation of the embryo. This review highlights the implications of these endometrial pathologies and their association with RIF.
Collapse
Affiliation(s)
| | - Babatunde Okewale
- IVF and Fertility Unit, St. Ives Specialist Hospital, Lagos, Nigeria
| |
Collapse
|
17
|
Ota K, Takahashi T, Mitsui J, Kuroda K, Hiraoka K, Kawai K. A case of discrepancy between three ERA tests in a woman with repeated implantation failure complicated by chronic endometritis. BMC Pregnancy Childbirth 2022; 22:891. [PMID: 36456975 PMCID: PMC9714241 DOI: 10.1186/s12884-022-05241-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/23/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Endometrial receptivity array (ERA) is used to determine the timing of embryo transfer (ET) synchronized with the window of implantation (WOI). The effectiveness and evaluation of ERAs in women with recurrent implantation failure remain controversial. We report the case of a patient with recurrent implantation failure that raises the issue of reproducibility of ERA tests. CASE REPORT A 36-year-old Japanese woman with secondary infertility who had previously given birth failed to conceive after three frozen-thawed embryo transfer (FET) cycles. An ERA test was conducted to confirm the WOI. The first ERA test was performed 125 h after progesterone exposure. The laboratory reported that the endometrium was in a non-receptive (post-receptive) phase, and recommended retesting 101 h after progesterone exposure. A simultaneous chronic endometritis (CE) test showed a score of 3. After the antibiotics administration to treat CE, the second ERA test was performed after 101 h of progesterone exposure. The laboratory reported that the endometrium had not reached the WOI and estimated the WOI to be 113 ± 3 h after progesterone exposure. The third ERA test was performed 113 h after progesterone exposure. The laboratory reported that the endometrium was in a non-receptive (pre-receptive) phase and estimated the WOI to be 137 ± 3 h after progesterone exposure. A CE test performed at the same time as the second and third ERA tests showed a score of 1 for the collected endometrium. According to the third ERA test results, the vitrified-warmed blastocyst was transferred at 137 h of progesterone exposure. Pregnancy was achieved and the patient had an uncomplicated vaginal delivery at 39 weeks. One year later, another pregnancy was achieved after FET at 137 h of progesterone exposure, and the patient delivered at 33 weeks due to an unexpected membrane rupture. CONCLUSION Because the results of the ERA test may vary in the presence of CE, CE should be diagnosed simultaneously with or before conducting ERA tests. If CE is diagnosed, ERA testing should be performed after treatment with antimicrobials or other drugs.
Collapse
Affiliation(s)
- Kuniaki Ota
- grid.411582.b0000 0001 1017 9540Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295 Japan
| | - Toshifumi Takahashi
- grid.411582.b0000 0001 1017 9540Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295 Japan
| | | | - Kishio Kuroda
- grid.174567.60000 0000 8902 2273Department of Pathology, Nagasaki University, Nagasaki, 852-8501 Japan
| | | | | |
Collapse
|
18
|
Liu J, Liu ZA, Liu Y, Cheng L, Yan L. Impact of antibiotic treatment for chronic endometritis on pregnancy outcomes in women with reproductive failures (RIF and RPL): A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:980511. [PMID: 36405621 PMCID: PMC9669752 DOI: 10.3389/fmed.2022.980511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The aim of this study was to investigate the effect of antibiotic treatment for chronic endometritis (CE) on reproductive outcomes. Design Systematic review and meta-analysis. Patients Women with reproductive failures, including recurrent implantation failure (RIF), and recurrent pregnancy loss (RPL). Interventions Literature searches were performed using three electronic databases (PubMed, Embase, and Web of Science) until 1 December 2021 (without date restriction). The following comparators were included: women with CE receiving antibiotics vs. untreated controls; women with cured CE vs. women with normal endometrial histology (negative for CE); and women with cured CE vs. women with persistent CE (PCE). The summary measures were indicated as odds ratio (OR) with a 95% confidence interval (CI). Main outcome measures These include on-going pregnancy rate/live birth rate (OPR/LBR), clinical pregnancy rate (CPR), and miscarriage rate/pregnancy loss rate (MR/PLR). Results A total of 2,154 women (from twelve studies) were enrolled. Compared with the control group, women with CE receiving antibiotics did not show a statistically significant difference in OPR/LBR (P = 0.09) and CPR (P = 0.36), although there was a lower MR (P = 0.03). Women with cured CE have higher OPR/LBR (OR 1.57) and CPR (OR 1.56) in comparison with those with non-CE. There was a statistically significantly higher OPR/LBR (OR 6.82, P < 0.00001) and CPR (OR 9.75, P < 0.00001) in women with cured CE vs. those with persistent CE. Conclusion While antibiotic treatment is a sensible option to cure CE, more well-designed prospective studies are needed to evaluate the reproductive impact of antibiotic treatment. Cured CE provides high-quality maternal conditions for subsequent embryo transfer and successful pregnancy.
Collapse
Affiliation(s)
- Jingjing Liu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zheng Ai Liu
- Maternal and Child Health Hospital of Zoucheng, Zoucheng, Shandong, China
| | - Yichun Liu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lei Cheng
- Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, China
- Lei Cheng,
| | - Lei Yan
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- *Correspondence: Lei Yan,
| |
Collapse
|
19
|
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
| | | |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Sieg W, Kiewisz J, Podolak A, Jakiel G, Woclawek-Potocka I, Lukaszuk J, Lukaszuk K. Inflammation-Related Molecules at the Maternal-Fetal Interface during Pregnancy and in Pathologically Altered Endometrium. Curr Issues Mol Biol 2022; 44:3792-3808. [PMID: 36135172 PMCID: PMC9497515 DOI: 10.3390/cimb44090260] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
The blastocyst expresses paternally derived alloantigens and induces inflammation during implantation. However, it is necessary for the onset of pregnancy. An abnormal response might result in a pathological course of pregnancy or pregnancy failure. On the other hand, a state of maternal immune tolerance is necessary to ensure the normal development of pregnancy by suppressing inflammatory processes. This article discusses recognized mechanisms and the significance of inflammatory processes for embryo implantation and pregnancy establishment. We would also like to present disorders involving excessive inflammatory response and their influence on events occurring during embryo implantation. The chain of correlation between the processes responsible for embryo implantation and the subsequent physiological course of pregnancy is complicated. Many of those interrelationships are still yet to be discovered. Undoubtedly, their recognition will give hope to infertile couples for the emergence of new treatments that will increase the chance of giving birth to a healthy child.
Collapse
Affiliation(s)
| | - Jolanta Kiewisz
- Department of Human Histology and Embryology, Medical Faculty, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland
| | - Amira Podolak
- Department of Obstetrics and Gynecology Nursing, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Grzegorz Jakiel
- Invicta Research and Development Center, 81-740 Sopot, Poland
- The Center of Postgraduate Medical Education, 1st Department of Obstetrics and Gynecology, University of Gdansk, 01-004 Warsaw, Poland
| | - Izabela Woclawek-Potocka
- Department of Gamete and Embryo Biology, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, 10-748 Olsztyn, Poland
| | - Jakub Lukaszuk
- Invicta Research and Development Center, 81-740 Sopot, Poland
| | - Krzysztof Lukaszuk
- Invicta Research and Development Center, 81-740 Sopot, Poland
- Department of Obstetrics and Gynecology Nursing, Medical University of Gdansk, 80-210 Gdansk, Poland
| |
Collapse
|
22
|
Zhu N, Yang X, Liu Q, Chen Y, Wang X, Li H, Gao H. “Iron triangle” of regulating the uterine microecology: Endometrial microbiota, immunity and endometrium. Front Immunol 2022; 13:928475. [PMID: 36016947 PMCID: PMC9396262 DOI: 10.3389/fimmu.2022.928475] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
The uterus is the core place for breeding new life. The balance and imbalance of uterine microecology can directly affect or even dominate the female reproductive health. Emerging data demonstrate that endometrial microbiota, endometrium and immunity play an irreplaceable role in regulating uterine microecology, forming a dynamic iron triangle relationship. Up to nowadays, it remains unclear how the three factors affect and interact with each other, which is also a frontier topic in the emerging field of reproductive tract microecology. From this new perspective, we aim to clarify the relationship and mechanism of the interaction of these three factors, especially their pairwise interactions. Finally, the limitations and future perspectives of the current studies are summarized. In general, these three factors have a dynamic relationship of mutual dependence, promotion and restriction under the physiological or pathological conditions of uterus, among which the regulatory mechanism of microbiota and immunity plays a role of bridge. These findings can provide new insights and measures for the regulation of uterine microecology, the prevention and treatment of endometrial diseases, and the further multi-disciplinary integration between microbiology, immunology and reproductive medicine.
Collapse
Affiliation(s)
- Na Zhu
- Department of Nursing, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- School of Nursing, University of South China, Hengyang, China
| | - Xuyan Yang
- Department of Nursing, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Qiao Liu
- School of Nursing, University of South China, Hengyang, China
| | - Yahui Chen
- School of Nursing, University of South China, Hengyang, China
| | - Xiaolan Wang
- Center for Reproductive Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Huanhuan Li
- Department of Gynecology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Hong Gao
- Department of Nursing, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- *Correspondence: Hong Gao,
| |
Collapse
|
23
|
Kitaya K, Tanaka SE, Sakuraba Y, Ishikawa T. Multi-drug-resistant chronic endometritis in infertile women with repeated implantation failure: trend over the decade and pilot study for third-line oral antibiotic treatment. J Assist Reprod Genet 2022; 39:1839-1848. [PMID: 35653041 PMCID: PMC9428093 DOI: 10.1007/s10815-022-02528-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/23/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To evaluate the yearly prevalence and annual transition of multi-drug-resistant-chronic endometritis (MDR-CE) in infertile women with a history of repeated implantation failure (RIF) and to establish the third-line antibiotic treatment regimen against MDR-CE. METHODS This retrospective/prospective cohort and pilot study included 3473 RIF women between April 2010 and September 2021. The endometrial stromal plasmacyte density index (ESPDI) was calculated in 3449 CD138-immunostained endometrial sections to evaluate CE. The microbiota in the vaginal secretions and endometrial fluid was compared between 17 patients with MDR-CE and 16 patients with antibiotics-sensitive CE. In a pilot study, oral moxifloxacin (400 mg/day, 10 days, n = 24) or azithromycin (500 mg/day, 3 days, n = 24) was administered to eligible patients with MDR-CE. RESULTS From April 2010 to March 2020, CE was detected in 31.4% of RIF women and MDR was detected in 7.8% of CE. While the prevalence of CE was stable for a decade, MDR in CE increased steadily (OR 8.27, 95% CI 2.58-26.43, p trend < 0.001). The bacterial species/communities unique to MDR-CE were not found. The histopathologic cure rate of MDR-CE was similar between the moxifloxacin and azithromycin groups (79.2% vs 75.0%, OR 1.27, 95% CI 0.32-4.89, p value 0.73), as well as reproductive outcomes in subsequent embryo transfer cycles. CONCLUSION In RIF women, MDR in CE increased over the decade. As a third-line treatment for MDR-CE, azithromycin may have a clinical advantage due to its shorter time administration periods. CLINICAL TRIAL NUMBER ClinicalTrials.gov Identifier: UMIN-CTR 000029449/000031909.
Collapse
Affiliation(s)
- Kotaro Kitaya
- Reproduction Clinic Osaka, Grand Front Osaka Tower-A 15F, 4-20 Oofuka-cho, Kita-ku, Osaka, 530-0011 Japan
| | - Suguru E. Tanaka
- Varinos, Inc, DiverCity Tokyo Office Tower 12F, 1-1-20 Aomi, Koutou-ku, Tokyo, 135-0064 Japan
| | - Yoshiyuki Sakuraba
- Varinos, Inc, DiverCity Tokyo Office Tower 12F, 1-1-20 Aomi, Koutou-ku, Tokyo, 135-0064 Japan
| | - Tomomoto Ishikawa
- Reproduction Clinic Osaka, Grand Front Osaka Tower-A 15F, 4-20 Oofuka-cho, Kita-ku, Osaka, 530-0011 Japan
| |
Collapse
|
24
|
Murtinger M, Wirleitner B, Spitzer D, Bralo H, Miglar S, Schuff M. Diagnosing chronic endometritis: when simplification fails to clarify. Hum Reprod Open 2022; 2022:hoac023. [PMID: 35722504 PMCID: PMC9202642 DOI: 10.1093/hropen/hoac023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/03/2022] [Indexed: 11/19/2022] Open
Abstract
Reproductive immunology has grown in importance in recent years and has even developed into a discipline of its own within the field of reproductive medicine. Many aspects of reproductive failure such as repeated implantation failure or recurrent miscarriages are, meanwhile, seen as a consequence of aberrant expression of immunological factors. This is reflected by the increasing number of tests for assessing and quantifying different immune cell types as well as by a wide range of immune therapies offered to a clientele consisting of desperate patients requesting additional 'IVF tools': first, what is still usually disregarded is the enormous plasticity and fluctuation of most immune cells in the genital tract; second, their still poorly characterized functions in the endometrial cycle: further, their partially unknown role in embryo implantation and in establishing a pregnancy; and third, the fact that one of the fundamental hypotheses of reproductive immunology-of note-the Medawar concept or 'Medawar's Paradox' of semi-allogeneic graft embryo, is partially based on an erroneous assumption, i.e. the immunologic rejection and tolerance of an embryo. In the present opinion article, we comment on the diagnostic procedures and therapy approaches for chronic endometritis within the scope of reproductive medicine.
Collapse
Affiliation(s)
| | | | | | - Helena Bralo
- Next Fertility IVF Prof. Zech—Bregenz, Bregenz, Austria
| | - Susanna Miglar
- Next Fertility IVF Prof. Zech—Salzburg, Salzburg, Austria
| | | |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW To succinctly review the basic mechanisms of implantation and luteal phase endometrial differentiation, the etiologies of impaired endometrial function and receptivity, and the current methods that exist to evaluate and treat impaired endometrial receptivity. RECENT FINDINGS Human embryo implantation requires bidirectional communication between blastocyst and a receptive endometrium. Etiologies of impaired endometrial receptivity are varied. Some of these include delayed endometrial maturation, structural abnormalities, inflammation, and progesterone resistance. Current methods to evaluate endometrial receptivity include ultrasonography, hysteroscopy, and endometrial biopsy. Treatments are limited, but include operative hysteroscopy, treatment of endometriosis, and personalized timing of embryo transfer. SUMMARY Although some mechanisms of impaired endometrial receptivity are well understood, treatment options remain limited. Future efforts should be directed towards developing interventions targeted towards the known mediators of impaired endometrial receptivity.
Collapse
|
26
|
Wang S, Zhao H, Li F, Xu Y, Bao H, Zhao D. Higher Chronic Endometritis Incidences within Infertile Polycystic Ovary Syndrome Clinical Cases. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9748041. [PMID: 35449841 PMCID: PMC9017445 DOI: 10.1155/2022/9748041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023]
Abstract
Background Clinical cases of a polycystic ovarian syndrome (PCOS) have prolonged subclinical inflammation. Hysteroscopy has revealed worsened chronic endometritis (CE), particularly endometrial diffuse hyperemia, in PCOS patients. However, the possible relationships between PCOS and CE remain largely unexplored. Methods This retrospective-based investigation was conducted on 3336 infertile patients. The PCOS group consisted of 508 patients, while the non-POCS group consisted of 2828 individuals with normal ovarian function. Their clinical features and CE prevalence diagnosed with hysteroscopy were compared. The risk factors affecting the incidence of diffuse endometrial hyperemia were analyzed by binary logistic regression. Results The PCOS cohort and the non-PCOS cohort showed marked variations in age, body mass index (BMI), infertility (primary, secondary), basal hormone level (bFSH, bLH, bT, and PRL), anti-Müllerian hormone (AMH), and CA125 (P < 0.05). The prevalence of CE in PCOS women was 41.73% (212/508), markedly higher than the 28.50% in the non-PCOS cohort (806/2828). Variations within diffuse endometrial hyperemia prevalence were especially marked (P < 0.05). Furthermore, we found that the variables of BMI, bLH, bT, and AMH correlated with diffuse endometrial hyperemia. Conclusions CE prevalence was elevated in clinical cases of infertility associated with PCOS, and diffuse endometrial hyperemia was prevalent, as indicated by hysteroscopy. Furthermore, increased BMI, bLH, bT, and AMH levels all contribute to the risk of diffuse endometrial hyperemia.
Collapse
Affiliation(s)
- Shuang Wang
- Department of Reproductive Medicine, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai 264000, China
| | - Huishan Zhao
- Central Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai 264000, China
| | - Fenghua Li
- Department of Reproductive Medicine, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai 264000, China
| | - Yanping Xu
- Department of Reproductive Medicine, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai 264000, China
| | - Hongchu Bao
- Department of Reproductive Medicine, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai 264000, China
| | - Dongmei Zhao
- Department of Reproductive Medicine, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai 264000, China
| |
Collapse
|
27
|
Peng J, Guo J, Zeng Z, Liang X, Zeng H, Li M. Endometrial polyp is associated with a higher prevalence of chronic endometritis in infertile women. Int J Gynaecol Obstet 2022; 159:563-567. [PMID: 35373335 DOI: 10.1002/ijgo.14207] [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: 11/26/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the prevalence of chronic endometritis (CE) among infertile women with endometrial polyps (EP). METHODS From June 2017 to October 2021, 583 patients in the polyp group (group A-group A1: single-polyp group, 322 patients; group A2: multiple-polyp group, 261 patients) and 4534 patients in the non-polyp group (group B) were included in this retrospective study. Hysteroscopic polypectomy was performed in group A. Endometrial biopsy and CD138 immunohistochemistry staining for specimens was carried out in all groups. RESULTS Prevalence of CE was significantly higher in group A than in group B (45.28% vs. 27.94%, P < 0.001). A significantly higher prevalence of CE was found in group A1 and group A2 compared with group B (42.24% vs. 27.94%, P < 0.001; 49.04% vs. 27.94%, P < 0.001; respectively). No significant difference in the comparison of CE prevalence was found between group A1 and group A2. Similar results were achieved in the subgroup analysis among patients aged 40 years or older and patients younger than 40 years. CONCLUSION EP, either single EP or multiple EP, positively correlates with CE. The prevalence of CE was similar between the single-polyp group and the multiple-polyp group.
Collapse
Affiliation(s)
- Jintao Peng
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiayi Guo
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi Zeng
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Liang
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haitao Zeng
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Manchao Li
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
28
|
Tanaka SE, Sakuraba Y, Kitaya K, Ishikawa T. Differential Vaginal Microbiota Profiling in Lactic-Acid-Producing Bacteria between Infertile Women with and without Chronic Endometritis. Diagnostics (Basel) 2022; 12:diagnostics12040878. [PMID: 35453926 PMCID: PMC9030043 DOI: 10.3390/diagnostics12040878] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: Chronic endometritis (CE) is an infectious and inflammatory disorder associated with infertility of unknown etiology, repeated implantation failure, and recurrent pregnancy loss. In the current clinical practice, intrauterine interventions such as endometrial biopsy/histopathologic examinations and/or hysteroscopy are required for the diagnosis of CE. In this study, we analyzed the microbiota in vaginal secretions (VS) as a potential prediction tool for CE in infertile women. Methods: Using next-generation sequencing analysis, we compared the VS and endometrial fluid (EF) microbiota in infertile women with (n = 20) or without CE (n = 103). Results: The detection rate of Streptococcus and Enterococcus as well as the bacterial abundance of Atopobium and Bifidobacterium in the VS microbiota was significantly lower in the CE group than in the non-CE group. Meanwhile, the detection rate and bacterial abundance of Lactobacillus in the EF and VS microbiota were at similar levels between the two groups. Conclusion: These findings suggest that VS microbiota in infertile women with CE is characterized by the reduction in Bifidobacterium and lactic-acid-producing bacteria other than Lactobacillus. Our results hold promise for the prediction of CE, not by somewhat interventional intrauterine procedures, but by less invasive VS sampling. TRIAL REGISTRATION NUMBER: UMIN000029449 (registration date 6 October 2017).
Collapse
Affiliation(s)
- Suguru E. Tanaka
- Varinos Inc., DiverCity Tokyo Office Tower, 12F, 1-1-20 Aomi, Koto-ku, Tokyo 135-0064, Japan;
| | - Yoshiyuki Sakuraba
- Varinos Inc., DiverCity Tokyo Office Tower, 12F, 1-1-20 Aomi, Koto-ku, Tokyo 135-0064, Japan;
- Correspondence:
| | - Kotaro Kitaya
- Reproduction Clinic Osaka, Grand Front Osaka Tower-A 15F, 4-20 Oofuka-cho, Kita-ku, Osaka 530-0011, Japan; (K.K.); (T.I.)
| | - Tomomoto Ishikawa
- Reproduction Clinic Osaka, Grand Front Osaka Tower-A 15F, 4-20 Oofuka-cho, Kita-ku, Osaka 530-0011, Japan; (K.K.); (T.I.)
| |
Collapse
|
29
|
PPARγ regulates the expression of genes involved in the DNA damage response in an inflamed endometrium. Sci Rep 2022; 12:4026. [PMID: 35256739 PMCID: PMC8901773 DOI: 10.1038/s41598-022-07986-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/22/2022] [Indexed: 12/14/2022] Open
Abstract
AbstractInflammation is a biological response of the immune system, which can be triggered by many factors, including pathogens. These factors may induce acute or chronic inflammation in various organs, including the reproductive system, leading to tissue damage or disease. In this study, the RNA-Seq technique was used to determine the in vitro effects of peroxisome proliferator-activated receptor gamma (PPARγ) ligands on the expression of genes and long non-coding RNA, and alternative splicing events (ASEs) in LPS-induced inflammation of the porcine endometrium during the follicular phase of the estrous cycle. Endometrial slices were incubated in the presence of LPS and PPARγ agonists (PGJ2 or pioglitazone) and a PPARγ antagonist (T0070907). We identified 169, 200, 599 and 557 differentially expressed genes after LPS, PGJ2, pioglitazone or T0070907 treatment, respectively. Moreover, changes in differentially expressed long non-coding RNA and differential alternative splicing events were described after the treatments. The study revealed that PPARγ ligands influence the LPS-triggered expression of genes controlling the DNA damage response (GADD45β, CDK1, CCNA1, CCNG1, ATM). Pioglitazone treatment exerted a considerable effect on the expression of genes regulating the DNA damage response.
Collapse
|
30
|
Morimune A, Kimura F, Moritani S, Tsuji S, Katusra D, Hoshiyama T, Nakamura A, Kitazawa J, Hanada T, Amano T, Kushima R, Murakami T. The association between chronic deciduitis and preeclampsia. J Reprod Immunol 2022; 150:103474. [PMID: 35030355 DOI: 10.1016/j.jri.2022.103474] [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: 08/25/2021] [Revised: 12/18/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
Chronic deciduitis (CD) is slight inflammation of the decidua found during pregnancy. The cause of preeclampsia is thought to be placental hypoplasia, and various theories have been proposed to explain the detailed mechanism; however, its association with decidual inflammation is unclear. A retrospective case control study was conducted in a single university. Subjects were cases who delivered by cesarean section between January 1, 2013 and June 30, 2020 and whose placentas were pathological assessed. CD was diagnosed by CD138 immunostaining of placental decidua tissue, and the perinatal prognosis and incidences of hypertensive disorder of pregnancy and preeclmpsia were examined according to the presence or absence of CD. A logistic regression analysis was performed to evaluate the association between preeclampsia and 11 explanatory variables (10 patient or perinatal background factors and CD). The study population included 76 patients (non-CD, n = 54; CD, n = 22). The rate of preeclampsia was significantly higher in the CD group (P = 0.0006). Patients with CD gave birth at a significantly earlier gestational age (P=0.040) with a lower birth weight (P = 0.001), and a higher rate of LFD (P = 0.005). The Apgar scores at 1 and 5 min and umbilical artery pH were lower (P = 0.0003, 0.021 and 0.002, respectively) in the CD group. The logistic regression analysis revealed that CD was positively associated with preeclampsia. A retrospective examination of the placenta found that patients with CD had a significantly higher incidence of preeclampsia and CD is considered to be a factor that is associated with poor perinatal outcomes.
Collapse
Affiliation(s)
- Aina Morimune
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Fuminori Kimura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Suzuko Moritani
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Daisuke Katusra
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Takako Hoshiyama
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Akiko Nakamura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Jun Kitazawa
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Tetsuro Hanada
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Tsukuru Amano
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 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 Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Liu Z, Liu X, Li F, Sun Y, Yu L, Zhang W, Zhu P, Ma D, Wang X, Lai S, Bao H. Overexpression of hypoxia-inducible factor 1α and excessive vascularization in the peri-implantation endometrium of infertile women with chronic endometritis. Front Endocrinol (Lausanne) 2022; 13:1001437. [PMID: 36531509 PMCID: PMC9751377 DOI: 10.3389/fendo.2022.1001437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/14/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Chronic endometritis (CE) contributes to impaired endometrial receptivity and is closely associated with poor in vitro fertilization (IVF) outcomes. However, the mechanisms underlying CE are unclear. Here, we investigated the role of the hypoxic microenvironment and endometrial vascularization in the peri-implantation endometrium of infertile women with CE. METHODS This retrospective study involved 15 fertile women and 77 infertile patients diagnosed with CE based on CD138+ ≥1/10 high-power fields (HPFs). The CE patients were divided into Group 1 (CD138+ 1-4/10 HPFs, 53 cases) and Group 2 (CD138+ ≥5/10 HPFs, 24 cases). The expression levels of hypoxia-inducible factor 1α (HIF1α), vascular endothelial growth factor A (VEGFA), and vascular endothelial growth factor receptor 2 (VEGFR2) in peri-implantation endometrium were assessed by qRT-PCR and western blot analyses. Spatial levels of HIF1α, VEGFA, and VEGFR2 in various endometrial compartments was determined using immunohistochemistry and H-score analysis. Microvascular density (MVD) was determined using CD34 staining and scored using Image J. Finally, we used qRT-PCR to assess changes in the expression of HIF1α, VEGFA, and VEGFR2 in CE patients after treatment with first-line antibiotics. RESULTS Relative to Group 1 and control group, during the implantation window, protein and mRNA levels of HIF1α, VEGFA, and VEGFR2 were markedly high in Group 2 (P<0.05). H-score analysis showed that HIF1α, VEGFA, and VEGFR2 in the luminal, glandular epithelium, and stromal compartments were markedly elevated in Group 2, comparing to control group and Group 1 (P<0.05). Moreover, markedly elevated MVD levels were observed in Group 2. Notably, the above indexes did not differ significantly in the control group versus Group 1. Treatment with antibiotics significantly suppressed the endometrial HIF1α and VEGFA levels in CE-cured patients. CONCLUSIONS Here, we for the first time report the upregulation of HIF1α, VEGFA, and VEGFR2, as well as excessive endometrial vascularization in the peri-implantation endometrium of CE patients. Our findings offer new insights into reduced endometrial receptivity in CE-associated infertility.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Shoucui Lai
- *Correspondence: Shoucui Lai, ; Hongchu Bao,
| | - Hongchu Bao
- *Correspondence: Shoucui Lai, ; Hongchu Bao,
| |
Collapse
|
33
|
La Marca A, Gaia G, Mignini Renzini M, Alboni C, Mastellari E. Hysteroscopic findings in chronic endometritis. Minerva Obstet Gynecol 2021; 73:790-805. [PMID: 34905882 DOI: 10.23736/s2724-606x.21.04970-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic endometritis (CE) is a subtle pathology. Despite being difficult to detect and probably underdiagnosed, it has great clinical relevance, representing as it does a reversible cause of infertility. Nowadays, histological examination with identification of endometrial stromal plasma cells is considered the gold standard for diagnosis. Diagnostic difficulties persist, however, as a result of the technical limitations of this method and the lack of standardized histological diagnostic criteria. Hysteroscopy has been proposed as an aid for CE diagnosis. The method works by detecting signs of inflammation (focal or diffuse hyperemia, stromal edema, presence of micropolyps and the typical strawberry aspect) on the endometrial surface. Yet, the jury is still out on how reliable this technique is. Hysteroscopy displays a high sensitivity (over 86% and up to 100%) and high negative predictive value (over 92% and up to 100%) in the diagnosis of CE, and it should probably be performed routinely in the assessment of patients with unexplained infertility, repeated implantation failure and repeated pregnancy loss; however, since values in the literature regarding specificity are conflicting, in cases of suspected CE, hysteroscopy may be combined with histological examination, which remains the gold standard to confirm CE. Considering that histopathological evaluation probably underdiagnoses CE, and that hysteroscopy tends to overdiagnose, further studies are needed to determine which technique (or combination of techniques) has greater value for patients.
Collapse
Affiliation(s)
- Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy -
- Clinica Eugin Modena, Modena, Italy -
| | - Giorgia Gaia
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Mignini Renzini
- Clinica Eugin Modena, Modena, Italy
- Biogenesi Reproductive Medicine Center, Istituti Clinici Zucchi, Monza, Monza e Brianza, Italy
| | - Carlo Alboni
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Mastellari
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
34
|
Recent Advances and Current Perspectives on Endometrial Receptivity. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2021. [DOI: 10.1007/s13669-021-00313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
35
|
Anartaeva G, Kurmanova A, Mamedalieva N, Baikoshkarova S. ENDOMETRIAL RECEPTIVITY AS THE KEY TO THE SUCCESS OF ART PROGRAMS: A LITERATURE REVIEW. REPRODUCTIVE MEDICINE 2021. [DOI: 10.37800/rm.3.2021.17-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Relevance: To date, the success of in vitro fertilization (IVF) programs in Kazakhstan is 38%.
The purpose of the study was to evaluate the mechanisms of influence of various risk factors on endometrial receptivity in women in IVF programs.
Materials and Methods: This review was based on a search conducted for domestic and foreign publications available in Russian and international search systems (PubMed, eLibrary) for the past 25 years.
Results: Chronic endometritis is a verified cause of impaired receptivity. Many studies have proven the beneficial effect of complex empirical treatment using antibacterial, anti-inflammatory, hormonal therapy with transdermal forms of estrogens and vitamin therapy on the outcome of IVF.
Conclusion: The problem of recurrent implantation disorders in IVF programs is multifactorial. Women with unrealized reproductive function require rehabilitation after an unsuccessful fertilization attempt to prevent disorders of homeostasis and ensure adequate pain relief during transvaginal puncture of ovarian follicles. In addition to hormone therapy with transdermal forms of estradiol, complex rehabilitation measures shall include immunomodulatory therapy, psychotherapy, and vitamin therapy.
Collapse
|
36
|
Orazov M, Silantieva E, Orekhov R. THE CAPACITY OF PHYSICAL THERAPY FOR REPEATED IMPLANTATION FAILURES IN IVF PROGRAMS: A LITERATURE REVIEW. REPRODUCTIVE MEDICINE 2021. [DOI: 10.37800/rm.3.2021.27-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Relevance: Studies of the etiology and pathogenesis of implantation failures, both repeated and primary, as well as the possibilities of therapy today carry many contraversions. However, in recent years, numerous studies have demonstrated the high effectiveness of various physiotherapy methods in improving reproductive outcomes, including therapy and overcoming repeated implantation failures in in-vitro fertilization programs.
The purpose of the study was to study the capacity of physical therapy for repeated implantation failures in in-vitro fertilization programs.
Materials and Methods: The capacity of physical therapy for repeated implantation failures in in-vitro fertilization programs were studied through the search and analysis of the scientific sources for 1995-2021, available in the Scopus and Pubmed databases, using the keywords “in-vitro fertilization,” “repeated implantation failure,” “assisted reproductive technology,” and «physiotherapy.»
Results: Electrical impulse therapy has established itself as the most studied method in the treatment of disorders of endometrial receptivity with proven efficacy. Physical methods of exposure can improve reproductive outcomes through a beneficial effect on the angiogenesis and architectonics of the endometrium, improving its receptivity, and normalizing physiology. Further detailed study of the etiology, pathogenetic mechanisms, as well as the effectiveness of overcoming repeated implantation failures by various methods is needed to develop treatment protocols.
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
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.
Collapse
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.
| |
Collapse
|
39
|
Orazov M, Mikhaleva L, Silantieva E, Orekhov R. CHRONIC ENDOMETRITIS IN PATIENTS WITH REPEATED IMPLANTATION FAILURES:EPIDEMIOLOGY, ETIOLOGY, PATHOGENESIS AND OVERCOMING INFERTILITY. REPRODUCTIVE MEDICINE 2021. [DOI: 10.37800/rm2021-2-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recent evidence indicates that the endometrium plays a much more important role in successful implantation and clinical pregnancy than many other recognized factors. Chronic endometritis (CE) is associated with negative reproductive outcomes, including repeated implantation failures. Streptococcus spp., Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Staphylococcus spp., Corynebacterium and Mycoplasma / Ureaplasmaspp are currently considered the main pathogens of CE. This disease disrupts the architectonics of the endometrium at different levels: first of all, CE promotes changes in the population of immunocompetent cells and, therefore, contributes to the disruption of the local immune response in the endometrium at the time of implantation. Antibiotic treatment for CE improves implantation rates and decreases abortion rates, although there are no well-designed prospective studies to support this conclusion. Considering the insufficient effectiveness of antibiotic therapy for CE, especially in cases of resistance of pathogens, or in the case of viral chronic endometritis, it is necessary to develop schemes with additional use of drugs that affect other etiopathogenetic pathways of development and maintenance of CE. An example of such a treatment can be cytokine therapy, which requires further study regarding the efficacy and safety in CE therapy.
Collapse
|
40
|
Woźna-Wysocka M, Rybska M, Błaszak B, Jaśkowski BM, Kulus M, Jaśkowski JM. Morphological changes in bitches endometrium affected by cystic endometrial hyperplasia - pyometra complex - the value of histopathological examination. BMC Vet Res 2021; 17:174. [PMID: 33902588 PMCID: PMC8077759 DOI: 10.1186/s12917-021-02875-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/11/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cystic endometrial hyperplasia-pyometra complex (CEH-P) is one of the most common uteropathies in bitches. In diseases with mild or obscure clinical signs and normal uterine size, a diagnosis based on a clinical assessment might be incorrect. The main aim of the research was to determine the morphological variables accompanying uterine diseases in bitches in microscopic evaluation. Consequently, the obtained results can be used to create a new classification system for uterine pathological changes during the development of the CEH-P, diagnosed by microscopic examination in bitches. Material for the study consisted of the uteri of 120 female dogs, aged 1-16 years, obtained during routine ovariohysterectomies. Macroscopic observation after a longitudinal incision of the uterine horns, allowed a preliminary classification of the uteri into research groups: control group (physiological uteri), and groups GI-III uteri collected form bitches with varying degrees of endometrial pathology. These preliminary classifications were then verified by histological analysis (H&E stain). RESULTS The obtained results made it possible to determine and describe the prevalence (%) of pathological changes characteristic of the analyzed uterine diseases in the examined bitches. Histopathological analyses that were conducted have confirmed preliminary macroscopic evaluation for the control group, group GII (CEH), and group GIII (pyometra). In the uteri of the GI group, a severe congestion of the endometrium has been observed - this is typical of inflammation - which was not confirmed during histopathological examinations. However, these examinations revealed acute endometrial haemorrhage of varying severity. CONCLUSIONS Early reproduction disorders in bitches are, in general, not confirmed by clinical signs in the examined animals. The results show that during classification of typical morphological changes in the endometrium over the development of the CEH-P complex in bitches microscopic examinations are required. The obtained results indicate a frequent lack of consistency in the macroscopic assessment and histological analysis of the endometrium, observed in the analyzed uterine diseases, which in most cases is not followed by clinical symptoms. The presented classification of uterine diseases may be useful as a diagnostic tool in reproductive disorders in bitches and in examination in the field of basic research.
Collapse
Affiliation(s)
- Magdalena Woźna-Wysocka
- Department of Medical Biotechnology, Institute of Bioorganic Chemistry, Polish Academy of Sciences, 12/14 Z. Noskowskiego St, 61-704, Poznań, Poland.
| | - Marta Rybska
- Department of Preclinical Sciences and Infectious Diseases, Faculty of Veterinary Medicine and Animal Sciences, Poznan University of Life Sciences, Poznań, Poland
| | - Beata Błaszak
- Department of Tumour Pathology, Grater Poland Cancer Centre, Poznań, Poland
| | - Bartłomiej M Jaśkowski
- Department of Reproduction and Clinic of Farm Animals, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wrocław, Poland
| | - Magdalena Kulus
- Department of Veterinary Surgery, Institute of Veterinary Medicine, Nicolaus Copernicus University in Torun, Toruń, Poland
| | - Jędrzej M Jaśkowski
- Department of Diagnostics and Clinical Sciences, Institute of Veterinary Medicine, Nicolaus Copernicus University in Torun, Toruń, Poland
| |
Collapse
|
41
|
Gültiken N, Yarim M, Yarim GF, Sözmen M, Anadol E, Findik M. Plasma concentration and uterine and ovarian expressions of insulin-like growth factor-2 in dogs with cystic endometrial hyperplasia-pyometra. Acta Vet Hung 2021; 69:73-79. [PMID: 33891559 DOI: 10.1556/004.2021.00013] [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: 01/22/2021] [Accepted: 03/18/2021] [Indexed: 11/19/2022]
Abstract
The objective of this study was to investigate the plasma concentrations of insulin-like growth factor-2 (IGF-2) as well as its expression in the uterus and ovary of healthy dogs and those with cystic endometrial hyperplasia (CEH)-pyometra complex. Group 1 (n = 10) included bitches with open cervix pyometra, while Group 2 (n = 7) consisted of clinically healthy bitches in dioestrus. The number of IGF-2 immunopositive interstitial cells was significantly higher in Group 1, whereas in Group 2 there were only two cases in which a few cells were IGF-2 immunopositive. IGF-2 immunopositivity was observed in the endometrial glandular epithelium in both groups. Additionally, interstitial fibroblasts and macrophages in the endometrium were also positive in Group 1. The concentration of plasma IGF-2 was higher in Group 1 than in Group 2 (P < 0.05). The concentration was positively correlated with IGF-2 expression in the endometrial glands (r = 0.926; P < 0.001) in Group 1. However, a negative correlation was present between plasma IGF-2 concentration and IGF-2 expression in the interstitial endocrine cells of the ovary in Group 1 (r = -0.652; P < 0.05). The results suggest that IGF-2 plays an important role during the inflammatory process occurring in bitches with CEH-pyometra complex as well as in the endometrium of healthy bitches in dioestrus.
Collapse
Affiliation(s)
- Nilgün Gültiken
- 1Department of Obstetrics and Gynaecology, Faculty of Veterinary Medicine, University of Ondokuz Mayis, Samsun, Turkey
| | - Murat Yarim
- 2Department of Pathology, Faculty of Veterinary Medicine, University of Ondokuz Mayis, Samsun, Turkey
| | - Gül Fatma Yarim
- 3Department of Biochemistry, Faculty of Veterinary Medicine, University of Ondokuz Mayis, Samsun, Turkey
| | - Mahmut Sözmen
- 2Department of Pathology, Faculty of Veterinary Medicine, University of Ondokuz Mayis, Samsun, Turkey
| | - Elvan Anadol
- 4Laboratory Animal Breeding and Experimental Research Center, University of Gazi, Ankara, Turkey
| | - Murat Findik
- 1Department of Obstetrics and Gynaecology, Faculty of Veterinary Medicine, University of Ondokuz Mayis, Samsun, Turkey
| |
Collapse
|
42
|
Altered Gene Expression Encoding Cytochines, Grow Factors and Cell Cycle Regulators in the Endometrium of Women with Chronic Endometritis. Diagnostics (Basel) 2021; 11:diagnostics11030471. [PMID: 33800186 PMCID: PMC7999985 DOI: 10.3390/diagnostics11030471] [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] [Received: 02/03/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 12/17/2022] Open
Abstract
To evaluate the expression of genes encoding cytokines, grow factors and cell cycle regulators in the proliferative endometrium of women with chronic endometritis (CE) compared to controls. We performed a case-control study on seven women with CE as diagnosed by hysteroscopy and histology (Cases) compared to six women without CE (Controls). All women underwent diagnostic hysteroscopy plus endometrial biopsy during the mid-proliferative phase of the menstrual cycle. Endometrial samples were divided into two different aliquots for histological and molecular analyses. The endometrial expression profile of 16 genes encoding proteins involved in the inflammatory process, proliferation and cell cycle regulation/apoptosis was assessed by using high-throughput qPCR. Study endpoints were between-group differences in the expression of VEGF A, VEGF B, VEGF C, EGF, TNF, TGF B1, IFNG, TP73, TP73L, BAXva, CDC2, CDC2va, CCND3, CCNB1, BAX and IL12. RESULTS: VEGF A, VEGF B, VEGF C, EGF, TNF, TGF B1, IFNG, TP73, TP73L, BAXva, CDC2, CDC2va, CCND3, CCNB1 were significantly overexpressed in women with CE compared to controls, while BAX and IL12 had similar expression between groups. In women with CE, we found an altered endometrial expression of genes involved in inflammatory, cell proliferation, and apoptosis processes. The dominance of proliferative and anti-apoptotic activity in CE may potentially promote the development of polyps and hyperplastic lesions.
Collapse
|
43
|
Espinós JJ, Fabregues F, Fontes J, García-Velasco JA, Llácer J, Requena A, Checa MÁ, Bellver J. Impact of chronic endometritis in infertility: a SWOT analysis. Reprod Biomed Online 2021; 42:939-951. [PMID: 33736994 DOI: 10.1016/j.rbmo.2021.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022]
Abstract
Chronic endometritis is a pathology often associated with reproductive failure, but there are still no clear recommendations on whether its inclusion in the initial study of infertile couples is necessary. In this discussion paper, based on a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis, the different aspects of the repercussions of chronic endometritis in fertility are evaluated. To avoid possible subjectivity in the analysis and results of this study, the researchers followed the Oxford criteria for the evaluation of evidence. The results from the evaluation of the reviewed literature seem to indicate that, pending new evidence, it would be advisable not to include chronic endometritis in the initial baseline study before assisted reproduction in order not to delay other assisted reproduction treatments. However, it would be advisable in cases of repetitive implantation failure and pregnancy loss after having undergone IVF with viable embryos and before continuing with costly reproductive processes, since results could be improved. The development of randomized studies assessing the impact of antibiotic treatment as a possible therapeutic option in infertile women with chronic endometritis, as well as the possible impact on endometrial microbiota and receptivity/implantation, would allow for the establishment of more precise clinical guidelines in this regard.
Collapse
Affiliation(s)
- Juan J Espinós
- Fertty, Barcelona, Spain, Universidad Autónoma de Barcelona, Bellaterra Barcelona, Spain.
| | - Francisco Fabregues
- Institut Clinic Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic Barcelona, Spain
| | - Juan Fontes
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | | | | | - José Bellver
- Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Spain, Instituto Valenciano de Infertilidad (IVI-RMA) Valencia, Valencia, Spain
| | | |
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|
45
|
Lin Y, Qi J, Sun Y. Platelet-Rich Plasma as a Potential New Strategy in the Endometrium Treatment in Assisted Reproductive Technology. Front Endocrinol (Lausanne) 2021; 12:707584. [PMID: 34733236 PMCID: PMC8558624 DOI: 10.3389/fendo.2021.707584] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
Abstract
The success rate of assisted reproduction techniques (ART) has long been less than satisfactory albeit the great progress made in recent years, demonstrating the need for alternative options in the ART cycles. Growing evidence correlates the effect of intrauterine platelet-rich plasma (PRP) infusion on the endometrium with reassuring reproductive results. Thus, in this review, we focus on the current clinical and mechanical evidence on PRP and its effect on endometrial receptivity, and assess the features, benefits and limitations of the current studies and potential risks of PRP in ART.
Collapse
Affiliation(s)
- Yunying Lin
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Jia Qi
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yun Sun
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- *Correspondence: Yun Sun,
| |
Collapse
|
46
|
Buzzaccarini G, Vitagliano A, Andrisani A, Santarsiero CM, Cicinelli R, Nardelli C, Ambrosini G, Cicinelli E. Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review. J Assist Reprod Genet 2020; 37:2897-2911. [PMID: 33025403 PMCID: PMC7714873 DOI: 10.1007/s10815-020-01955-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Chronic endometritis (CE) is a frequent hysteroscopic and histological finding which affects embryo transfer implantation during IVF-ICSI cycles. In particular, CE impairs proper decidualization and, subsequently, implantation. Although this correlation has been clearly clarified, a pathophysiological explanation assembling all the studies performed has not been elucidated yet. For this reason, we have structured a systematic review considering all the original articles that evaluated a pathological element involved in CE and implantation impairment. METHODS The authors searched electronic databases and, after screening, collected 15 original articles. These were fully scanned and used to create a summary pathway. RESULTS CE is primarily caused by infections, which lead to a specific cytokine and leukocyte pattern in order to prepare the uterus to fight the noxa. In particular, the immunosuppression requested for a proper semi-allogenic embryo transfer implantation is converted into an immunoreaction, which hampers correct embryo implantation. Moreover, endometrial vascularization is affected and both irregular vessel density and luminal thickening and thrombosis reduce what we have first identified as endometrial flow reserve. Finally, incorrect uterine wave propagation could affect embryo contact with decidua. CONCLUSION This is the first summary of evidence on CE pathophysiology and its relationship with infertility. Understanding the CE pathophysiology could improve our knowledge in embryo transfer success.
Collapse
Affiliation(s)
- Giovanni Buzzaccarini
- Gynecological Clinic, UOS Medically Assisted Procreation, University of Padova, via Nicolò Giustiniani 3, Padova, Italy.
| | - Amerigo Vitagliano
- Gynecological Clinic, UOS Medically Assisted Procreation, University of Padova, via Nicolò Giustiniani 3, Padova, Italy
| | - Alessandra Andrisani
- Gynecological Clinic, UOS Medically Assisted Procreation, University of Padova, via Nicolò Giustiniani 3, Padova, Italy
| | - Carla Mariaflavia Santarsiero
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Piazza G. Cesare 11, Bari, Italy
| | - Rossana Cicinelli
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Piazza G. Cesare 11, Bari, Italy
| | - Claudia Nardelli
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Piazza G. Cesare 11, Bari, Italy
| | - Guido Ambrosini
- Gynecological Clinic, UOS Medically Assisted Procreation, University of Padova, via Nicolò Giustiniani 3, Padova, Italy
| | - Ettore Cicinelli
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Piazza G. Cesare 11, Bari, Italy
| |
Collapse
|
47
|
Kuroda K, Matsumura Y, Ikemoto Y, Segawa T, Hashimoto T, Fukuda J, Nakagawa K, Uchida T, Ochiai A, Horimoto Y, Arakawa A, Nojiri S, Itakura A, Sugiyama R. Analysis of the risk factors and treatment for repeated implantation failure: OPtimization of Thyroid function, IMmunity, and Uterine Milieu (OPTIMUM) treatment strategy. Am J Reprod Immunol 2020; 85:e13376. [PMID: 33166020 DOI: 10.1111/aji.13376] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/12/2020] [Accepted: 10/28/2020] [Indexed: 01/05/2023] Open
Abstract
PROBLEM What are the pregnancy outcomes after the OPtimization of Thyroid function, Immunity, and Uterine Milieu (OPTIMUM) treatment strategy in patients with repeated implantation failure (RIF)? METHOD OF STUDY Infertile women with a history of RIF after more than three embryo transfer (ET) cycles underwent implantation testing, including a hysteroscopy, endometrial biopsy for CD138 immunostaining and bacterial culture, and serum 25-hydroxyvitamin D3 , interferon-γ-producing helper T (Th1) cell, IL-4-producing helper T (Th2) cell, thyroid-stimulating hormone, thyroid peroxidase antibody, and thrombophilia screening between April 2017 and August 2018. We treated chronic endometritis with antibiotics, aberrant high Th1/Th2 cell ratios with vitamin D and/or tacrolimus intake, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. Of the 116 RIF women, 88 women with 133 ET cycles were recruited from a questionnaire-based survey regarding pregnancy outcomes. Fifty-nine consecutive RIF patients without the OPTIMUM treatment strategy were also recruited as a control. RESULTS The 116 women with RIF after the OPTIMUM treatment strategy were 38.3 ± 3.8 years old and had an implantation failure history over 5 (3-19) ET cycles. Implantation testing identified impaired intrauterine circumstances in 75 women (64.7%), an aberrant elevated Th1/Th2 cell ratio in 56 women (48.3%), and thyroid abnormalities in 33 women (28.4%). Cumulative ongoing pregnancy rates including spontaneous pregnancy in the patients aged < 40 and ≥ 40 years were 72.7% and 45.5% within two ET cycles, respectively. The pregnancy outcomes in the OPTIMUM group were significantly higher than those in the control. CONCLUSIONS The OPTIMUM treatment strategy improved pregnancy outcomes in patients with RIF.
Collapse
Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuko Matsumura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuko Ikemoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | | | | | | | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Toyoyoshi Uchida
- Departments of Metabolism and Endocrinology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Asako Ochiai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshiya Horimoto
- Departments of Human Pathology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsushi Arakawa
- Departments of Human Pathology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.,Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| |
Collapse
|
48
|
Mayoral Andrade G, Vásquez Martínez G, Pérez-Campos Mayoral L, Hernández-Huerta MT, Zenteno E, Pérez-Campos Mayoral E, Martínez Cruz M, Martínez Cruz R, Matias-Cervantes CA, Meraz Cruz N, Romero Díaz C, Cruz-Parada E, Pérez-Campos E. Molecules and Prostaglandins Related to Embryo Tolerance. Front Immunol 2020; 11:555414. [PMID: 33329514 PMCID: PMC7710691 DOI: 10.3389/fimmu.2020.555414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/19/2020] [Indexed: 12/20/2022] Open
Abstract
It is generally understood that the entry of semen into the female reproductive tract provokes molecular and cellular changes facilitating conception and pregnancy. We show a broader picture of the participation of prostaglandins in the fertilization, implantation and maintenance of the embryo. A large number of cells and molecules are related to signaling networks, which regulate tolerance to implantation and maintenance of the embryo and fetus. In this work, many of those cells and molecules are analyzed. We focus on platelets, polymorphonuclear leukocytes, and group 2 innate lymphoid cells involved in embryo tolerance in order to have a wider view of how prostaglandins participate. The combination of platelets and neutrophil extracellular traps (Nets), uterine innate lymphoid cells (uILC), Treg cells, NK cells, and sex hormones have an important function in immunological tolerance. In both animals and humans, the functions of these cells can be regulated by prostaglandins and soluble factors in seminal plasma to achieve an immunological balance, which maintains fetal-maternal tolerance. Prostaglandins, such as PGI2 and PGE2, play an important role in the suppression of the previously mentioned cells. PGI2 inhibits platelet aggregation, in addition to IL-5 and IL-13 expression in ILC2, and PGE2 inhibits some neutrophil functions, such as chemotaxis and migration processes, leukotriene B4 (LTB4) biosynthesis, ROS production, and the formation of extracellular traps, which could help prevent trophoblast injury and fetal loss. The implications are related to fertility in female when seminal fluid is deposited in the vagina or uterus.
Collapse
Affiliation(s)
- Gabriel Mayoral Andrade
- Research Centre Medicine National Autonomous University of Mexico-Benito Juárez Autonomous University of Oaxaca (UNAM-UABJO), Faculty of Medicine, Benito Juárez Autonomous University of Oaxaca, Oaxaca, Mexico
| | | | - Laura Pérez-Campos Mayoral
- Research Centre Medicine National Autonomous University of Mexico-Benito Juárez Autonomous University of Oaxaca (UNAM-UABJO), Faculty of Medicine, Benito Juárez Autonomous University of Oaxaca, Oaxaca, Mexico
| | | | - Edgar Zenteno
- Department of Biochemistry, School of Medicine, UNAM, Mexico City, México
| | - Eduardo Pérez-Campos Mayoral
- Research Centre Medicine National Autonomous University of Mexico-Benito Juárez Autonomous University of Oaxaca (UNAM-UABJO), Faculty of Medicine, Benito Juárez Autonomous University of Oaxaca, Oaxaca, Mexico
| | | | - Ruth Martínez Cruz
- Research Centre Medicine National Autonomous University of Mexico-Benito Juárez Autonomous University of Oaxaca (UNAM-UABJO), Faculty of Medicine, Benito Juárez Autonomous University of Oaxaca, Oaxaca, Mexico
| | | | - Noemi Meraz Cruz
- School of Medicine, Branch at National Institute of Genomic Medicine, Mexico City, Mexico
| | - Carlos Romero Díaz
- Research Centre Medicine National Autonomous University of Mexico-Benito Juárez Autonomous University of Oaxaca (UNAM-UABJO), Faculty of Medicine, Benito Juárez Autonomous University of Oaxaca, Oaxaca, Mexico
| | - Eli Cruz-Parada
- Biochemistry and Immunology Unit, National Technological of Mexico/ITOaxaca, Oaxaca, Mexico
| | - Eduardo Pérez-Campos
- Biochemistry and Immunology Unit, National Technological of Mexico/ITOaxaca, Oaxaca, Mexico
| |
Collapse
|
49
|
Di Simone N, Santamaria Ortiz A, Specchia M, Tersigni C, Villa P, Gasbarrini A, Scambia G, D’Ippolito S. Recent Insights on the Maternal Microbiota: Impact on Pregnancy Outcomes. Front Immunol 2020; 11:528202. [PMID: 33193302 PMCID: PMC7645041 DOI: 10.3389/fimmu.2020.528202] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 08/27/2020] [Indexed: 12/20/2022] Open
Abstract
Hormonal changes during and after pregnancy are linked with modifications in the maternal microbiota. We describe the importance of the maternal microbiota in pregnancy and examine whether changes in maternal microbiotic composition at different body sites (gut, vagina, endometrium) are associated with pregnancy complications. We analyze the likely interactions between microbiota and the immune system. During pregnancy, the gastrointestinal (gut) microbiota undergoes profound changes that lead to an increase in lactic acid-producing bacteria and a reduction in butyrate-producing bacteria. The meaning of such changes needs clarification. Additionally, several studies have indicated a possible involvement of the maternal gut microbiota in autoimmune and lifelong diseases. The human vagina has its own microbiota, and changes in vaginal microbiota are related to several pregnancy-related complications. Recent studies show reduced lactobacilli, increased bacterial diversity, and low vaginal levels of beta-defensin 2 in women with preterm births. In contrast, early and healthy pregnancies are characterized by low diversity and low numbers of bacterial communities dominated by Lactobacillus. These observations suggest that early vaginal cultures that show an absence of Lactobacillus and polymicrobial vaginal colonization are risk factors for preterm birth. The endometrium is not a sterile site. Resident endometrial microbiota has only been defined recently. However, questions remain regarding the main components of the endometrial microbiota and their impact on the reproductive tract concerning both fertility and pregnancy outcomes. A classification based on endometrial bacterial patterns could help develop a microbiota-based diagnosis as well as personalized therapies for the prevention of obstetric complications and personalized treatments through nutritional, microbiotic, or pharmaceutical interventions.
Collapse
Affiliation(s)
- Nicoletta Di Simone
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | - Monia Specchia
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Tersigni
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Paola Villa
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Antonio Gasbarrini
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Giovanni Scambia
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Silvia D’Ippolito
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| |
Collapse
|
50
|
Kuroda K, Horikawa T, Moriyama A, Nakao K, Juen H, Takamizawa S, Ojiro Y, Nakagawa K, Sugiyama R. Impact of chronic endometritis on endometrial receptivity analysis results and pregnancy outcomes. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:650-658. [PMID: 32969185 PMCID: PMC7654412 DOI: 10.1002/iid3.354] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/08/2020] [Accepted: 09/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the relationship between chronic endometritis (CE) and a personalized window of implantation (WOI), identified by results of endometrial receptivity analysis (ERA), and pregnancy outcomes following embryo transfer (ET) based on the ERA outcomes. METHODS The single-center, cross-sectional study was designed. The study population consisted of 101 infertile women who underwent endometrial sampling between June 2018 and February 2020. We recruited 88 patients who underwent ERA testing and immunohistochemistry of the plasma cell marker CD138 to diagnose CE within 3 months of testing. Subjects were divided into three groups as follows: 33 without CE (non-CE group); 19 with untreated CE at ERA testing (CE group); and 36 successfully treated for CE before ERA testing (cured-CE group). CE diagnosis was defined as ≥5 CD138-positive plasma cells per 10 random stromal areas at ×400 magnification. RESULTS In non-CE, CE, and cured-CE groups, the numbers of CD138-positive cells were 0.7 ± 1.0, 28.5 ± 30.4, and 1.3 ± 1.3, respectively (p < .001). The rates of "receptive" endometrium in non-CE and cured-CE groups were 57.6% (19 women) and 50.0% (18 women), respectively; however, in the CE group, this rate was significantly lower than the other two groups (p = .009) at only 15.8% (3 women). After CE were treated prior or posterior to the ERA test in cured-CE or CE groups, the clinical pregnancy rates at the first ET in non-CE, CE, and cured-CE groups were 77.8% (21/27 cycles), 22.2% (4/18 cycles), and 51.7% (15/29 cycles), respectively (p < 0.001). CONCLUSION CE had detrimental effects on the individual WOI, leading to embryo-endometrial asynchrony; therefore, diagnosis and treatment of CE should be done before ERA testing.
Collapse
Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takashi Horikawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Azusa Moriyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Kazuki Nakao
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Hiroyasu Juen
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Yuko Ojiro
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| |
Collapse
|