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Li J, Wei J, Chen S, Wang X, Chen J, Zeng D, Fan L. Prevalence and risk factors for chronic endometritis in patients with adenomyosis and infertility: a retrospective cohort study. BMC Womens Health 2024; 24:403. [PMID: 39014375 PMCID: PMC11251133 DOI: 10.1186/s12905-024-03245-2] [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: 03/23/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND To explore the incidence of chronic endometritis (CE) in patients with infertility and different forms of adenomyosis and analyze potential high-risk factors for infection. METHODS This retrospective cohort study included 154 patients with infertility in the Liuzhou Maternity and Child Healthcare Hospital. Among them, 77 patients with adenomyosis were divided into four subgroups based on magnetic resonance imaging (MRI): internal, exterior, intramural, and full-thickness. Meanwhile, 77 patients did not have adenomyosis. Hysteroscopy and endometrial biopsy were performed in the proliferative phase. The main outcome measures were the morphology of the endometrium, syndecan-1 (CD138) immunohistochemical staining, clinical characteristics, and prevalence of CE in the adenomyosis subgroups. RESULTS In comparison to the non-adenomyosis group, the adenomyosis group had significantly higher body mass index (BMI) and CA125 levels. The menstrual cycle in the adenomyosis group was significantly shorter, and menarche was significantly earlier. In comparison to the non-adenomyosis group, the adenomyosis group had a significantly higher diagnostic rate of CE (75.3% vs. 46.8% according to hysteroscopy and 74.0% vs. 33.8% according to histopathology, both with p < .050). The incidence of CE was significantly lower in patients with internal adenomyosis when compared with the other three subgroups. Increased BMI contributed to a higher risk of CE. CONCLUSIONS The prevalence of CE was significantly higher in patients with adenomyosis and infertility. The differences in the incidence of CE are closely associated with the classification of adenomyosis. When patients with infertility are diagnosed with adenomyosis, it is recommended to identify the subtype and screen for endometritis.
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Affiliation(s)
- Jingjing Li
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Jiajia Wei
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Saiqiong Chen
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Xindan Wang
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Jing Chen
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Dingyuan Zeng
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Li Fan
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China.
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Kapetanios V, Lampraki M, Georgoulias G, Kasdaglis S, Kliafas S, Gkavra N, Xountasi M, Tsilivakos V, Leventopoulos M. Correlation between hysteroscopic features and specific microbial species in women with chronic endometritis. Heliyon 2024; 10:e30259. [PMID: 38711647 PMCID: PMC11070820 DOI: 10.1016/j.heliyon.2024.e30259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
Objective and rationale Chronic endometritis (CE) has recently been associated with unexplained infertility and recurrent miscarriages. The current gold standard for CE detection is histopathological examination. However, office hysteroscopy and endometrial cultures are also significant, due to the possible link between CE and various microorganisms. Bacterial colonization of the endometrium has been associated with reduced success rates of in vitro fertilisation embryo transfer. Few studies have tried to correlate CE hysteroscopy findings with pathogenic microorganisms. This prospective cohort study sought to establish whether hysteroscopic diagnostic lesions correlate with specific microbial species. Methods The study encompassed women undergoing diagnostic tests for a range of subfertility health issues. 189 women completed the standard office diagnostic hysteroscopy (DH). 181 had also endometrial samples taken for microbial culture investigation. Correlation analysis (χ2 and Fisher's exact test) between hysteroscopic findings suggestive of CE and endometrial cultures was carried out. Logistic regression models were also fitted to measure whether a positive endometrial culture could affect CE conditions. Results A significant association of E. coli was observed between the hysteroscopically characterized CE + group with focal hyperplasia, when compared to the non-CE group. Logistic regression analysis revealed that women positive for E. coli were 4.423 times more likely to have focal endometrial hyperplasia. No other significant correlations were identified between DH and positive endometrial cultures. Conclusions The presence of E. coli in the endometrium was significantly correlated with focal hyperplasia findings from hysteroscopy, emphasizing the importance of microbial cultures in the diagnosis and targeted treatment of CE in women with subfertility.
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Affiliation(s)
| | - Maria Lampraki
- Department of Gynecology, Locus Medicus S.A., Athens, Greece
| | | | | | - Stylianos Kliafas
- School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Greece
| | - Nikolaos Gkavra
- School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Greece
| | - Maria Xountasi
- Department of Cellular Biology and Immunology, Locus Medicus S.A., Athens, Greece
| | - Vassilis Tsilivakos
- Department of Cellular Biology and Immunology, Locus Medicus S.A., Athens, Greece
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3
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Rani K, Durga Mounika K, Singhal S. Correlation of Hysteroscopy With Histopathological Findings of the Endometrium in Women With Polycystic Ovary Syndrome (PCOS)-Related Infertility. Cureus 2024; 16:e57666. [PMID: 38707142 PMCID: PMC11070178 DOI: 10.7759/cureus.57666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction There have been numerous studies on the anovulatory factor, leading to infertility in women with polycystic ovary syndrome (PCOS); however, studies on the endometrium factor causing infertility in PCOS women are scarce. While hysteroscopy can accurately diagnose endometrial disorders such as endometrial polyps, it may be ineffective in detecting probable endometrial pathologies due to different hormonal habitats in these patients. Materials and methods Sixty patients with PCOS-related infertility were included in the study. All participants underwent hysteroscopic examination followed by endometrial biopsy and histopathological examination. The clinical and hormonal profiles of two main subgroups, that is, (a) normal endometrium (N), which included proliferative endometrium and secretory endometrium on histology, and (b) disordered endometrium (D), which included disordered endometrium on histology, were compared. Results There was no correlation between hysteroscopic and histopathological findings of PCOS infertile women. In the subgroup analysis of the two main histological types, that is, normal (proliferative and secretory) and disordered (disordered endometrium), age (28.70±4.66 vs. 32.9±5.61, p=0.012) and duration of amenorrhea (5.49±2.43 vs. 7.82±2.93, p=0.008) were significantly higher in the disordered group. There was a statistically nonsignificant higher BMI in the patients of the disordered endometrium group. Conclusion These findings suggest that endometrial biopsy and histopathological evaluation along with hysteroscopy should be desired in women with PCOS-related infertility, especially if they are in the late reproductive age group and have a longer duration of amenorrhea, regardless of endometrial thickening. This approach is essential to diagnose and treat endometrial disorder, which can be an additional cause of infertility, recurrent implantation failure, and recurrent pregnancy loss, in addition to ovulatory dysfunction.
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Affiliation(s)
- Kanchan Rani
- Obstetrics and Gynaecology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, IND
| | - Kante Durga Mounika
- Obstetrics and Gynaecology, Teerthanker Mahaveer Medical college and Research Centre, Moradabad, IND
| | - Shivangi Singhal
- Obstetrics and Gynaecology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, IND
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Xia Q, Lv S, Xu H, Wang X, Xie Z, Lin R, Zhang J, Shu C, Chen Z, Gong X. Non-invasive evaluation of endometrial microvessels via in vivo intrauterine photoacoustic endoscopy. PHOTOACOUSTICS 2024; 36:100589. [PMID: 38318428 PMCID: PMC10839775 DOI: 10.1016/j.pacs.2024.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
The endometrium microvessel system, responsible for supplying oxygen and nutrients to the embryo, holds significant importance in evaluating endometrial receptivity (ER). Visualizing this system directly can significantly enhance ER evaluation. Currently, clinical methods like Narrow-band hysteroscopy and Color Doppler ultrasound are commonly used for uterine blood vessel examination, but they have limitations in depth or resolution. Endoscopic Photoacoustic Imaging (PAE) has proven effective in visualizing microvessels in the digestive tract, while its adaptation to uterine imaging faces challenges due to the uterus's unique physiological characteristics. This paper for the first time that uses high-resolution PAE in vivo to capture a comprehensive network of endometrial microvessels non-invasively. Followed by continuous observation and quantitative analysis in the endometrial injury model, we further corroborated that PAE detection of endometrial microvessels stands as a valuable indicator for evaluating ER. The PAE system showcases its promising potential for integration into reproductive health assessments.
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Affiliation(s)
- Qingrong Xia
- Institute of Medical Imaging, University of South China, Hengyang 421001, China
- Affiliated Nanhua Hospital, University of South China, Hengyang 421002, China
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Shengmiao Lv
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Haoxing Xu
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Xiatian Wang
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Zhihua Xie
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Riqiang Lin
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Department of Electrical and Electronic Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Jinke Zhang
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Chengyou Shu
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Zhiyi Chen
- Institute of Medical Imaging, University of South China, Hengyang 421001, China
- Institution of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha 410000, China
| | - Xiaojing Gong
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
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Wei L, Zhao Y, Xu S, Zhang C. Association Between Endometritis and Endometrial Polyp: A Mendelian Randomization Study. Int J Womens Health 2023; 15:1963-1970. [PMID: 38144947 PMCID: PMC10749105 DOI: 10.2147/ijwh.s434299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background Endometrial polyps (EPs) are one of the most common intrauterine benign tumors, and are an important cause of uterine bleeding and female infertility. Previous studies have suggested that endometritis may contribute to the onset of EPs. This study aims to reveal the causal effect of endometritis on EPs by a two-sample Mendelian randomization (MR) study. Methods Utilizing summarized statistics from genome-wide association studies (GWAS) in the European population, we conducted a Mendelian randomization study. In order to select suitable instrumental variables (IVs) that were significantly related to the exposures, a number of quality control approaches were used. For endometritis, 2144 cases and 111,858 controls were included, while for EPs, 2252 cases and 460,758 controls. Utilizing the inverse variance weighted (IVW) as the primary analysis, the data were subjected to a two-sample MR analysis, and the weighted median (WM) technique and MR-Egger regression were carried out additionally. The sensitivity analysis revealed neither heterogeneity nor horizontal pleiotropy. Results Four independent single nucleotide polymorphisms (SNPs) from endometritis GWAS as IVs were selected. The IVW data did not agree to a causal association between endometritis and EPs (β=1.11e-04, standard error [SE] =4.88e-04, P = 0.82). Directional pleiotropy did not affect the outcome, according to the MR-Egger regression (intercept = 0.09, P = 0.10); Additionally, it showed no causation association between endometritis and EPs (β= -3.28e-03, SE = 3.54e-03, P = 0.45). Similar results were obtained using the weighted-median method (β=8.56e-05, SE=5.97e-04, P = 0.89). No proof of heterogeneity and horizontal pleiotropy between IV estimates was discovered. Conclusion In conclusion, by large scale genetic data, the results of this MR analysis provided suggestive evidence that the presence of endometritis is not associated with higher EPs risk.
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Affiliation(s)
- Longlong Wei
- Department of Reproductive Medicine Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
- Department of Reproductive Medicine Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Yan Zhao
- Department of Reproductive Medicine Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Siyue Xu
- Department of Reproductive Medicine Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Cuilian Zhang
- Department of Reproductive Medicine Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
- Department of Reproductive Medicine Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
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Pérez-Cejuela BA, Vitale SG, Pérez-Medina T, Rios-Vallejo M, Della Corte L, Vicente AR, Angioni S, Calles-Sastre L. Hysteroscopic versus histopathological agreement in the diagnosis of chronic endometritis: results from a retrospective observational study. Arch Gynecol Obstet 2023; 308:1817-1822. [PMID: 37737882 PMCID: PMC10579145 DOI: 10.1007/s00404-023-07163-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: 06/21/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To evaluate the agreement rate between hysteroscopy and pathological examination in case of chronic endometritis. METHODS A retrospective observational study carried out at Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, Spain, from January 2021 to June 2022 was performed by obtaining data from 115 medical records of women who underwent office hysteroscopies that was compared with the findings of final histological examination of endometrial biopsy. Cohen's kappa index was used to evaluate this agreement rate. In addition, sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were obtained. RESULTS The agreement between hysteroscopic findings and histological examination showed a modest result with a Cohen's kappa index of 34%. In addition, we obtained a specificity of 70% and a sensitivity of 64%. The positive and negative predictive value were 60.8% and 73.4%, respectively. An excellent agreement rate (100%) between histological and hysteroscopic results was observed in presence of hyperemia and micropolyps. CONCLUSION Although the sample size is not as large as that of other studies published so far, the first glance of our experience is that hysteroscopic signs are not yet sufficient to make an accurate diagnosis of chronic endometritis, thus requiring a histopathological confirmation to make it.
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Affiliation(s)
- Belén Almoguera Pérez-Cejuela
- Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, 28223, Majadahonda, Madrid, Spain
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124, Cagliari, Italy
| | - Tirso Pérez-Medina
- Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, 28223, Majadahonda, Madrid, Spain.
| | - Mar Rios-Vallejo
- Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, 28223, Majadahonda, Madrid, Spain
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131, Naples, Italy
| | - Ana Royuela Vicente
- Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, 28223, Majadahonda, Madrid, Spain
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124, Cagliari, Italy
| | - Laura Calles-Sastre
- Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, 28223, Majadahonda, Madrid, Spain
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Wu X, Niu S, Zhao T. Establishment and verification of hysteroscopic scoring system for chronic endometritis in infertile patients. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:46-53. [PMID: 37283117 PMCID: PMC10407986 DOI: 10.3724/zdxbyxb-2022-0513] [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: 09/01/2022] [Accepted: 12/27/2022] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To establish and verify a hysteroscopic scoring system for the diagnosis of chronic endometritis (CE) in infertile patients. METHODS A total of 238 infertile patients who underwent hysteroscopy and endometrial biopsy in the Reproductive Medicine Center, Shijiazhuang Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University from October 1 to December 31, 2019 were enrolled in the study. According to the results of CD138 immunohistochemistry, the patients were divided into CE group (n=73) and non-CE group (n=165). Univariate and binary logistic regression analyses were used to screen the risk factors of CE and a nomogram was establish for hysteroscopic scoring. Receiver operating characteristic (ROC) curve, calibration curve and Bootstrap resampling method were used to evaluate and verify the system. RESULTS Univariate and binary logistic regression analyses showed that hyperemia area (HA) degree ≥2, micropolyps, polypoid hyperplasia of endometrium and history of ectopic pregnancy were independent risk factors for CE (all P<0.05). A nomogram was generated to establish a hysteroscopy scoring system based on the above four factors. The area under ROC curve of the hysteroscopy scoring system for predicting CE was 0.801 (95%CI:0.742-0.861), the sensitivity was 74.0% and the specificity was 73.9%. The calibration curve showed that the predicting value of the scoring system was highly consistent with the actual value. In the internal verification, the C-index was 0.7811. The predicting value of the verification group in the calibration curve was basically consistent with the actual value, indicating that the scoring system had good stability. CONCLUSIONS The hysteroscopic scoring system composed of HA, micropolyp, polypoid hyperplasia of endometrium and history of ectopic pregnancy can effectively and intuitively predict CE, which is conducive to improving the diagnosis of CE.
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Affiliation(s)
- Xiaohua Wu
- Reproductive Medicine Center, Shijiazhuang Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University, Shijiazhuang 050035, China.
| | - Shufang Niu
- Reproductive Medicine Center, Shijiazhuang Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University, Shijiazhuang 050035, China
| | - Tingting Zhao
- Reproductive Medicine Center, Shijiazhuang Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University, Shijiazhuang 050035, China
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Sharami SH, Kabodmehri R, Milani F, Sorouri ZR, Ghanami N, Fatemeh Dalil S, Eslami-Kenarsari H. The prevalence of endometrial polyp in women with tubal factor infertility is higher than male factor infertility: Is PID one of the causes of endometrial polyp? J Obstet Gynaecol Res 2023; 49:658-664. [PMID: 36448572 DOI: 10.1111/jog.15485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/18/2022] [Accepted: 10/20/2022] [Indexed: 12/02/2022]
Abstract
AIMS Previous studies have shown an association between chronic endometritis and endometrial polyps, and only one study in infertile women reported an association between tubal obstruction and polyps. This study aimed to compare the prevalence of endometrial polyps in two groups of women with tubal factor infertility and male factor infertility to assess if is there any association between tubal factor infertility and endometrial polyps. METHODS This case-control study was performed on infertile women. The case group included women with tubal factor infertility and the control group included all women with male factor infertility. In all patients, vaginal ultrasound was performed between days 8 and 12 of the menstrual cycle to diagnose endometrial polyp, its size, and number. Demographic and obstetrics variables were recorded. Patients underwent hysteroscopy and polypectomy and the diagnosis of the polyp was confirmed by pathology report. RESULT In the present study, 245 people participated in two groups. There was a statistically significant difference between the two groups in terms of demographic and obstetric characteristics like type of infertility, duration of infertility, and gravidity. The prevalence of polyps in the tubal factor group was higher than in the male factor group (63 [60%] vs. 12 [9.8%]), and this difference was statistically significant (p = 0.0001). In addition, the prevalence of chronic endometritis in the tubal factor group was higher than in the male factor group (19 [18.8%] vs. 4 [3.3%]), and this difference was statistically significant (p = 0.001). CONCLUSIONS In the present study, a strong association was observed between endometrial polyps and tubal obstruction, and considering that the most common cause of tubal obstruction is pelvic and genital infections, after confirmation with more studies, it may be possible to consider antibiotic treatment in these patients, especially in patients with recurrent polyps.
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Affiliation(s)
- Seyedeh Hajar Sharami
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Roya Kabodmehri
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Forozan Milani
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Rafie Sorouri
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Nasrin Ghanami
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyedeh Fatemeh Dalil
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Habib Eslami-Kenarsari
- Vice-Chancellorship of Research and Technology, Guilan University of Medical Science, Rasht, Iran
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Luncan M, Huniadi A, Bimbo-Szuhai E, Botea M, Zaha I, Stefan L, Beiusanu C, Romanescu D, Pallag A, Bodog A, Pop LO, Șandor MI. The effectiveness of intrauterine antibiotic infusion versus oral antibiotic therapy in the treatment of chronic endometritis in patients during IVF (in vitro fertilization) procedures. BMC Womens Health 2022; 22:529. [PMID: 36528581 PMCID: PMC9759887 DOI: 10.1186/s12905-022-02128-8] [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: 09/16/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic Endometritis (CE) is a subtle pathology, likely infectious in most cases, with a negative impact on the female fertility, but often overlooked even among fertility specialists. The purpose of the study is to demonstrate the predominant infectious nature of CE and to find the best therapeutic option by comparing the results of oral antibiotic therapy versus intrauterine antibiotic infusion in patients with CE undergoing IVF procedures. The objective was to compare the cure rate of CE-defined as the percentage of patients without CE at the test of cure, between the two groups and, the hysteroscopic aspect with the positive CD 138 staining. METHODS This was a prospective, case-control study that took place in a single university fertility clinic, in Oradea, Romania and included 57 patients with CE divided into 2 groups: orally administered antibiotics group who received a combination of antibiotics compared to intrauterine infusion group who received intrauterine infusion of antibiotic. Chronic Endometritis was diagnosed through hysteroscopy and immunohistochemistry for CD 138. Patients in both groups were tested for CE twice to evaluate the cure rate after oral combination antibiotic therapy versus intrauterine infusion of antibiotic. RESULTS Out of 115 patients with endometrial biopsies 57 tested positive for CE, with a 49.6% chronic endometritis prevalence. Among the group that was administered oral antibiotics, 11 patients (45.83%) experienced CE resolution after triple antibiotic therapy. Of the intrauterine infusion group, 25 patients (89.29%) presented negative results (p 0.0020). The normal hysteroscopic aspect had a similar prevalence in the patients with immunohistochemical positive and negative CD 138. CONCLUSIONS Our study demonstrated the effectiveness and superiority of intrauterine antibiotic infusion over the use of oral combination antibiotic therapy for CE cure. TRIAL REGISTRATION ISRCTN17542620/14.09.2022.
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Affiliation(s)
- Mihai Luncan
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania ,Pelican Clinical Hospital, Corneliu Coposu Street, 2, 41045Ö, Oradea, Romania
| | - Anca Huniadi
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania ,Pelican Clinical Hospital, Corneliu Coposu Street, 2, 41045Ö, Oradea, Romania ,Calla-Infertility Diagnostic and Treatment Center, Constantin A. Rosetti Street, 410103 Oradea, Romania
| | - Erika Bimbo-Szuhai
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania ,Pelican Clinical Hospital, Corneliu Coposu Street, 2, 41045Ö, Oradea, Romania
| | - Mihai Botea
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania ,Pelican Clinical Hospital, Corneliu Coposu Street, 2, 41045Ö, Oradea, Romania
| | - Ioana Zaha
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania ,Calla-Infertility Diagnostic and Treatment Center, Constantin A. Rosetti Street, 410103 Oradea, Romania
| | - Liana Stefan
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania ,Pelican Clinical Hospital, Corneliu Coposu Street, 2, 41045Ö, Oradea, Romania ,Calla-Infertility Diagnostic and Treatment Center, Constantin A. Rosetti Street, 410103 Oradea, Romania
| | - Corina Beiusanu
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania
| | - Dana Romanescu
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania
| | - Annamaria Pallag
- grid.19723.3e0000 0001 1087 4092Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 Nicolae Jiga Street, 410028 Oradea, Romania
| | - Alin Bodog
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania
| | - Laurean Ovidiu Pop
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania
| | - Mircea Ioan Șandor
- grid.19723.3e0000 0001 1087 4092Faculty of Medicine and Pharmacy, University of Oradea, 1St December Square 10, 410073 Oradea, Romania
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10
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Wang S, Li F, Zhang W, Sui X, Hao C. Investigation of the Relationship between Chronic Endometritis Manifestations under Hysteroscope and CD138 Expression. Appl Bionics Biomech 2022; 2022:8323017. [PMID: 35911610 PMCID: PMC9337969 DOI: 10.1155/2022/8323017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Methods This study was performed to retrospectively analyze clinical cases of 523 CE patients from January 2018 to June 2020 that were confirmed by hysteroscopy before in vitro fertilization. Based on manifestations of CE under hysteroscopy, the cases were divided into three cohorts, i.e., hyperemia cohort where the patients had diffuse endometrium hyperemia; endometrial micropolyp cohort, and endometrial stroma edema and hyperplasia cohort. Small amount of endometrial tissue was collected from the patients, and CD138 IHC examination was performed. According to the results of CD138 IHC, positive patients were given antibiotic treatment (doxycycline 100 mg BID orally for 14 days), and hysteroscopy was performed again after treatment to check the efficacy of antibiotics. Results In the comparison of overall status for all patient cohorts, infertility type, BMI, bFSH, bLH, bP, bT, PRL, AMH, and CA125 were varied markedly across all cohorts (P < 0.05), with predominant incidences of polycystic ovary syndrome (PCOS) peaking within hyperemia cohort. Incidence/diagnostic rate for CD138 within hyperemia cohort was 10.06%, which was lower than the 63.16% in micropolyp cohort and 74% in edema and hyperplasia cohort (P < 0.05). No major variation existed within CD138 across micropolyp cohort/edema and hyperplasia cohort (P > 0.05). After CD138-positive CE patients were treated with antibiotics, the effective rate (0/16) within hyperemia cohort was lower than micropolyp cohort (73.61%, 53/72) and edema and hyperplasia cohort (83.24%, 154/185) (P < 0.05). The effective rate across micropolyp cohort/edema and hyperplasia cohort was not significantly different (P > 0.05). Conclusion Cases of diffuse endometrial hyperemia under hysteroscope had the lowest positive rate of CD138, and the effect of antibiotic treatment on these patients was poor. The positive rate of CD138 in patients with endometrial micropolyps and endometrial stroma edema and hyperplasia under hysteroscope was high, and the effect of antibiotic treatment was better.
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Affiliation(s)
- Shuang Wang
- School of Medicine, Shandong University, Jinan, Shandong, China
- Reproductive Medicine Centre, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - FengHua Li
- Reproductive Medicine Centre, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Wei Zhang
- Reproductive Medicine Centre, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - XiaoLong Sui
- Department of Pathology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - CuiFang Hao
- School of Medicine, Shandong University, Jinan, Shandong, China
- Reproductive Medicine Centre, Qingdao Women and Children's Hospital, Qingdao, Shandong, China
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11
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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.
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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
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12
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Mercer VJ, Naseemuddin A, Webb A. Monckeberg's arteriosclerosis: a case report of chronic endometritis presenting as postmenopausal bleeding. Menopause 2021; 29:247-249. [PMID: 34905746 DOI: 10.1097/gme.0000000000001902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Chronic endometritis is rarely reported in the postmenopausal population. Here, we describe a case of chronic endometritis in a patient who had undergone premature menopause that was later found to have Monckeberg arteriosclerosis (MocA) of the uterine vessels. METHODS A review of the literature revealed a single report of MocA affecting the uterine vessels and no reports in a patient who had undergone premature menopause. A case of a 69-year-old presenting with postmenopausal bleeding and having the diagnosis of chronic endometritis is described. RESULTS Following definitive management with hysterectomy, final histopathology showed MocA of the uterine vessels. CONCLUSIONS The lack of reviews of chronic endometritis in postmenopausal women reveals a gap in the literature. Further studies are necessary to review MocA and decreased uterine perfusion in the context of a possible predisposition to chronic endometrial infection and/or inflammation.
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Affiliation(s)
| | - Ather Naseemuddin
- Horizon Health, Dalhousie University Faculty of Medicine, Saint John, NB, Canada
| | - Amanda Webb
- Horizon Health, Dalhousie University Faculty of Medicine, Saint John, NB, Canada
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13
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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.
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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
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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.
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15
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Pirtea P, Cicinelli E, De Nola R, de Ziegler D, Ayoubi JM. Endometrial causes of recurrent pregnancy losses: endometriosis, adenomyosis, and chronic endometritis. Fertil Steril 2021; 115:546-560. [PMID: 33581856 DOI: 10.1016/j.fertnstert.2020.12.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 12/19/2022]
Abstract
Chronic inflammatory processes affecting the endometrium, as encountered in endometriosis, adenomyosis, and chronic endometritis, alter endometrial receptivity. These disorders are associated with early pregnancy losses and possibly recurrent pregnancy losses (RPL). In the cases of endometriosis, other factors associated with the disease also are susceptible of causing miscarriages and possibly RPL, such as an impact of intrapelvic inflammatory processes affecting the oocyte and embryo in case of natural conception. Conversely these latter effects obviously are bypassed in case of assisted reproductive technology. Chronic inflammation of the endometrium in the condition known as chronic endometritis also causes early pregnancy losses and RPL with beneficial effects achieved when specific treatment is undertaken.
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Affiliation(s)
- Paul Pirtea
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medicine Paris Ouest, Suresnes, France.
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Bari, Italy; Piazza Giulio Cesare, Policlinico, Bari, Italy
| | - Rosalba De Nola
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Bari, Italy; Piazza Giulio Cesare, Policlinico, Bari, Italy
| | - Dominique de Ziegler
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medicine Paris Ouest, Suresnes, France
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medicine Paris Ouest, Suresnes, France
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16
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Song D, He Y, Wang Y, Liu Z, Xia E, Huang X, Xiao Y, Li TC. Impact of antibiotic therapy on the rate of negative test results for chronic endometritis: a prospective randomized control trial. Fertil Steril 2021; 115:1549-1556. [PMID: 33549312 DOI: 10.1016/j.fertnstert.2020.12.019] [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: 05/03/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the rates of negative test results for chronic endometritis (CE) between subjects who did and did not receive antibiotic treatment. DESIGN Prospective, single-blind randomized controlled trial. SETTING Tertiary hysteroscopic center in a university teaching hospital. PATIENT(S) A total of 132 women with CE confirmed with immunohistochemical study with CD138 epitope. INTERVENTION(S) Women randomized to antibiotic therapy received oral levofloxacin 500 mg and tinidazole 1,000 mg daily for 14 days. Women randomized to the control group did not receive any treatment. A repeated endometrial biopsy was performed 4 to 8 weeks after the initial biopsy to determine whether CE was still present. MAIN OUTCOME MEASURE(S) The rate of negative test results for CE (from positive to negative). RESULT(S) The CE rate of negative test results in the treatment group (89.3%) after one course of antibiotic treatment was significantly higher than that in the control group (12.7%). Among subjects who attempted pregnancy, there was no significant difference in ongoing pregnancy rates and miscarriage rates between the treatment arm (43.2%, 5.4%) and the control arm (25.7%, 14.3%). Among subjects randomized, there was also no significant difference in ongoing pregnancy rates and miscarriage rates between the treatment arm (27.1%, 3.4%) and the control arm (16.4%, 9.1%). CONCLUSION A course of broad-spectrum oral antibiotic therapy for 14 days is effective in the treatment of CE in >89.8% of cases. However, it is not yet clear whether treatment improved pregnancy outcomes. CLINICAL TRIAL IDENTIFICATION NUMBER NCT02648698.
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Affiliation(s)
- Dongmei Song
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Yanfei He
- Reproductive Health Department, Dezhou Decheng Maternal and Child Health Hospital, Shandong, People's Republic of China
| | - Yixuan Wang
- University of Science and Technology, Beijing, People's Republic of China
| | - Ziyu Liu
- Department of Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Enlan Xia
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Xiaowu Huang
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Yu Xiao
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Tin-Chiu Li
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China; Assisted Conception Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China.
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17
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A New Hysteroscopic Scoring System for Diagnosing Chronic Endometritis. J Minim Invasive Gynecol 2020; 27:1127-1132. [PMID: 32240839 DOI: 10.1016/j.jmig.2019.08.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To develop a new hysteroscopic morphologic scoring system to diagnose chronic endometritis (CE). DESIGN Prospective study. SETTING Medical hysteroscopy office. PATIENTS In total, 320 patients underwent hysteroscopy, dilation and curettage, and endometrial biopsies from February 2017 to June 2018 with the intention of undergoing assisted reproductive technology treatment because of infertility or recurrent miscarriage. INTERVENTIONS All patients underwent hysteroscopy, dilation and curettage, and endometrial biopsies for histologic examination and were classified according to the new hysteroscopic morphologic scoring system. MEASUREMENTS AND MAIN RESULTS Of the 320 patients, 164 received a diagnosis of CE by histology (group A), whereas 156 patients were found not to have CE (group B). A total of 116 patients were diagnosed by our hysteroscopy scoring system to have CE, and 204 patients did not have CE. The scoring system showed a sensitivity and specificity of 62.8% and 91.7%, respectively. The positive predictive values and negative predictive values were 88.8% and 70.1%, respectively. Receiver operating characteristic analysis showed a cutoff value of >2 and an area under the curve of 0.823. Hysteroscopic and histologic grading showed moderate agreement (κ index = 0.529). CONCLUSION Our hysteroscopic scoring system has a high sensitivity and specificity for CE; it is hoped that its use can reduce interobserver variability. Future clinical studies are warranted to confirm the validity and clinical applicability of the proposed hysteroscopic morphologic scoring system for CE.
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18
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Amooee S, Akbarzadeh-Jahromi M, Motavas M, Zarei F. Comparing endometrial hysteroscopic and histological findings of infertile women with polycystic ovary syndrome and unexplained infertility: A cross-sectional study. Int J Reprod Biomed 2020; 18:33-40. [PMID: 32043069 PMCID: PMC6996121 DOI: 10.18502/ijrm.v18i1.6195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/20/2019] [Accepted: 08/27/2019] [Indexed: 11/24/2022] Open
Abstract
Background Infertility is a critical condition in women with polycystic ovary syndrome (PCOS), caused not only by anovulation but also by endometrial abnormality. Objective This study aimed to evaluate and compare the hysteroscopic and histological findings of endometrial biopsies in infertile women with PCOS and normal endometrial thickness and women with unexplained infertility (UI). Materials and Methods This cross-sectional study compared the initial hysteroscopy and endometrial histological findings of 70 infertile women with PCOS and normal endometrial thickness with those of 35 women with UI. The relationship between endometrial histology and clinical parameters such as including luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, testosterone, prolactin, fasting blood sugar, body mass index (BMI), and infertility duration was analyzed. Results The mean age of women with PCOS was significantly lower than that of women with UI (27.5 ± 4.1 vs. 30 ± 4.5 years, respectively) (p < 0.001). The mean BMI was higher in women with PCOS than in women with UI (28.7 ± 4.4 vs. 25.1 ± 3 kg/m2) (p < 0.001). The hysteroscopic findings of all women with PCOS were normal, whereas 91.4% of women with UI had normal hysteroscopic findings, 2.9% had a polyp, and 5.7% had endometrial thickening. The histological findings of women with PCOS revealed proliferative endometrium in 54.3%, disordered proliferative endometrium in 17.1%, secretory endometrium in 8.6%, and endometrial polyp in 17.1%, whereas these percentages in women with UI were 28.6%, 0%, 54.3%, and 20%, respectively. Conclusion The hysteroscopic evaluation alone of infertile women might not detect all probable endometrial pathologies in women with PCOS.
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Affiliation(s)
- Sedigheh Amooee
- Department of Obstetrics and Gynecology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojgan Akbarzadeh-Jahromi
- Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.,Maternal-fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maedeh Motavas
- Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Zarei
- Department of Obstetrics and Gynecology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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19
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Cicinelli E, Vitagliano A, Kumar A, Lasmar RB, Bettocchi S, Haimovich S. Unified diagnostic criteria for chronic endometritis at fluid hysteroscopy: proposal and reliability evaluation through an international randomized-controlled observer study. Fertil Steril 2019; 112:162-173.e2. [PMID: 31104760 DOI: 10.1016/j.fertnstert.2019.03.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To develop a consensus on the diagnostic criteria for chronic endometritis (CE) at hysteroscopy (HSC), and to evaluate these proposed criteria in a randomized-controlled observer study. DESIGN Systematic review of studies evaluating the diagnostic accuracy of HSC in CE diagnosis; Delphi consensus on hysteroscopic diagnostic criteria for CE; randomized-controlled observer study to evaluate the reproducibility of the proposed diagnostic criteria. SETTING Not applicable. PARTICIPANT(S) Experts from different countries were involved in the systematic review and contributed to the Delphi consensus. Physicians from different countries were involved in the observer study. INTERVENTION(S) After reaching consensus on the diagnostic criteria, the Delphi poll created a questionnaire including 100 hysteroscopic pictures (50 from women with CE [domain 1] and 50 from women without CE [domain 2]), with a single question per picture (Answer_A: suggestive of CE; answer B: not suggestive of CE). A total of 200 physicians were invited to take part in the observer study. Before completing the questionnaire, physicians were randomized to receive a description of the diagnostic criteria (group A) or no such information (group B). MAIN OUTCOME MEASURE(S) The primary outcome was to compare the questionnaire scores for the two groups of observers. The secondary outcome was to assess the interobserver agreement in the diagnosis of CE in each group. RESULT(S) A total of 126 physicians completed the questionnaire (62 in group A and 64 in group B). Observers in group A obtained higher total scores compared with those in group B (P<.001). Specifically, group A showed higher mean score in domain 1 (P<.001), but not in domain 2 (P=.975). A substantial agreement was found among observers in group A (intraclass correlation coefficient [ICC] 0.78), whereas a fair agreement was found among observers in group B (ICC 0.40). CONCLUSION(S) This randomized-controlled observer study found a positive impact of our criteria on physicians' ability to recognize CE.
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Affiliation(s)
- Ettore Cicinelli
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, Policlinico University of Bari, Bari, Italy
| | - Amerigo Vitagliano
- Department of Women and Children's Health University of Padua, Padua, Italy.
| | - Alka Kumar
- Hysteroscopic Surgery Division, Women's Health Centre, Jaipur, India
| | | | - Stefano Bettocchi
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, Policlinico University of Bari, Bari, Italy
| | - Sergio Haimovich
- Department of Obstetrics and Gynecology, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
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20
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Di Nicuolo F, D'Ippolito S, Castellani R, Rossi ED, Masciullo V, Specchia M, Mariani M, Pontecorvi A, Scambia G, Di Simone N. Effect of alpha-lipoic acid and myoinositol on endometrial inflammasome from recurrent pregnancy loss women. Am J Reprod Immunol 2019; 82:e13153. [PMID: 31148259 DOI: 10.1111/aji.13153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 04/05/2019] [Accepted: 05/24/2019] [Indexed: 12/22/2022] Open
Abstract
PROBLEM A significant increased expression/activation of one of the most well-characterized inflammasomes, the NAcht leucine-rich-repeat protein-3 (NALP-3), in the endometrium from idiopathic recurrent pregnancy loss women (RPL) has been previously found by our research group. We therefore, suggested this event as being one of the molecular mechanisms altering endometrial inflammatory status during early pregnancy. In the present research, we attempt to investigate whether molecules with anti-inflammatory activity, alpha-lipoic acid (ALA), and/or myoinositol affect the endometrial NALP-3 expression and activation. METHOD OF STUDY Women with a history of idiopathic RPL (n = 30) were included in the study and compared to a control group (n = 15). Endometrial tissues were collected by hysteroscopy during the mid-luteal phase. RPL women underwent a three-month prescription of tablets containing ALA plus myoinositol (Sinopol® ). After treatment, hysteroscopic biopsies were repeated in RPL patients. Inflammasome expression was evaluated by immunohistochemical and Western blot analysis. NALP-3 activation was studied by quantifying the secretion of both caspase-1 and interleukin (IL)-1ß and IL-18 through ELISA. In ex vivo experiments, the effects of each molecule on endometrial inflammasome were studied. RESULTS Sinopol® significantly reduced the RPL endometrial inflammasome expression and activation. ALA, but not myoinositol, significantly reduced the endometrial inflammasome expression and activity. CONCLUSION Our data suggest a role for ALA on RPL inflammasome. Understanding the mechanisms involved in RPL and the observation that specific molecules are able to interfere with such complex at the endometrium might provide new rational design approaches to a personalized evaluation of endometrial status and, ultimately, a targeted medicine.
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Affiliation(s)
- Fiorella Di Nicuolo
- Paolo VI International Scientific Institute, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Silvia D'Ippolito
- U.O.C. di Ostetricia e Patologia Ostetrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Roberta Castellani
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Esther Diana Rossi
- U.O.C. di Anatomia Patologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Valeria Masciullo
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italia.,U.O.C. di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Monia Specchia
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Marco Mariani
- Istituto di Sanità Pubblica, Sezione di Igiene, Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Alfredo Pontecorvi
- Paolo VI International Scientific Institute, Università Cattolica del Sacro Cuore, Roma, Italia.,U.O.C di Endocrinologia e Diabetologia, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Istituto di Patologia Medica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Giovanni Scambia
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italia.,U.O.C. di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Nicoletta Di Simone
- U.O.C. di Ostetricia e Patologia Ostetrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italia
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Song D, Li TC, Zhang Y, Feng X, Xia E, Huang X, Xiao Y. Correlation between hysteroscopy findings and chronic endometritis. Fertil Steril 2019; 111:772-779. [DOI: 10.1016/j.fertnstert.2018.12.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
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22
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Sun Y, Zhang J, Bai W. Higher Prevalence of Endometrial Polyps in Patients with Fallopian Tube Obstruction: A Case-control Study. J Minim Invasive Gynecol 2018; 26:935-940. [PMID: 30273685 DOI: 10.1016/j.jmig.2018.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/01/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE To study the association between endometrial polyps and fallopian tube patency diagnosed by hysteroscopy, conventional histology, and 4-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy). DESIGN A case-control study (Canadian Task Force classification II-2). SETTING A university hospital. PATIENTS A total of 323 women of reproductive age underwent 4D HyCoSy and hysteroscopy between January 2015 and December 2017. INTERVENTION A retrospective analysis of the association of endometrial polyps and fallopian tube obstruction (n = 154) or patency (n = 169) in patients who underwent 4D HyCoSy. MEASUREMENTS AND MAIN RESULTS The prevalence of endometrial polyps was significantly higher in patients with bilateral fallopian tube obstruction than in patients with bilateral fallopian tube patency (42.9% [66/154] vs 20.1% [34/169], p <.0001). In univariate and multivariate analyses, the presence of endometrial polyps was found to be a risk factor for tubal obstruction with an odds ratio of 3.16 and 2.59, respectively. CONCLUSION The prevalence of endometrial polyps is higher in infertile patients with fallopian tube obstruction than in patients with fallopian tube patency. History of endometrial polyps, ectopic pregnancy, and pelvic inflammatory disease are risk factors for tubal obstruction.
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Affiliation(s)
- Yu Sun
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (Drs. Sun and Bai)
| | - Jing Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China (Dr. Zhang)
| | - Wenpei Bai
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (Drs. Sun and Bai).
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Vitagliano A, Saccardi C, Noventa M, Di Spiezio Sardo A, Saccone G, Cicinelli E, Pizzi S, Andrisani A, Litta PS. Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis. Fertil Steril 2018; 110:103-112.e1. [DOI: 10.1016/j.fertnstert.2018.03.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/19/2018] [Accepted: 03/09/2018] [Indexed: 12/28/2022]
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The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology. Am J Obstet Gynecol 2018; 218:602.e1-602.e16. [PMID: 29477653 DOI: 10.1016/j.ajog.2018.02.012] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/07/2018] [Accepted: 02/15/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic endometritis is a persistent inflammation of the endometrial mucosa caused by bacterial pathogens such as Enterobacteriaceae, Enterococcus, Streptococcus, Staphylococcus, Mycoplasma, and Ureaplasma. Although chronic endometritis can be asymptomatic, it is found in up to 40% of infertile patients and is responsible for repeated implantation failure and recurrent miscarriage. Diagnosis of chronic endometritis is based on hysteroscopy of the uterine cavity, endometrial biopsy with plasma cells being identified histologically, while specific treatment is determined based on microbial culture. However, not all microorganisms implicated are easily or readily culturable needing a turnaround time of up to 1 week. OBJECTIVE We sought to develop a molecular diagnostic tool for chronic endometritis based on real-time polymerase chain reaction equivalent to using the 3 classic methods together, overcoming the bias of using any of them alone. STUDY DESIGN Endometrial samples from patients assessed for chronic endometritis (n = 113) using at least 1 or several conventional diagnostic methods namely histology, hysteroscopy, and/or microbial culture, were blindly evaluated by real-time polymerase chain reaction for the presence of 9 chronic endometritis pathogens: Chlamydia trachomatis, Enterococcus, Escherichia coli, Gardnerella vaginalis, Klebsiella pneumoniae, Mycoplasma hominis, Neisseria gonorrhoeae, Staphylococcus, and Streptococcus. The sensitivity and specificity of the molecular analysis vs the classic diagnostic techniques were compared in the 65 patients assessed by all 3 recognized classic methods. RESULTS The molecular method showed concordant results with histological diagnosis in 30 samples (14 double positive and 16 double negative) with a matching accuracy of 46.15%. Concordance of molecular and hysteroscopic diagnosis was observed in 38 samples (37 double positive and 1 double negative), with an accuracy of 58.46%. When the molecular method was compared to microbial culture, concordance was present in 37 samples (22 double positive and 15 double negative), a matching rate of 56.92%. When cases of potential contamination and/or noncultivable bacteria were considered, the accuracy increased to 66.15%. Of these 65 patients, only 27 patients had consistent histological + hysteroscopic diagnosis, revealing 58.64% of nonconcordant results. Only 13 of 65 patients (20%) had consistent histology + hysteroscopy + microbial culture results. In these cases, the molecular microbiology matched in 10 cases showing a diagnostic accuracy of 76.92%. Interestingly, the molecular microbiology confirmed over half of the isolated pathogens and provided additional detection of nonculturable microorganisms. These results were confirmed by the microbiome assessed by next-generation sequencing. In the endometrial samples with concordant histology + hysteroscopy + microbial culture results, the molecular microbiology diagnosis demonstrates 75% sensitivity, 100% specificity, 100% positive and 25% negative predictive values, and 0% false-positive and 25% false-negative rates. CONCLUSION The molecular microbiology method describe herein is a fast and inexpensive diagnostic tool that allows for the identification of culturable and nonculturable endometrial pathogens associated with chronic endometritis. The results obtained were similar to all 3 classic diagnostic methods together with a degree of concordance of 76.92% providing an opportunity to improve the clinical management of infertile patients with a risk of experiencing this ghost endometrial pathology.
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25
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Cicinelli E, Matteo M, Trojano G, Mitola PC, Tinelli R, Vitagliano A, Crupano FM, Lepera A, Miragliotta G, Resta L. Chronic endometritis in patients with unexplained infertility: Prevalence and effects of antibiotic treatment on spontaneous conception. Am J Reprod Immunol 2017; 79. [PMID: 29135053 DOI: 10.1111/aji.12782] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/19/2017] [Indexed: 12/26/2022] Open
Abstract
PROBLEM The correlations between chronic endometritis and unexplained infertility are unexplored. METHOD OF STUDY We performed a retrospective study on consecutive patients referred to our hysteroscopy service due to unexplained infertility. All women underwent endometrial sampling with histological and cultural examinations. If chronic endometritis was diagnosed, patients received antibiotic therapy, and chronic endometritis resolution was subsequently ascertained by histological examination. We aimed to estimate chronic endometritis prevalence and the effects of antibiotic therapy on spontaneous conception during the year following hysteroscopy. RESULTS A total number of 95 women were included. Pooled prevalence of chronic endometritis was 56.8%. Antibiotic therapy resulted in chronic endometritis resolution in 82.3% of patients, while in 17.6% disease was persistent. Women with cured chronic endometritis showed higher pregnancy rate and live birth rate in comparison with both women with persistent disease and women without chronic endometritis diagnosis (pregnancy rate = 76.3% vs 20% vs 9.5%, P < .0001; live birth rate = 65.8% vs 6.6% vs 4.8%, P < .0001). CONCLUSION Chronic endometritis is highly prevalent in patients with unexplained infertility. Diagnosis and treatment of chronic endometritis improve spontaneous pregnancy rate and live birth rate in such patients.
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Affiliation(s)
- Ettore Cicinelli
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Bari, Italy
| | - Maria Matteo
- Institute of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giueseppe Trojano
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Bari, Italy
| | - Paola C Mitola
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Bari, Italy
| | | | - Amerigo Vitagliano
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | - Francesco M Crupano
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Bari, Italy
| | - Achiropita Lepera
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Bari, Italy
| | - Giuseppe Miragliotta
- Institute of Microbiology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Bari, Italy
| | - Leonardo Resta
- Institute of Pathology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Bari, Italy
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Cicinelli E, Trojano G, Mastromauro M, Vimercati A, Marinaccio M, Mitola PC, Resta L, de Ziegler D. Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.05.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Radzinsky VE, Kostin IN, Petrov YA, Polina ML, Gasanova BM. Diagnostic significance of chronic endometritis macrotypes differentiation among women with reproductive losses. Gynecol Endocrinol 2017; 33:36-40. [PMID: 29264986 DOI: 10.1080/09513590.2017.1399697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
To evaluate the prognostic value of a comprehensive endometrial study after early reproductive losses (RL). A group of 306 women with early RL (missed abortion (n = 120), spontaneous miscarriage (n = 120), and ineffective in vitro fertilization attempts (n =66) were prospectively examined up to 6 months after the discharge of the uterus at the hospital bases of the Department of Obstetrics and Gynecology with the Сourse of perinatology at the PFUR Medical Faculty. Hysteroscopic macrotypes differentiation - hyperplastic (n = 89), hypoplastic (n = 94) and mixed (n = 87) - was carried out on the basis of features grouping characterizing the thickness, color and structure of the mucosa, the intensity of a vascular pattern in the presence of a chronic endometritis (CE). Evaluation of sonographic accuracy after hysteroscopic CE macrotypes differentiation showed the presence of false-negative conclusions: about unchanged mucosa (6.9%); endometrium polyps (3.5%); intrauterine synechiae (4.2%). Immunohistochemical staining with CD138 isolation showed higher diagnostic accuracy in CE detecting in comparison with the morphological method: in a hyperplastic macrotype (90.5% and 84.1%, respectively), hypo- (93.7% and 89.8%) and mixed (81.6% and 79.4%). Great diagnostic value is shown in identifying histopathic CE features in the context of hysteroscopic macrotypes differentiation in groups of women with RL.
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Affiliation(s)
- V E Radzinsky
- a Department of Obstetrics and Gynecology with a Course in Perinatology , People's Friendship University of Russia , Moscow , Russia
| | - I N Kostin
- a Department of Obstetrics and Gynecology with a Course in Perinatology , People's Friendship University of Russia , Moscow , Russia
| | - Yu A Petrov
- b Department of Obstetrics and Gynecology no. 1 , Rostov State Medical University , Rostov-on-Don , Russia
| | - M L Polina
- a Department of Obstetrics and Gynecology with a Course in Perinatology , People's Friendship University of Russia , Moscow , Russia
| | - B M Gasanova
- c Department of Obstetrics and Gynecology , Dagestan State Medical Academy , Makhahkala , Russia
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Park HJ, Kim YS, Yoon TK, Lee WS. Chronic endometritis and infertility. Clin Exp Reprod Med 2016; 43:185-192. [PMID: 28090456 PMCID: PMC5234283 DOI: 10.5653/cerm.2016.43.4.185] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/09/2016] [Accepted: 06/30/2016] [Indexed: 11/22/2022] Open
Abstract
Chronic endometritis (CE) is a condition involving the breakdown of the peaceful co-existence between microorganisms and the host immune system in the endometrium. A majority of CE cases produce no noticeable signs or mild symptoms, and the prevalence rate of CE has been found to be approximately 10%. Gynecologists and pathologists often do not focus much clinical attention on CE due to the time-consuming microscopic examinations necessary to diagnose CE, its mild clinical manifestations, and the benign nature of the disease. However, the relationship between CE and infertility-related conditions such as repeated implantation failure and recurrent miscarriage has recently emerged as an area of inquiry. In this study, we reviewed the literature on the pathophysiology of CE and how it may be associated with infertility, as well as the literature regarding the diagnosis and treatment of CE. In addition, we discuss the value of hysteroscopic procedures in the diagnosis and treatment of CE.
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Affiliation(s)
- Hyun Jong Park
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gumi Medical Center, CHA University, Gumi, Korea
| | - You Shin Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Tae Ki Yoon
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
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29
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Does experience in hysteroscopy improve accuracy and inter-observer agreement in the management of abnormal uterine bleeding? Surg Endosc 2016; 30:5558-5564. [DOI: 10.1007/s00464-016-4928-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
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30
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D'Ippolito S, Tersigni C, Marana R, Di Nicuolo F, Gaglione R, Rossi ED, Castellani R, Scambia G, Di Simone N. Inflammosome in the human endometrium: further step in the evaluation of the "maternal side". Fertil Steril 2015; 105:111-8.e1-4. [PMID: 26474737 DOI: 10.1016/j.fertnstert.2015.09.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/11/2015] [Accepted: 09/18/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the expression of inflammosome components (NALP-3, associated speck-like protein containing a CARD [ASC]) and their activation (caspase-1, interleukin [IL]-1β, and IL-18 secretion) in the human endometrium from fertile and women with history of recurrent pregnancy loss (RPL). DESIGN Experimental study. SETTING University hospital. PATIENT(S) Ten fertile women (control group [CTR]) and 30 women with RPL. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Endometrial samples were collected by hysteroscopy during the putative window of implantation and evaluated for chronic endometrial inflammation by hystopathological analysis. Inflammosome expression was analysed by immunohystochemical staining (27 RPL and 10 CTR women). The expression of NALP-3 and ASC protein was quantified by Western blot (30 RPL and 10 CTR women). Caspase-1 activation and IL-1β and IL-18 secretion was quantified by ELISA (30 RPL and 10 CTR women). RESULT(S) We observed a significantly increased expression of inflammasome NALP-3 and ASC protein, an increased activation of caspase-1, and increased levels of IL-1β and IL-18 in RPL endometrium compared with CTR. CONCLUSION(S) Abnormal activation of endometrial innate immunity by means of inflammosome, stimulated by pathogen- or damage-associated molecular patterns, may represent an additional mechanism, currently not investigated, negatively interfering with endometrial receptivity. More studies are required [1] to identify the primary trigger of endometrial inflammosome activation and its clinical impact in the occurrence of RPL; and [2] to validate the inflammosome components as a novel family of endometrial biomarkers and promising therapeutic targets in RPL.
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Affiliation(s)
- Silvia D'Ippolito
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, A. Gemelli Universitary Hospital, Rome, Italy
| | - Chiara Tersigni
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, A. Gemelli Universitary Hospital, Rome, Italy
| | - Riccardo Marana
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, A. Gemelli Universitary Hospital, Rome, Italy; International Scientific Institute Paolo VI, ISI, Università Cattolica Del Sacro Cuore, A. Gemelli Universitary Hospital, Rome, Italy
| | - Fiorella Di Nicuolo
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, A. Gemelli Universitary Hospital, Rome, Italy
| | - Raffaele Gaglione
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, A. Gemelli Universitary Hospital, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica Del Sacro Cuore, A. Gemelli Universitary Hospital, Rome, Italy
| | - Roberta Castellani
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, A. Gemelli Universitary Hospital, Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, A. Gemelli Universitary Hospital, Rome, Italy
| | - Nicoletta Di Simone
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, A. Gemelli Universitary Hospital, Rome, Italy.
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Tapilskaya NI, Karpeyev SA, Gaidukov SN. Justification of the efficacy of antibacterial therapy for the treatment of chronic endometritis. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-2-130-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
A review of studies on chronic endometritis enables the authors to conclude that bacterially contaminated endometrium is the reason causing reduced fertility in case of confirmed subclinical inflammation. Chronic subclinical inflammation of the endometrium is often associated with genital endometriosis, which apparently leads to abnormal uterine bleedings. The identification of a microbial agent in case of endometritis in the routine outpatient practice is not mandatory because global experience including high-level evidence-based studies confirms the expediency of an empirical therapy based on minimum clinical criteria; otherwise, there may be irreversible consequences for the reproductive system. A preventive antibacterial therapy during the pre-conception period in infertile patients suffering from recurrent miscarriages is an efficient method to prevent reproductive losses.
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Total Laparoscopic Hysterectomy: Overtreatment for Misdiagnosed Organic cause or Undertreatment for Idiopathic Chronic Pelvic Pain? JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2014. [DOI: 10.5301/je.5000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Chronic pelvic pain (CPP) is considered a symptom but also a syndrome with misunderstood pathophysiology and treatment options ranging from conservative management to opioid analgesia and surgical intervention. The aim of this study was to evaluate the role of gynecological surgery in modifying presurgical pain status and reducing the postoperative analgesic use of patients suffering CPP. The second aim of the study was to analyze intraoperative and histological differences in patients who benefited from surgery versus those without benefit. Methods An observational study was conducted in 16 fertile women affected by CPP, treated by total laparoscopic hysterectomy (TLH) to solve their pelvic pain. In 7 cases, undetected pelvic endometriosis was found. Results A complete resolution of pre-operative pain symptoms (score 0) occurred in 9 patients (56.2%), an occasional pelvic discomfort (score 1) in 2 cases (12.5%), 2 patients reported minimal benefit of pelvic pain (score 2), while in 3 cases, severe pain persisted (score 3). The correlation between intraoperative/histological features and reported symptoms after surgery showed that 7 of 9 patients (77.7%) who benefited from surgery were affected by an organic cause; while 5 women with minimal or no benefits from the surgery did not have any organic disease (idiopathic CPP). Conclusions If conservative treatment fails to treat CPP, investigative laparoscopy represents a necessary step to discriminate patients with misdiagnosed organic from idiopathic CPP, selecting those who will potentially benefit from hysterectomy. The role of concomitant appendectomy needs to be defined in surgical treatment of idiopathic CPP.
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Tortorella C, Piazzolla G, Matteo M, Pinto V, Tinelli R, Sabbà C, Fanelli M, Cicinelli E. Interleukin-6, interleukin-1β, and tumor necrosis factor α in menstrual effluents as biomarkers of chronic endometritis. Fertil Steril 2014; 101:242-7. [DOI: 10.1016/j.fertnstert.2013.09.041] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 09/09/2013] [Accepted: 09/29/2013] [Indexed: 01/12/2023]
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Functional endometrial polyps in infertile asymptomatic patients: a possible evolution of vascular changes secondary to endometritis. Eur J Obstet Gynecol Reprod Biol 2013; 170:152-6. [DOI: 10.1016/j.ejogrb.2013.05.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 03/09/2013] [Accepted: 05/20/2013] [Indexed: 12/25/2022]
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Di Pietro C, Cicinelli E, Guglielmino MR, Ragusa M, Farina M, Palumbo MA, Cianci A. Altered transcriptional regulation of cytokines, growth factors, and apoptotic proteins in the endometrium of infertile women with chronic endometritis. Am J Reprod Immunol 2013; 69:509-17. [PMID: 23351011 DOI: 10.1111/aji.12076] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 12/28/2012] [Indexed: 11/28/2022] Open
Abstract
PROBLEM Chronic endometritis (CE) is a poorly investigated and probably underestimated pathology, which may cause abnormal uterine bleeding (AUB), pain, and reproductive failures. Due to undefined symptoms and the normal presence of leukocytes in the endometrial mucosa, diagnosis may be missed. Fluid hysteroscopy is a reliable technique for diagnosing this pathology. Few data exist on the biochemical and paracrine alterations that occur in the endometrium of women diagnosed with CE. The aim of the study was to find molecular modification in endometrium related to CE. METHOD OF STUDY Sixteen women with hysteroscopic and histological diagnosis of CE and 10 healthy women as controls were enrolled. We compared the endometrial expression profile of 25 genes encoding proteins involved in the inflammatory response, proliferation, and apoptosis in endometrium during implantation window, using high-throughput real-time RT-PCR. RESULTS In women with CE, the endometrial expression of some genes was significantly altered. In particular, IGFBP1, BCL2, and BAX were up-regulated, while IL11, CCL4, IGF1, and CASP8 were down-regulated. CONCLUSION The altered gene endometrial expression may explain the impaired endometrial receptivity and the finding of endometrial hyperplastic lesions in women affected by CE.
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Affiliation(s)
- Cinzia Di Pietro
- Dipartimento G.F. Ingrassia, Biologia Generale, Biologia Cellulare, Genetica Molecolare G Sichel, Az. Policlinico, Università di Catania, Catania, Italy.
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