AimTo determine whether single endometrial polyp (EP) or multiple EP (polyp number ≥ 6) are associated with chronic endometritis (CE).MethodsFrom June 2017 to December 2018, this study enrolled a total of 277 patients, including 92 patients with multiple EP, 82 patients with a single EP and 103 patients without polyps who underwent hysteroscopic examination and polypectomy. Polyps and endometrium samples were obtained and subjected to immunohistochemistry for CD138 to identify plasma cells and CE was diagnosed as CD138‐positive plasma cells greater than or equal to 5/high power field. The prevalence of CE was compared and analyzed using the logistic regression model.ResultsAll baseline parameters were comparable among the three groups except that the prevalence of abnormal uterine bleeding (AUB) was much higher in both polyp groups than the non‐polyp control. The prevalence of CE was significantly higher in the multiple EP group than in the single EP group (58.7% vs 28.0%, P < 0.001). There was no difference on the prevalence of CE between the single EP and the non‐polyp groups (28.0% vs 29.1%, P = 0.872). Multivariable analysis revealed that AUB (adjusted OR 2.81, 95% CI 1.35–5.87) and multiple EP (adjusted OR 2.58, 95% CI 1.38–4.82) were independently associated with CE, while the single EP did not increase the odds of CE compared to the non‐polyp group (adjusted OR 0.74, 95% CI 0.38–1.45).ConclusionMultiple EP were positively associated with CE among reproductive‐aged women, suggesting a possible hidden etiopathogenetic link between chronic inflammation and multiple EP.

Background The role of autoantibodies in recurrent miscarriage (RM) is unclear. Commonly studied autoimmune markers in RM include anti-nuclear (ANA), thyroid peroxidase (TPO-Ab), and anti-thyroid globulin antibodies (Tg-Ab) and peripheral blood natural killer (pbNK) cells. The correlation between autoimmune markers (TPO-Ab, Tg-Ab, ANA) and pbNK cells in women with unexplained recurrent miscarriage (uRM) is unexamined. Because NK cells are associated with the adaptive immune response, we hypothesized that the change in pbNK cell number might be a result of the immune response to autoimmunity in women with RM rather than a cause of RM. We aimed to explore whether the pbNK count is significantly different in women testing positive than in those testing negative for autoantibodies. Methods The clinical data and performed pbNK cell measurements of patients who visited the specialist clinic for RM of the First Affiliated Hospital between May 2014 and August 2021 were analyzed. Eligible patients were divided into two groups: High-pbNK group (n=118) and Normal-pbNK group (n=184). Results The positive rates of TPO-Ab in High-pbNK group were significantly higher than in Normal-pbNK group (20.3% vs. 10.9%, p=0.04), and the positive rates of ANA in Normal-pbNK group were significantly higher than in High-pbNK group (22.3% vs. 11.9%, p=0.02). There was a statistically significant positive association between TPO-Ab positivity and high pbNK cells (p=0.016, OR=5.097, 95% CI 1.356–19.159), while there was a statistically significant negative association between ANA positivity and high pbNK cells (p=0.013, OR=0.293, 95% CI 0.111–0.773). Conclusion Our results indicated that changes in pbNK cell count are a result of the miscarriage-associated autoimmune response rather than a causal factor for RM. Hence, the increased number of pbNK cells cannot be applied as a therapeutic index for immunological abnormalities in patients with uRM.

Study objective The current knowledge on recurrent pregnancy loss (RPL) is largely limited, with up to 70% of RPL cases still classified as unexplained. More than 30% of patients with unexplained recurrent pregnancy loss (uRPL) will suffer an additional pregnancy loss. The majority of scholars are supportive of an immune basis, while clinical data fail to support established therapies. In addition, the effectiveness of immunotherapies is difficult to evaluate because of the lack of diagnostic and predictive indicators. Natural Killer (NK) cells are the largest population of lymphocytes in the endometrium during early pregnancy and play a key regulatory rather than participatory role in the cytotoxic killing reaction to embryos at the maternal-fetal interface. Specifically, they support the invasion of trophoblast cells and embryo implantation. Previous studies on the roles of NK cells with distinct phenotypes in pregnancy loss were based on NK cells derived from the peripheral blood or decidua, and it is difficult to determine whether the reported changes in decidual NK cells are causes or consequences of pregnancy loss. Hence, whether the results of these studies are applicable to the interaction between NK cells and embryonic trophoblast cells during the earliest pregnancy stage remains unknown.Design This study evaluated the expression of 9 receptors and cytokines after coculture of the HTR-8/SVneo human chorionic trophoblast cell line with peripheral blood NK (pbNK) cells and uterine NK (uNK) cells collected during the same embryo implantation window. Then the phenotypes of NK cells during this period were analyzed, and the associations of NK cell functional features with early pregnancy outcomes were explored.Results We found that a decrease in the CD3-CD56 + CD27 + uNK cell population and increases in the frequencies of CD3-CD56 + CD107a + NK cells in women with the recurrence of pregnancy loss.Conclusions CD3-CD56 + IFN-γ + pbNK cells and CD3-CD56 + IFN-γ + uNK cells were immunological risk factors associated with the recurrence of pregnancy loss in uRPL.

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Background Ovarian stimulation during medically assisted reproduction treatment should be individualized to optimize outcomes and reduce complications. This study assessed whether use of the recombinant human follicle-stimulating hormone (r-hFSH) pen injector allowing small 12.5 IU dose increments resulted in lower r-hFSH dose per oocyte retrieved in a subgroup of patients at risk of OHSS, compared with r-hFSH injection devices allowing only 37.5 IU increments. Methods This multicenter, comparative, observational study evaluated patients from a prospective (study group) and historical (control group) cohort. The study group enrolled 1783 patients using the redesigned r-hFSH pen injector (GONAL-f®, Merck Healthcare KGaA, Darmstadt, Germany) from a prospective phase IV, non-interventional, open-label study, conducted in Korea, Vietnam, Indonesia, and China. The control group consisted of 1419 patients from a historical study using r-hFSH devices allowing 37.5 IU increments. In the study group, 397 patients were considered at risk of OHSS; this information was unavailable for the control group, so biomarkers and patient characteristics were used to match 123 patients from the study group and control group. Each center adhered to standard practice; starting dose and intra-cycle dose adjustments were allowed at any point. The primary endpoint, amount of r-hFSH (IU) administered per oocyte retrieved, was assessed in matched patients only. Additional outcomes and safety were assessed in the overall populations. Results Baseline characteristics were comparable between groups. Mean (SD) total dose of r-hFSH administered per oocyte retrieved in patients at risk of OHSS, was significantly lower in the study group compared with the control group (132.5 [85.2] vs. 332.7 [371.6] IU, P < 0.0001, n = 123). Implantation rate, clinical pregnancy rate, and live birth rates in the overall study and control groups were 30.0 vs. 20.6%, 50.3 vs. 40.7%, and 43.8 vs. 34.0%, respectively. OHSS incidence was significantly lower in the study group compared with the control group (27/1783 [1.5%] vs. 57/1419 [4.0%] patients, P < 0.0001). AEs were reported by 5.0% of patients in the study group. Conclusions A significantly lower r-hFSH dose per oocyte retrieved and lower OHSS incidence were observed in patients using the redesigned injector compared with patients using other injection devices.