Chronic endometritis (CE) is a disease of continuous and invisible inflammation characterized by infiltration of plasma cells in the stromal region of the endometrium. Numerous studies have proven that CE leads to repeated implantation failures. While it is believed that the etiology of CE is mainly associated with microorganisms, the key links in pathogenesis are yet not fully understood, although there is a modern evidence that CE causes local immune disorders and impaired endometrial decidualization. Considering the insufficient effectiveness of antibiotic therapy for CE, especially in cases of resistant pathogens, or in the case of viral chronic endometritis, regimens with additional treatment that affect other etiopathogenetic pathways of CE development and maintenance are necessary. One of the methods that affects etiopathogenesis of CE is a cytokine therapy. In this review, the authors tried to consider CE with special emphasis on the etiology, epidemiology, clinical features, pathophysiology, and treatment of CE and reproductive disorders in women in association with repeated implantation failures. The review ends with a description of the clinical case.

This review summarizes current understanding of the pathogenesis of one of the most common forms of external genital endometriosis ovarian endometriomas. Due to their frequent occurrence in young women of reproductive age and extremely negative impact on the morphophysiological state of the ovaries, this disease makes a significant contribution to the structure of endometriosis-associated infertility. The main determinant of the negative effect of ovarian endometriomas on reproductive function is a decrease in ovarian reserve, which can occur either due to the direct gonadotoxic effect of the endometriod cyst itself, or due to the unintentional removal of healthy ovarian tissue during surgery or the use of aggressive methods of electrosurgery. Hence, the question of methods for achieving hemostasis during surgery in terms of iatrogenic effects on healthy ovarian tissue is debatable. The management strategy for patients with infertility associated with ovarian endometriosis consists of two components: surgical treatment and/or the use of assisted reproductive technologies. Laparoscopic cystectomy is indicated for cysts larger than 3 cm. Repeated surgical interventions in case of endometriosis do not improve fertility outcomes. Assisted reproductive technologies methods should be considered as a priority tactic in patients of older reproductive age with low ovarian reserve indicators or infertility duration of more than 2 years, as well as in cases of recurrent ovarian endometriomas. Management of such patients must be personalized and take into account the age, state of the ovarian reserve, duration of infertility, stage and number of surgical interventions for this disease.

The article highlights modern ideas about the role of the endometrium in the genesis of reproductive failures. A crucial place of chronic endometritis in the structure of the endometrial infertility factor in endometriosis is noted. Given the frequent association of chronic endometritis and endometriosis, common features of these diseases have been identified. The characteristic of endometrial microbiota in infertility, chronic endometritis and endometriosis is given. An extremely important area of scientific research is precisely the interaction between the microbiota of the endometrium and its immunity, and not just the confirmation of the presence of microorganisms in the endometrium. The modern aspects of the etiology and pathogenesis of chronic endometritis and endometriosis are described. The main pathogenetic determinants of chronic endometritis are the failure of adaptation mechanisms to the constant effects of microbes and, as a consequence, the decrease and inferiority of the immune response and the development of autoimmune reactions. The modern paradigm for the development and progression of endometriosis involves the presence of bacterial contamination of the endometrium and the abdominal cavity, which in turn becomes a trigger for genetically-epigenetic modifications of cells, launching different cascades that underlie reproductive function disorders. The pathogenetically significant relationship between chronic endometritis and endometriosis is highlighted. It was revealed that chronic endometritis can be both a cause and a consequence of endometriosis. Disorders of the endometrial receptivity in chronic endometritis associated with endometriosis, their importance in the implementation of endometrial infertility are described. The important role of the microbiome in the formation of reproductive disorders is noted.

Endometriosis remains an unresolved problem in gynecology. The urgency of the fight against this disease is due to its high prevalence among women of reproductive age. Endometriosis, especially its infiltration forms, affects all aspects of the patients life, its clinical manifestations pelvic pain, dyspareunia, dysmenorrhea, dyschezia, lead to social disadaptation, problems in personal life, depression and anxiety. The socio-economic burden of the disease motivates researchers to further study the pathogenesis of endometriosis and search for pathogenetically justified pharmacological solutions.

The literature review presents domestic and foreign data on the relationship between pelvic floor dysfunction (PFD) and cervical diseases found in PubMed, Scopus, Embase and eLibrary systems over the past 10 years. This relationship is mainly realized due to alterations in vaginal biocenosis as the earliest clinical manifestation of PFD. The article describes PFD prevalence, classification, and risk factors for PFD. It also describes main methods of treatment and their side effects. The article provides data on changes in the vaginal biocenosis in PFD. Attention is paid to the risk for cervical intraepithelial neoplasia and cervical cancer in PFD.