Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome—A Systematic Review and Meta-Analysis

Vitagliano, Amerigo; Laganà, Antonio Simone; Ziegler, Dominique de; Cicinelli, Rossana; Santarsiero, Carla Mariaflavia; Buzzaccarini, Giovanni; Chiàntera, Vito; Cicinelli, Ettore; Marinaccio, Marco

doi:10.3390/diagnostics12092250

Cited by 35 publications

(30 citation statements)

References 56 publications

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“…Nevertheless, our data and analysis demonstrates that hysteroscopic CE plays an important role in predicting IVF pregnancy outcomes. According to previous literature, endometrial plasma cells do not predict pregnancy outcomes at low levels, 34 and IVF success may be affected only by severe, and not mild, CE 35 . Considering this, patients with hysteroscopic CE in our study seemed to have greater severity of CE compared to patients with histopathologic CE.…”

Section: Discussionsupporting

confidence: 39%

High prevalence of chronic endometritis is associated with metabolic abnormality and reduced live birth rate among IVF women with non‐uniform endometrial echogenicity

Guo,

Li,

Liu

et al. 2023

American J Rep Immunol

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ObjectiveTo assess the prevalence of chronic endometritis (CE) among women with non‐uniform endometrial echogenicity, and to evaluate the association between CE and metabolic characteristics as well as pregnancy outcomes in the subsequent frozen–thawed embryo transfer (FET) cycles.DesignRetrospective cohort study.SettingUniversity‐based hospitals and an academic medical center.PatientsA total of 315 patients included in this research underwent hysteroscopy and endometrial biopsy before the first FET cycle after whole embryos freezing. Patients were divided into CE (histopathologic CE or hysteroscopic CE) and non‐CE groups.Intervention(s)Freeze‐all strategy, hysteroscopy and endometrial biopsy.Main Outcome MeasuresBaseline and cycle characteristics, hysteroscopic, and histopathological profile, as well as pregnancy outcomes.ResultsThe prevalence of histopathologic CE and hysteroscopic CE were 78.1% and 34.9%, respectively. CE was associated with higher homocysteine level and BMI, independent of insulin response and dyslipidemia. High homocysteine level and BMI were risk factors for histopathologic CE (OR: 1.182; 95% CI: 1.01–1.384; p = .037) and hysteroscopic CE (OR: 1.117; 95% CI: 1.041–1.199; p = .002), respectively. Histopathologic CE was a risk factor for live birth (OR:2.167; 95% CI: 1.037–4.525; p = .04), and hysteroscopic CE was an independent risk factor for both live birth (OR: 4.239; 95% CI: 1.929–9.313; p = .001) and cumulative live birth (OR: 3.963; 95% CI: 1.875–8.376; p = .001).ConclusionsInfertile women with non‐uniform endometrial echogenicity have a high prevalence of CE which significantly reduces the live birth rate. Diagnosing CE by hysteroscopy is important to assess the cumulative probability of pregnancy in IVF patients.

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Section: Discussionsupporting

confidence: 39%

High prevalence of chronic endometritis is associated with metabolic abnormality and reduced live birth rate among IVF women with non‐uniform endometrial echogenicity

Guo,

Li,

Liu

et al. 2023

American J Rep Immunol

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“…In a meta-analysis of eight studies, Vitagliano et al [ 40 ] demonstrated a lower OPR/LBR (OR = 1.97, 95% CI = 1.11–3.48, p = 0.02) and CPR (OR = 2.28, 95% CI = 1.34–3.86, p = 0.002) in infertile women with CE than in those without CE (defined as ≥1 CD138(+)-ESPC in 1 HPF = 10 ESPCs in 10 HPFs), whereas there was no difference in the MR. Additionally, a subgroup analysis of two studies disclosed that severe CE (defined as ≥50 ESPCs in 10 HPFs) was associated with poor reproductive outcomes (OPR/LBR: OR = 0.43, 95% CI = 0.25–0.74, p = 0.003, and CPR: OR = 0.40, 95% CI = 0.24–0.68, p = 0.0007) compared to mild CE (defined as 10–40 CD138(+) ESPCs in 10 HPFs), but again, without any difference in the MR. By contrast, there was no difference between mild CE and non-CE in terms of the OPR/LBR, CPR, and MR.…”

Section: Challenges In Clinical Diagnosis Of Histopathologic Cementioning

confidence: 99%

Challenges in Clinical Diagnosis and Management of Chronic Endometritis

Yasuo

Kitaya²

2022

Diagnostics

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Chronic endometritis (CE) is a local mucosal infectious and inflammatory disorder characterized by unusual filtration of CD138(+) endometrial stromal plasmacytes. CE is attracting attention due to its potential association with infertility of unknown etiology, repeated implantation failure, recurrent pregnancy loss, and several maternal/neonatal complications. Due to the variance in study design among researchers, universal diagnostic criteria remain to be established for the clinical diagnosis and management of CE. This review article aims to summarize current knowledge and provide insights into unsolved questions on CE to establish clinical guidelines for the disease from the viewpoint of human reproduction.

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“…Предложены различные теории для объяснения связанных с ХЭ нарушений рецептивности эндометрия, включая активацию местных воспалительных процессов с измененной секрецией цитокинов (ЦК) и хемокинов, аномальную лейкоцитарную инфильтрацию эндометрия, измененную сократимость матки, нарушения децидуализации и васкуляризации эндометрия [10]. Однако, как отмечают эксперты, несмотря на «интригующий» характер этих теорий, имеющиеся данные о корреляции между ХЭ и дефектами имплантации преимущественно основаны на данных исследований с определенными недостатками (гетерогенный дизайн, различные критерии диагностики ХЭ и др.…”

Section: Introductionunclassified

“…Однако, как отмечают эксперты, несмотря на «интригующий» характер этих теорий, имеющиеся данные о корреляции между ХЭ и дефектами имплантации преимущественно основаны на данных исследований с определенными недостатками (гетерогенный дизайн, различные критерии диагностики ХЭ и др. ), и, таким образом, научное сообщество остается разделенным на тех, кто за и против того, чтобы признать, что ХЭ является реальной причиной женского бесплодия [10].…”

Section: Introductionunclassified

“…Ученые пришли к заключению, что «золотым стандартом» следует считать иммуногистохимическое исследование с окрашиванием синдеканом-1 для обнаружения ПК (CD138+) на срезах ткани эндометрия [13,14]. Тем не менее количество ПК на «образец/площадь» или поле микроскопа для диагностики ХЭ остается неопределенным [10]. Одни авторы предлагают использовать критерий «5 и более ПК по крайней мере в одном из 30 полей зрения с высоким увеличением» [15], другие -в одном из 20 [16], третьи -«в каждом поле зрения при 400-кратном увеличении» [17], четвертые -«одна ПК в пяти случайно выбранных полях зрения» [18].…”

Section: Introductionunclassified

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Discussion issues in the treatment of chronic endometritis

Dikke

2023

Medicinskij sovet

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The prevalence of chronic endometritis (CE) in the general population ranges from 14.1 to 24.4% and is 2–3 times higher in patients with impaired reproductive function. The treatment of CE presents certain difficulties due to different approaches and conflicting information about the effectiveness of the methods used. According to studies, the cure rate of CE with antibiotics (AB) is 82.6–87.9% with a live birth rate of 56–62.4%. In ART programs in patients who have undergone a course of AB-therapy, there is a 5-fold increase in the frequency of live births. The need to reach a consensus on the diagnostic criteria for CE was noted to exclude the influence of study heterogeneity on treatment outcomes. In recent years, the need to restore immune protection in CE has been widely discussed. Of the immunomodulators available in the Russian Federation with proven efficacy is a complex of exogenous natural cytokines and chemokines, the use of which in combination with AB allows to achieve elimination of pathogens in 86% of patients with CE of viral and bacterial aetiology (56% in the treatment of AB alone) and achieve pregnancy, ended in childbirth, in 60% of cases (29% without cytokines). Immune function can be improved by addressing micronutrient deficiencies, in particular the vitamin and mineral complex Pregnoton, which can contribute to increased resistance to infection, faster recovery, and improved reproductive function. Treatment of CE should include broad-spectrum antibiotic therapy and antiviral therapy aimed at reducing the activity of viruses. The complex of exogenous natural cytokines and chemokines for topical application helps to increase the rates of pregnancy and live births. Biologically active supplements, including the Pregnoton vitaminmineral complex, can be used as additional means to improve the functions of innate and acquired immunity.

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Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome—A Systematic Review and Meta-Analysis

Cited by 35 publications

References 56 publications

High prevalence of chronic endometritis is associated with metabolic abnormality and reduced live birth rate among IVF women with non‐uniform endometrial echogenicity

High prevalence of chronic endometritis is associated with metabolic abnormality and reduced live birth rate among IVF women with non‐uniform endometrial echogenicity

Challenges in Clinical Diagnosis and Management of Chronic Endometritis

Discussion issues in the treatment of chronic endometritis

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