Chronic endometritis in patients with unexplained infertility: Prevalence and effects of antibiotic treatment on spontaneous conception

Cicinelli, Ettore; Matteo, Maria; Trojano, Giuseppe; Mitola, Paola Carmela; Tinelli, Raffaele; Vitagliano, Amerigo; Crupano, Francesco Maria; Lepera, Achiropita; Miragliotta, G.; Resta, Leonardo

doi:10.1111/aji.12782

Cited by 200 publications

(206 citation statements)

References 35 publications

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“…The relationship between CE and infertility has recently emerged as an important clinical challenge. In fact, 2.8–56.8% of infertile women, 14–67.5% of women with RIF, and 9.3–67.6% of women with recurrent pregnancy loss are diagnosed with CE . Considering these high prevalence rates, CE is a condition that must not be ignored during fertility treatment.…”

Section: Epidemiology and Clinical Featuresmentioning

confidence: 99%

Review: Chronic endometritis and its effect on reproduction

Kimura

Takebayashi

Ishida

et al. 2019

J of Obstet and Gynaecol

209

144

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Aim Chronic endometritis (CE) is a disease of continuous and subtle inflammation characterized by the infiltration of plasma cells in the endometrial stromal area. Although the clinical significance of CE has been thought in clinical practice for a long time because it is either asymptomatic or presents with subtle symptoms, recent studies have shown the potential adverse effects of CE on fertility. In the present review, we focus on the concept, diagnosis, etiology, pathophysiology, diagnosis, impact on reproduction and treatment for it to understand CE. Methods The published articles were reviewed. Results The prevalence of CE has been found to be 2.8–56.8% in infertile women, 14–67.5% in women with recurrent implantation failure (RIF), and 9.3–67.6% in women with recurrent pregnancy loss. Microorganisms are thought to be a main cause of CE, since antibiotic treatment has been reported to be an effective therapy for CE. Common bacteria are frequently detected in the uterine cavity of CE patients by microbial culture. In CE endometrium, the prevalence of immune cells and decidualization has been reported to be modified, and these modifications are thought to adversely affect fertility. The gold standard for the diagnosis of CE is the histological detection of plasma cells in the stromal area of the endometrium in endometrial specimens, although universally accepted criteria for the diagnosis of CE have not been determined. The treatment currently thought to be most effective for the recovery of fertility in CE is administration of oral antibiotics. Patients whose CE has been cured have been reported to have a higher ongoing pregnancy rate, clinical pregnancy rate, and implantation rate compared with patients with persistent CE. Conclusion CE greatly affects implantation and impairs fertility. Antibiotic administration is an effective therapeutic option. Pregnancy rate in in vitro fertilization is improved when CE is cured by antibiotic.

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Section: Epidemiology and Clinical Featuresmentioning

confidence: 99%

Review: Chronic endometritis and its effect on reproduction

Kimura

Takebayashi

Ishida

et al. 2019

J of Obstet and Gynaecol

209

144

View full text Add to dashboard Cite

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“…These findings suggest that diagnosing and treating CE in RIF patients before embryo transfer could be a useful intervention to eliminate the source of infection, improve the endometrial microbial health, and increase the live birth rates in these patients . Importantly, antibiotic therapy has been also effective in patients with CE and unexplained infertility to increase their chances to conceive spontaneously and maintain a safe pregnancy to term after CE resolution …”

Section: Role Of Bacteria In Human Reproductionmentioning

confidence: 99%

Deciphering the effect of reproductive tract microbiota on human reproduction

Moreno

Simón

2018

Reprod Medicine & Biology

115

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BackgroundThe female reproductive tract contains an active microbiome comprising mainly bacteria from the Lactobacillus genus, which is associated with a healthy microbiome state. However, spatio‐temporal fluctuations of this microbiome that occur in response to internal and external factors may impact the physiology of the reproductive tract organs and even lead to pathological states.MethodsCurrent literature covering the reproductive tract microbiome is summarized and contextualized in this review.Main findingsThis review presents the current knowledge about the bacterial composition of the lower and upper reproductive tract as well as the impact of the microbiota on women's health and reproduction. We place special focus on the impact of the endometrial microbiome in infertility and assisted reproductive technologies.ConclusionThe assessment of the reproductive tract microbiome adds a new microbiological perspective to human reproduction, pregnancy, and onset of new life, highlighting the importance of considering the evaluation of microbial communities to improve personalized care in reproductive medicine and women's health.

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“…This rate is higher than that found in CE patients (65%, 26/40), and it was also signi cantly higher compared with infertility patients with other than unexplained infertility (21/55, P = 0.033). Patients with unexplained infertility include a high proportion of patients diagnosed with implantation failure and endometriosis [26][27][28]. The high frequency of the EMT in unexplained infertility suggests that the EMT may be associated with implantation failure and endometriosis.…”

Section: Discussionmentioning

confidence: 99%

Induction of the epithelial-mesenchymal transition in the endometrium by chronic endometritis in infertile patients

Ishida

Takebayashi

Kimura

et al. 2020

Preprint

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Background The purpose of the present study was to evaluate the relationship between chronic endometritis (CE) and the epithelial-mesenchymal transition (EMT) in the eutopic endometrium of infertile patients in the implantation phase. Methods Endometrial biopsy specimens from 74 infertility patients were enrolled. The presence of CE was investigated by immunostaining for CD138. Immunohistochemical staining for E-cadherin, N-cadherin, Slug, and Snail was performed, and expression profiles were statistically analyzed according to the presence of CE. When loss of E-cadherin expression and/or positive N-cadherin expression was detected, the specimen was considered EMT-positive. EMT-positive cases were also statistically analyzed according to the presence of CE. Patients’ characteristics were compared between the EMT-positive and EMT-negative groups. Logistic regression analysis was also performed with variables including age, body mass index (BMI), gravidity, parity, and each factor causing infertility to examine the independent effect of each variable on EMT-positive status. Results Loss of E-cadherin expression, N-cadherin expression and EMT-positive were significant in CE patients (p = 0.0037, 0.0039 and < 0.0001, respectively). Slug, cytoplasmic Snail, and nuclear Snail expression were significant in CE patients (p = 0.0008, 0.0004 and 0.028, respectively). Differences were detected in unexplained infertility and CE between EMT-positive and EMT-negative cases. Unexplained infertility and CE were identified as variables related to EMT-positive status on logistic analysis. Conclusion The EMT was frequent in the eutopic endometrium in infertile patients with CE. Since the EMT is associated with unexplained infertility and CE, the EMT appears to be involved in altered mechanisms of implantation.

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Chronic endometritis in patients with unexplained infertility: Prevalence and effects of antibiotic treatment on spontaneous conception

Abstract: 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.

Cited by 200 publications

References 35 publications

Review: Chronic endometritis and its effect on reproduction

Review: Chronic endometritis and its effect on reproduction

Deciphering the effect of reproductive tract microbiota on human reproduction

Induction of the epithelial-mesenchymal transition in the endometrium by chronic endometritis in infertile patients

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