Neoadjuvant Diagnosis and Management of Chronic Endometritis

Крутова, В. А.; Чулкова, А. М.; Ванян, Д. Л.; Чуприненко, Л. М.; Каспарян, Р. А.; E, Kopytko; Дьякова, Т. Г.

doi:10.25207/1608-6228-2018-25-1-23-29

Cited by 4 publications

(2 citation statements)

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“…The meta-analysis found neither a signifi cant effect of CE on the miscarriage rate nor improvements in pregnancy outcomes in treated patients (p < 0.05). It can be assumed that spontaneous abortion involves too many different etiopathogenetic factors related to both the mother and the embryo which in this case reduces the role of endometrial infl ammation [63][64][65][66]. In particular, aneuploidy is considered to be the main factor behind miscarriage, while maternal age (≥35 years) constitutes a major risk factor [61,[67][68][69][70].…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

“…One of the most promising additional methods for diagnosing CE is hysteroscopy [6,16,32,34,65,71], especially in cases of diagnostic uncertainties [70,72,73]. Through visual evaluation of the entire endometrial surface, hysteroscopy can enable the identifi cation of specifi c endometrial changes that are consistent with severe forms (e.g., micropolyps) [73,74].…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

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Chronic endometritis and infertility — in vitro fertilization outcomes: systematic review and meta-analysis

Lokshin,

Kutsenko,

Borovikov

et al. 2023

Kuban. nauсh. med. vestnik

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Background. The relevance of the problem is related to the high prevalence of chronic endometritis (CE); its role in female infertility, implantation failures during assisted reproductive technology procedures, and recurrent miscarriage; as well as the lack of a unified strategy in the diagnosis and treatment of this pathology. The present systematic review with a meta-analysis focuses on evaluating the impact of CE and its therapy on the outcome of in vitro fertilization. In addition, the effect of CE of various severity on the outcomes of assisted reproductive technologies is analyzed. Objective. To analyze the effect of CE of varying severity and its treatment on the outcomes of in vitro fertilization. Methods. Using PubMed, Medline, Scopus, Embase, ELibrary, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry, and Russian Science Citation Index, a systematic search was conducted for articles published over the past 12 years that met the following criteria: randomized controlled trial examining the effect of CE of varying severity on fertility and ways to treat it. The following indicators were calculated: ongoing pregnancy/live birth, clinical pregnancy, and miscarriage rates. A total of 4145 patients (from ten studies) were included. A meta-analysis was performed using Stata 11.0 software (The Cochrane Collaboration, Oxford, UK). The heterogeneity was considered low at I2 <30%, moderate at 30–50%, and high at >50%. Results. Women with CE exhibited lower ongoing pregnancy/live birth (OR 1.97; p = 0.02) and clinical pregnancy rates (OR 2.28; p = 0.002) as compared to women without it. CE treatment increased the ongoing pregnancy/live birth (OR 5.33; p < 0.0001) and clinical pregnancy rates (OR 3.64; p = 0.0001). In vitro fertilization outcomes were comparable in women treated for CE and women without CE (ongoing pregnancy/live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Women with severe CE exhibited lower ongoing pregnancy/live birth (OR 0.43; p = 0.003) and clinical pregnancy rates (OR 0.40; p = 0.0007). Mild CE showed no significant effect on in vitro fertilization outcomes (ongoing pregnancy/ live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Conclusion. The conducted meta-analysis showed that CE significantly reduces the ongoing pregnancy/live birth and clinical pregnancy rates in infertile women undergoing in vitro fertilization. Noteworthy is that antimicrobial therapy in such patients improves the results of assisted reproductive technologies, which are comparable to those of patients without CE. The negative impact of this pathology on the implantation capacity of the endometrium is most often observed in the severe form, while its mild form has virtually no effect on the in vitro fertilization outcome.

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Section: Interpretation Of Resultsmentioning

confidence: 99%

Section: Interpretation Of Resultsmentioning

confidence: 99%

Chronic endometritis and infertility — in vitro fertilization outcomes: systematic review and meta-analysis

Lokshin,

Kutsenko,

Borovikov

et al. 2023

Kuban. nauсh. med. vestnik

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Expression of vascular endothelial growth factor a in the endometrium in uterine factor infertility

Чуприненко

Славинский

Севостьянова

et al. 2020

Kuban. nauсh. med. vestnik

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Aim. To assess the expression of vascular endothelial growth factor A for evaluating the functional state of the endometrium in women suffering from infertility and chronic endometritis.Materials and methods. Endometrium biopsy specimens obtained from 41 patients with uterine factor infertility (experimental group) were examined. A comparison group was composed of 39 women diagnosed with the “male factor” infertility exhibiting no infl ammatory processes of the reproductive organs. An endometrial biopsy was performed in both phases of the menstrual cycle: on days 8–10 of the follicular phase and on days 21–24 of the luteal phase. The expression of vascular endothelial growth factor receptors was evaluated on the basis of immunohistochemical staining of the biopsy specimens using monoclonal antibodies. The results of the immunohistochemical reaction were quantifi ed using the ImageJ software. A quantitative criterion — a stained area coeffi cient (per cent) representing the ratio of the immunohistochemical staining area to that of a biopsy specimen — was proposed for assessing the level of VEGF-A expression.Results. In the chronic endometritis group, the intensity of VEGF-A expression was found to be 1.4 times higher than that in the comparison group during the proliferation phase (p < 0.001). Expression values of the secretion phase were 1.9 times higher than those in the comparison group (p < 0.01).Conclusion. Chronic endometritis is characterized by an overexpression of VEGF-A by various endometrium cellular components. Interpretation of immunohistochemical stains using the method of computer morphometry allows quantitative indicators characterizing the intensity of angiogenesis marker expression in the endometrium during the menstrual cycle to be obtained. The level of VEGF-A expression can be used as an additional marker improving the quality of biopsy diagnostics in patients with infertility.

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Structural, functional, and molecular mechanisms of endometrial transformation in habitual pregnancy failure

Tral

Khobets

Tolibova

et al. 2022

jour

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Introduction. Habitual pregnancy failure (HPF) has long been a pressing problem of modern medicine and is characterized by multiple pathogenetic mechanisms of early pregnancy termination. The aim of the study was to examine the expression of estrogen, progesterone, progesterone-induced blocking factor and stromal cell factor-1 receptors in endometrial biopsy specimens from patients with HPF. Materials and methods. Histological and immunohistochemical studies were performed on 75 endometrial biopsies: 50 endometrial biopsies were taken from patients with HPF and chronic endometritis with no more than three pregnancies, and 25 endometrial biopsies were taken from conditionally healthy patients. Endometrial biopsy was performed on days 19 to 22 of the menstrual cycle. Histological examination of endometrial biopsy specimens was performed according to the standard technique with hematoxylin and eosin staining. The expression of estrogen receptor (ER), progesterone receptor (PR), progesterone-induced blocking factor (anti-PIBF), and stromal cell factor-1 (anti- SDF-1) was assessed by immunohistochemistry. Results. In patients with HPF, the endometrium corresponded to the middle stage of the secretion phase in 32 % of cases. Immunohistochemical study in patients with HPF verified multifocal decrease of estrogen and progesterone receptor expression in the stromal component in 82 % of cases. Assessment of PIBF and SDF-1 expression in the glands and stroma of the endometrial mid-stage secretion phase in patients with HPF revealed a statistically significant decrease compared to the control group. Discussion. The presence of chronic endometritis in patients with HPF leads to impaired endometrial secretory transformation, decreased expression of estrogen and progesterone receptors in the endometrial stroma, and decreased expression of PIBF and SDF-1 in the glands and endometrial stroma. The results of the study suggest the need for pathogenetic therapy of chronic endometritis and pregravidarial preparation in patients with HPF. Conclusion. Regardless of the completeness of endometrial transformation, desynchronosis of the receptor profile, altered expression of immunological markers (PIBF and SDF-1) against the background of chronic endometritis, and structural and molecular disturbances serve as factors of early pregnancy loss.

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Neoadjuvant Diagnosis and Management of Chronic Endometritis

Cited by 4 publications

References 4 publications

Chronic endometritis and infertility — in vitro fertilization outcomes: systematic review and meta-analysis

Chronic endometritis and infertility — in vitro fertilization outcomes: systematic review and meta-analysis

Expression of vascular endothelial growth factor a in the endometrium in uterine factor infertility

Structural, functional, and molecular mechanisms of endometrial transformation in habitual pregnancy failure

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