Review: Chronic endometritis and its effect on reproduction

Abstract

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.

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

“…Endometrial cancer and endometriosis, as well as CE, are known to be frequent in infertile patients [4][5][6][7][8][29][30][31][32]. Considering that CE is frequently found in infertile patients, CE, by triggering the EMT, might be the cause of the increased prevalence of endometrial cancer and endometriosis in infertile patients.…”

“…Chronic endometritis (CE) is a persistent chronic in ammatory process of the endometrium. CE is de ned as in ltration of plasma cells in the endometrial stroma [1][2][3][4], and immunostaining for CD138, a plasma cell marker, has been reported to be a useful method for demonstrating plasma cells in the endometrial stroma [2,5]. CE is usually asymptomatic or presents only with subtle symptoms, including abnormal uterine bleeding, dyspareunia, leucorrhea, and pelvic pain [1][2][3].…”

Possibilities of optimization of pregnancy preparation in the presence of conditions accompanied by endothelial dysfunction

“…Считается, что микроорганизмы являются основной причиной возникновения ХЭ, поскольку назначение антибиотиков является эффективной терапией для ХЭ [2]. Сообщалось, что пациенты, у которых был вылечен ХЭ, имеют более высокую частоту наступления беременности и имплантации по сравнению с пациентами с персистирующим ХЭ [3]. Учитывая то, что ХЭ -это длительный, часто полиэтиологичный воспалительный процесс, одним из его проявлений становится нарушение функции эндотелия сосудов эндометрия, приводящее к активации свертывающей системы крови и в результате к нарушению процессов инвазии трофобласта.…”

Histological diagnostic criterion for chronic endometritis based on the clinical outcome.

“…Chronic endometritis (CE) is defined as slight inflammation of the endometrium and is generally agreed that the presence of plasma cells within the endometrial stroma is the most useful histologic criterion for diagnosis [1][2][3][4][5][6]. Although patients with CE have no or subtle clinical symptoms, and no clinical significance has yet been found, there have recently been many reports that show its relationship with infertility and implantation failure [4,[7][8][9][10][11][12][13][14][15].…”