The effectiveness of intrauterine antibiotic infusion versus oral antibiotic therapy in the treatment of chronic endometritis in patients during IVF (in vitro fertilization) procedures

Abstract

Background Chronic Endometritis (CE) is a subtle pathology, likely infectious in most cases, with a negative impact on the female fertility, but often overlooked even among fertility specialists. The purpose of the study is to demonstrate the predominant infectious nature of CE and to find the best therapeutic option by comparing the results of oral antibiotic therapy versus intrauterine antibiotic infusion in patients with CE undergoing IVF procedures. The objective was to compare the cure rate of CE—defined as the percentage of patients without CE at the test of cure, between the two groups and, the hysteroscopic aspect with the positive CD 138 staining. Methods This was a prospective, case—control study that took place in a single university fertility clinic, in Oradea, Romania and included 57 patients with CE divided into 2 groups: orally administered antibiotics group who received a combination of antibiotics compared to intrauterine infusion group who received intrauterine infusion of antibiotic. Chronic Endometritis was diagnosed through hysteroscopy and immunohistochemistry for CD 138. Patients in both groups were tested for CE twice to evaluate the cure rate after oral combination antibiotic therapy versus intrauterine infusion of antibiotic. Results Out of 115 patients with endometrial biopsies 57 tested positive for CE, with a 49.6% chronic endometritis prevalence. Among the group that was administered oral antibiotics, 11 patients (45.83%) experienced CE resolution after triple antibiotic therapy. Of the intrauterine infusion group, 25 patients (89.29%) presented negative results (p 0.0020). The normal hysteroscopic aspect had a similar prevalence in the patients with immunohistochemical positive and negative CD 138. Conclusions Our study demonstrated the effectiveness and superiority of intrauterine antibiotic infusion over the use of oral combination antibiotic therapy for CE cure. Trial Registration: ISRCTN17542620/14.09.2022.

Autologous Platelet-Rich Plasma (PRP) Efficacy on Endometrial Thickness and Infertility: A Single-Centre Experience from Romania

“…Among these, VEGF is important in the vascularization process. By causing the increased expression of molecules that attract stem cells and increased cell migration, PRP treatment can stimulate endometrial receptivity as well as growth [ 40 ].…”

Perioperative Analgesia and Patients’ Satisfaction in Spinal Anesthesia for Cesarean Section: Fentanyl Versus Morphine

“…Recent studies emphasized that postoperative nausea and vomiting were triggered by hypotension most of the time [12,31,32]. During spinal anesthesia for cesarean section, these problems can be exacerbated by uterine manipulation and peritoneal closure [33]. Some authors advocated that adding an opioid to a local anesthetic in spinal anesthesia would decrease the requirement for intra-operative antiemetic drugs, effects provided mostly by intrathecal fentanyl and not by sufentanyl [34,35].…”

Unveiling the Role of Endometrial CD-138: A Comprehensive Review on Its Significance in Infertility and Early Pregnancy

“…CD-138, syndecan-1, is a transmembrane heparan sulfate proteoglycan that functions as an extracellular matrix receptor and is a specific marker for plasma cells. In the context of endometrial health and infertility, identifying CD-138+ cells within the endometrial stroma has been correlated with the diagnosis of CE and its potential impact on pregnancy outcomes [ 14 ]. Studies have revealed that CD-138+ cells, particularly in the proliferative-phase endometrium, may be an adverse indicator for pregnancy outcomes in in vitro fertilization (IVF) cycles.…”