The effects of chronic endometritis on the pregnancy outcomes

Morimune, Aina; Kimura, Fuminori; Nakamura, Akiko; Kitazawa, Jun; Takashima, Akira; Amano, Tsukuru; Kudoh, Shoji; Moritani, Suzuko; Kushima, Ryoji; Murakami, Takashi

doi:10.1111/aji.13357

Cited by 21 publications

(17 citation statements)

References 47 publications

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“… 59 , 60 , 61 Morimune, et al reported a comparison of data from pregnancy outcomes between women with and without CE, finding that the miscarriage rate in women with untreated CE was significantly higher than in women without CE (40.0% and 12.8%, respectively). 62 Although there have been only few reports on the pregnancy outcomes of women with untreated CE, a relationship between unexplained RPL and local endometrial proinflammatory response with aberrantly increased uNK cells and angiogenesis has been reported. 19 , 20 , 21 Among proinflammatory mediators in women with unexplained RPL, IL33/ST2 activity is disordered in the human endometrium.…”

Section: Discussionmentioning

confidence: 99%

Novel approaches to the management of recurrent pregnancy loss: The OPTIMUM (OPtimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu) treatment strategy

Kuroda

Ikemoto

Horikawa

et al. 2021

Reprod Medicine & Biology

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Section: Discussionmentioning

confidence: 99%

Novel approaches to the management of recurrent pregnancy loss: The OPTIMUM (OPtimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu) treatment strategy

Kuroda

Ikemoto

Horikawa

et al. 2021

Reprod Medicine & Biology

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“…The criteria for registration were set accordingly to a previous report with some modification [ 20 ]. Briefly, patients who had a history of RIF, recurrent pregnancy loss (RPL) or diseases suspected to cause implantation failure such as uterine malformation, multiple myoma, endometrial polyp, hydrosalpinx, adenomyosis with over a uterine wall > 2.5 cm thick or endometrial thinning (< 8 mm at implantation phase) detected by ultrasonography [ 21 – 26 ], were not enrolled.…”

Section: Methodsmentioning

confidence: 99%

“…After the identification of the ovulation day as reported previously [ 20 ], hysteroscopy and endometrial tissue collection were performed 5–9 days after ovulation. Whether endometrial macropolyps and uterine malformations were present was determined by hysteroscopy, and patients with these diseases were excluded from this study at that moment [ 23 , 24 ] (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Immediately after hysteroscopy, the tissue around the center of the anterior endometrium was collected with 4.5 J. A. M. W Type Uterine Curettes, and immunostaining of this sample for CD138 was performed, as reported previously [ 1 , 20 , 31 , 32 ]. One pathologist examined this tissue to determine how many plasma cells there were in 10 random HPFs (Olympus BX-41; hpf diameter = 0.55 mm; hpf area = 0.24 mm 2 ) of the endometrial stromal area.…”

Section: Methodsmentioning

confidence: 99%

“…A multivariate logistic regression analysis was performed for eight explanatory variables, which included seven infertility factors (male factor, tubal factor, endometriosis, ovarian factor, anti-sperm antibody-positive, fertilization failure, unexplained infertility) and CE, with respect to the objective variable of live birth to obtain factors that worked negatively for each criterion, as previously reported [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

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Histological diagnostic criterion for chronic endometritis based on the clinical outcome

et al. 2021

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Background The diagnostic criteria of chronic endometritis remain controversial in the treatment for infertile patients. Methods A prospective observational study was conducted in a single university from June 2014 to September 2017. Patients who underwent single frozen-thawed blastocyst transfer with a hormone replacement cycle after histological examination for the presence of chronic endometritis were enrolled. Four criteria were used to define chronic endometritis according to the number of plasma cells in the same group of patients: 1 or more (≥ 1) plasma cells, 2 or more (≥ 2), 3 or more (≥ 3), or 5 or more (≥ 5) in 10 high-power fields. Pregnancy rates, live birth rates, and miscarriage rates of the non-chronic endometritis and the chronic endometritis groups defined with each criterion were calculated. A logistic regression analysis was performed for live births using eight explanatory variables (seven infertility factors and chronic endometritis). A receiver operating characteristic curve was drawn and the optimal cut-off value was calculated. Results A total of 69 patients were registered and 53 patients were finally analyzed after exclusion. When the diagnostic criterion was designated as the presence of ≥ 1 plasma cell in the endometrial stroma per 10 high-power fields, the pregnancy rate, live birth rate, and miscarriage rate were 63.0% vs. 30.8%, 51.9% vs. 7.7%, and 17.7% vs. 75% in the non-chronic and chronic endometritis groups, respectively. This criterion resulted in the highest pregnancy and live birth rates among the non-chronic endometritis and the smallest P values for the pregnancy rates, live birth rates, and miscarriage rates between the non-chronic and chronic endometritis groups. In the logistic regression analysis, chronic endometritis was an explanatory variable negatively affecting the objective variable of live birth only when chronic endometritis was diagnosed with ≥ 1 or ≥ 2 plasma cells per 10 high-power fields. The optimal cut-off value was obtained when one or more plasma cells were found in 10 high-power fields (sensitivity 87.5%, specificity 64.9%). Conclusions Chronic endometritis should be diagnosed as the presence of ≥ 1 plasma cells in 10 high-power fields. According to this diagnostic criterion, chronic endometritis adversely affected the pregnancy rate and the live birth rate.

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Therapeutic efficacy of gentle endometrial curettage on antibiotic‐resistant chronic endometritis in infertile women

Kuroda

Ishiyama²,

Shiobara³

et al. 2023

Reprod Medicine & Biology

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PurposeTo identify the efficacy of endometrial curettage on antibiotic‐resistant chronic endometritis (CE) in infertile women.MethodsOf 1580 women with CE, 87 with antibiotic‐resistant CE after two to five cycles of antibiotic treatment were recruited between 2019 and 2021. The women who underwent endometrial curettage without applying any force and, in the subsequent menstrual cycle, endometrial sampling for CD138 immunostaining without antibiotic use. Pregnancy outcomes after in vitro fertilization treatment were analyzed in women who did not desire endometrial curettage and in those with cured and persistent CE after endometrial curettage.ResultsIn 64 women who underwent endometrial curettage, the number of CD138‐positive cells decreased from 28.0 ± 35.3 to 7.7 ± 14.0 (p < 0.0001), and CE in 41 women (64.1%) was cured (<5 CD138‐positive cells). The pathological findings detected 3.1% of endometrial hyperplasia and 1.6% of endometrial cancer. The ongoing pregnancy rates in women aged ≤42 without endometrial curettage were significantly lower than those of women with cured and persistent CE (26.7%, 67.6%, and 57.1%, respectively, p = 0.03).ConclusionsGentle endometrial curettage for antibiotic‐resistant CE significantly decreased the number of CD138‐positive cells, resulting in improved pregnancy outcomes regardless of remaining CE. Endometrial curettage is also important as a screening for endometrial malignancy.

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The effects of chronic endometritis on the pregnancy outcomes

Cited by 21 publications

References 47 publications

Novel approaches to the management of recurrent pregnancy loss: The OPTIMUM (OPtimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu) treatment strategy

Novel approaches to the management of recurrent pregnancy loss: The OPTIMUM (OPtimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu) treatment strategy

Histological diagnostic criterion for chronic endometritis based on the clinical outcome

Therapeutic efficacy of gentle endometrial curettage on antibiotic‐resistant chronic endometritis in infertile women

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