Is Chronic Endometritis Associated with Tubal Infertility? A Prospective Cohort Study.

STUDY OBJECTIVE: Chronic endometritis (CE), which often presents asymptomatically, is associated with recurrent pregnancy loss, recurrent implantation failure after in vitro fertilization, and endometriosis. Data connecting CE with fallopian tubal occlusion are limited. The aim was to assess a potential association of CE, defined by the presence of syndecan-1 (CD138)-positive plasma cells in endometrial tissue samples, with fallopian tube patency and other factors for infertility, including endometriosis, adenomyosis, and hydrosalpinges. DESIGN: Prospective, monocentral pilot study. SETTING: Tertiary care center. PATIENTS: A cohort of 100 women who were infertile was enrolled from July 2019 to December 2020. INTERVENTIONS: Hysteroscopy with endometrial biopsy and laparoscopy with chromopertubation. MEASUREMENTS AND MAIN RESULTS: CE was found in 13 women (13.0%) and was associated with endometriosis (p = .034) and unilateral/bilateral fallopian tube blockage (p = .013). In women with endometriosis, the mean number of CD138-positive cells was positively correlated with the revised American Society for Reproductive Medicine score (r = .302, p = .028). In a binary regression model, the presence of a hydrosalpinx on one or both sides (odds ratio 15.308; 95% confidence interval, 1.637-143.189; p = .017) and the finding of CE in the endometrial tissue sample (odds ratio 5.273; 95% confidence interval, 1.257-22.116; p = .023) were significantly associated with fallopian tubal occlusion. CONCLUSION: CE was significantly associated with blockage of the fallopian tubes and endometriosis. Endometriosis stage was associated with the number of CD138-positive cells in endometrial biopsies.

Müllerian duct anomalies: embryological development, classification, and MRI assessment.

Müllerian duct anomalies (MDA) occur due to abnormal development of the uterus, cervix, and vagina, many times affecting a woman's ability to conceive and carry a pregnancy to term. The spectrum of possible abnormalities are related to the development of two separate Müllerian systems, which then fuse and subsequently undergo degeneration of the fused segments. This multiphasic development explains the multiple variations within the scheme of MDA classification. The purpose of this article is to review the embryologic development of the Müllerian ducts, relate the development to the most commonly used classification system, and review the magnetic resonance imaging (MRI) assessment of Müllerian duct anomalies. A brief review of the treatment options, as they relate to the imaging diagnosis, will be provided as well.

New approaches to assisted reproductive technologies.

Egg infertility remains the greatest challenge in the treatment of the infertile couple. As women increasingly delay attempts at childbearing, egg infertility has become more prevalent. Attempts to overcome egg infertility by superovulation and in vitro fertilization have produced an epidemic of multiple gestations, itself a major public health concern. The pathophysiology of egg infertility arises from chromosomal nondisjunction. Cytogenetic analyses of polar bodies and/or blastomeres currently provide the most powerful predictors of egg infertility. Approaches that label all chromosomes (spectral karyotyping and comparative genomic hybridization), or identify predisposition to aneuploidy (spindle imaging, telomere length measurement) are on the horizon. For the foreseeable future, the treatment of egg infertility will be limited to egg donation for severe cases and transfer of the most viable embryos for milder cases. Oocyte reconstitution not only lacks evidence of clinical efficacy, but also biological credibility, given that growing evidence supports the primacy of chromosomes themselves in meiotic nondisjunction.