Prevalence and risk factors for chronic endometritis in patients with adenomyosis and infertility: a retrospective cohort study.

BACKGROUND: To explore the incidence of chronic endometritis (CE) in patients with infertility and different forms of adenomyosis and analyze potential high-risk factors for infection. METHODS: This retrospective cohort study included 154 patients with infertility in the Liuzhou Maternity and Child Healthcare Hospital. Among them, 77 patients with adenomyosis were divided into four subgroups based on magnetic resonance imaging (MRI): internal, exterior, intramural, and full-thickness. Meanwhile, 77 patients did not have adenomyosis. Hysteroscopy and endometrial biopsy were performed in the proliferative phase. The main outcome measures were the morphology of the endometrium, syndecan-1 (CD138) immunohistochemical staining, clinical characteristics, and prevalence of CE in the adenomyosis subgroups. RESULTS: In comparison to the non-adenomyosis group, the adenomyosis group had significantly higher body mass index (BMI) and CA125 levels. The menstrual cycle in the adenomyosis group was significantly shorter, and menarche was significantly earlier. In comparison to the non-adenomyosis group, the adenomyosis group had a significantly higher diagnostic rate of CE (75.3% vs. 46.8% according to hysteroscopy and 74.0% vs. 33.8% according to histopathology, both with p < .050). The incidence of CE was significantly lower in patients with internal adenomyosis when compared with the other three subgroups. Increased BMI contributed to a higher risk of CE. CONCLUSIONS: The prevalence of CE was significantly higher in patients with adenomyosis and infertility. The differences in the incidence of CE are closely associated with the classification of adenomyosis. When patients with infertility are diagnosed with adenomyosis, it is recommended to identify the subtype and screen for endometritis.

Chronic endometritis multiplies the recurrence risk of endometrial polyps after transcervical resection of endometrial polyps: a prospective study.

BACKGROUND: To investigate the impact of chronic endometritis (CE) on the recurrence of endometrial polyps (EPs) in premenopausal women after transcervical resection of endometrial polyps (TCRP). METHODS: This prospective study enrolled 507 women who underwent TCRP between January 1, 2022 and December 31, 2022. The patients were divided into a CE group (n = 133) and non-CE group (n = 374) based on the expression of CD138 in the endometrium. The EP recurrence rate at 1 year after TCRP was compared between the CE and non-CE groups and between groups with mild CE and severe CE. The impact of CD138 expression by resected EPs on EP recurrence also was investigated. RESULTS: The EP recurrence rate at 1 year post-TCRP was higher in the CE group than in the non-CE group (25.6% vs. 10.4%) and also higher in the severe CE group than in the mild CE group (34.5% vs. 18.7%). Additionally, the EP recurrence rate was higher among patients with CD138-expressing EPs than among those with EPs lacking CD138 expression (30.5% vs. 6.5%). The odds ratio (OR) for EP recurrence in the CE cohort compared with the non-CE cohort was 3.10 (95% confidence interval [CI] 1.84-5.23) after adjustment for EP number and precautions against EP recurrence. The ORs for EP recurrence in patients with mild CE and severe CE were 2.21 (95%CI 1.11-4.40) and 4.32 (95%CI 2.26-8.26), respectively. Similarly, the OR for EP recurrence in cases with CD138-expressing EPs relative to cases with EPs lacking CD138 expression was 6.22 (95%CI 3.59-10.80) after adjustment for EP number and precautions against EP recurrence. CONCLUSIONS: CE multiplied the recurrence rate of EPs in premenopausal women after TCRP, and this effect positively correlated with CE severity. CD138 expression by EPs also was associated with a higher risk for EP recurrence.

Chronic endometritis incidence in infertile women with and without polycystic ovary syndrome: a propensity score matched study.

BACKGROUND: Polycystic ovary syndrome (PCOS) is known to be associated with chronic low-grade inflammation and endometrial dysfunction. Chronic endometritis (CE) is a type of local inflammation that can contribute to endometrial dysfunction in infertile women. Some clinicians recommend screening for CE in women at high risk, such as those with endometrial polyps. However, it is still uncertain whether there is a relationship between PCOS and CE, as well as whether women with PCOS require enhanced screening for CE. This study was to assess the incidence of CE among infertile women with PCOS by hysteroscopy combined with histopathology CD138 immunohistochemical staining of endometrium. METHODS: A total of 205 patients in the PCOS group and 4021 patients in the non-PCOS group from July 2017 to August 2022 were included in this retrospective study. After nearest-neighbor 1:4 propensity score matching (PSM), 189 PCOS patients were matched with 697 non-PCOS patients. Basic information was recorded. The CE incidence was compared. The risk factors affecting CE incidence were also analyzed. RESULTS: No significantly higher CE incidence in infertile women with PCOS were found either in total analysis or after PSM (P = 0.969; P = 0.697; respectively). Similar results were discovered in the subgroup of Body Mass Index (BMI) (P = 0.301; P = 0.671; P = 0.427; respectively) as well as the four PCOS phenotypes (P = 0.157). Intriguingly, the incidence of CE increased as BMI increased in the PCOS group, even though no significant differences were found (P = 0.263). Multivariate logistic regression showed that age, infertility duration, infertility type, PCOS, and obesity were not the independent risk factors affecting CE incidence. CONCLUSION: The incidence of CE in PCOS patients did not significantly increase compared to non-PCOS patients. Similarly, no significant differences in the incidence of CE were observed among different PCOS phenotypes. The current evidence does not substantiate the need for widespread CE screening among PCOS women, potentially mitigating the undue financial and emotional strain associated with such screenings.

The association between endometrial polyps, chronic endometritis, and IVF outcomes.

OBJECTIVE: Endometrial polyps (EPs) are one of the most common pathologies detected during the examination of the uterine cavity of infertile women. We aimed to demonstrate the relationship between EPs, chronic endometritis (CE) and in vitro fertilization (IVF) outcomes. PATIENTS AND METHODS: This retrospective study was performed on 394 hysteroscopically examined infertility cases. We performed polyp resections (PR) and extensive biopsies of the endometrium to demonstrate the association with clinical pregnancy (CP) by IVF. We performed statistical analysis to compare these associations. RESULTS: The incidence of CE was twice as high in the presence of EPs as in the absence of EPs. The associations between EPs and PR were found to be significant for positive CP outcomes. A significant difference in IVF outcome was found between the group with EPs and the group without EPs. All these associations were statistically significant (p < 0.05). CONCLUSIONS: We found a frequent association between EPs and CE. The pregnancy rate obtained after IVF was negatively affected by the presence of EPs. Treatment of these pathologies improved IVF outcomes.

High prevalence of chronic endometritis is associated with metabolic abnormality and reduced live birth rate among IVF women with non-uniform endometrial echogenicity.

OBJECTIVE: To assess the prevalence of chronic endometritis (CE) among women with non-uniform endometrial echogenicity, and to evaluate the association between CE and metabolic characteristics as well as pregnancy outcomes in the subsequent frozen-thawed embryo transfer (FET) cycles. DESIGN: Retrospective cohort study. SETTING: University-based hospitals and an academic medical center. PATIENTS: A total of 315 patients included in this research underwent hysteroscopy and endometrial biopsy before the first FET cycle after whole embryos freezing. Patients were divided into CE (histopathologic CE or hysteroscopic CE) and non-CE groups. INTERVENTION(S): Freeze-all strategy, hysteroscopy and endometrial biopsy. MAIN OUTCOME MEASURES: Baseline and cycle characteristics, hysteroscopic, and histopathological profile, as well as pregnancy outcomes. RESULTS: The prevalence of histopathologic CE and hysteroscopic CE were 78.1% and 34.9%, respectively. CE was associated with higher homocysteine level and BMI, independent of insulin response and dyslipidemia. High homocysteine level and BMI were risk factors for histopathologic CE (OR: 1.182; 95% CI: 1.01-1.384; p = .037) and hysteroscopic CE (OR: 1.117; 95% CI: 1.041-1.199; p = .002), respectively. Histopathologic CE was a risk factor for live birth (OR:2.167; 95% CI: 1.037-4.525; p = .04), and hysteroscopic CE was an independent risk factor for both live birth (OR: 4.239; 95% CI: 1.929-9.313; p = .001) and cumulative live birth (OR: 3.963; 95% CI: 1.875-8.376; p = .001). CONCLUSIONS: Infertile women with non-uniform endometrial echogenicity have a high prevalence of CE which significantly reduces the live birth rate. Diagnosing CE by hysteroscopy is important to assess the cumulative probability of pregnancy in IVF patients.

Impact of antibiotic cured chronic endometritis on perinatal outcomes: Re-evaluation of a cohort study with a detailed follow-up.

PROBLEM: The impact of antibiotic-cured chronic endometritis (CE) on perinatal outcomes of patients conceived with frozen embryo transfer (FET) was unclear. METHOD: This study was to re-evaluate the perinatal outcomes of a cohort of infertile patients who had undergone endometrial biopsy for CE detection from February 2018 to December 2019 and successfully delivered babies after FET. The study population was divided into two groups: the non-CE (NCE) group (0-4/HPF CD138) and the cured-CE (CCE) group (CD138+/HPF≥5 and has been cured after one or two rounds of antibiotic treatment). For subgroup analysis, the NCE group was further divided into subgroup 1 (CD138+/HPF = 0), subgroup 2 (CD138+/HPF = 1-4 with antibiotic treatment), and subgroup 3 (CD138+/HPF = 1-4 without antibiotic treatment) RESULTS: A total of 321 live births, including 210 in the NCE group and 111 in the CCE group were analyzed. The prevalence rates of premature rupture of the membrane and preterm birth were comparable between NCE and CCE (6.2% vs. 7.1% and 10.8% vs. 10.1%, respectively) groups. In addition, no differences were detected in the rates of placenta-mediated complications, such as preeclampsia, placenta abruption, or low birthweight. Multiple logistic analyses confirmed that CCE was not associated with an increased risk of any adverse perinatal outcomes. Subgroup analysis in NCE failed to find any significant differences in the incidences of obstetrical and neonatal complications. CONCLUSIONS: CCE might not increase the risks of adverse perinatal outcomes after antibiotic treatment.

Clinical evidence of positive correlation between intrauterine adhesions and chronic endometritis: a retrospective study.

OBJECTIVE: This study aimed to analyze the potential correlation between chronic endometritis (CE) and intrauterine adhesions (IUA) with its associated risk factors. PATIENTS AND METHODS: We retrospectively analyzed data from 131 patients who underwent hysteroscopic transcervical resection of adhesions (TCRA) for intrauterine adhesions at our hospital between February 2020 and February 2021. General clinical data were collected and analyzed using univariate, multifactorial, and logistic regression analyses. Patients with mild, moderate, and severe IUA were divided into two groups based on whether they coincided with CE (CE group) or not (NCE group). Logistic regression analysis of the factors associated with IUA was performed, and the recurrence rates of IUA after TCRA in the CE and NCE groups were registered. RESULTS: The risk of severe IUA was higher in patients with a higher number of abortions, higher number of indolent abortions, and CD138 positivity. In addition, the incidence of IUA combined with chronic CE varied when comparing the different IUA stages: 10.70% (3/28) for patients with mild IUA, 25.00% (7/28) for patients with moderate IUA, and 64.30% (18/28) for patients with severe IUA. The recurrence rates of IUA after TCRA in the CE and NCE groups were 69.20% (9/26) and 30.08% (4/67), respectively, in patients with moderate to severe IUA, and the differences were statistically significant (χ2=12.782, p=0.001). CONCLUSIONS: A correlation was observed between CE and IUA. Patients presenting both conditions had more severe IUA stage and higher recurrence rates after TCRA.

Prevalence of chronic endometritis in patients with infertility due to hydrosalpinx or pelvic peritubal adhesions and effect of laparoscopic surgical correction on pregnancy rates post in vitro fertilization.

OBJECTIVE(S): To assess the prevalence of chronic endometritis (CE) in patients with infertility and hydrosalpinx or peritubal adhesions and to examine the effects of laparoscopic surgical correction (LSC) on CE and pregnancy rates post in vitro fertilization and embryo transfer (IVF-ET). STUDY DESIGN: This is a retrospective cohort study at private IVF-ET centers. A total of 438 patients, known to have hydrosalpinx (n = 194) or peritubal adhesions (n = 244), and undergoing IVF treatment between April 1, 2018 and September 30, 2020 were included in the study. Hysterosalpingography, magnetic resonance imaging, and transvaginal ultrasonography were used to diagnose the hydrosalpinx or peritubal adhesions. Laparoscopic examination and surgical correction were performed on patients with CE. IVF-ET was performed after recovery from LSC. RESULTS: CE was present in 45.9% of patients (89/194) with hydrosalpinx and 14.3% with peritubal adhesions (35/244). All the 89 patients with CE and hydrosalpinx underwent laparoscopic salpingostomy and/or fimbrioplasty, and 64 (71.9%) further underwent proximal tubal occlusion. All the 35 patients with CE and peritubal adhesions underwent laparoscopic adhesiolysis and/or fimbrioplasty, and 19 (54.3%) further underwent proximal tubal occlusion. CD138 PC levels after LSC decreased to < 5 in 70 of 124 patients (56.5%) in one menstrual cycle and decreased to < 5 in all cases within 6 months. Of the 66 patients who underwent a single blastocyst transfer, 57 delivered (cumulative live birth rate (LBR): 86.3%). The cumulative LBR of patients treated for CE with LSC (86.3%) was significantly different from those given antibiotic therapy (320 patients; 38.4%; p <.0001) and the CD138-negative groups (811; 31.8%; p <.0001). CONCLUSION: CE is prevalent in patients with hydrosalpinx and/or peritubal adhesions who present with infertility. LSC improved CE without antibiotic therapy, improving the CP and LBR after IVF-ET.

The Impact of Chronic Endometritis on Infertility: Prevalence, Reproductive Outcomes, and the Role of Hysteroscopy as a Screening Tool.

OBJECTIVES: The objective of this study was to examine the prevalence of chronic endometritis (CE) in infertile women, its impact on reproductive outcomes, and the accuracy of hysteroscopy as a screening tool for CE. DESIGN: This was a prospective observational study. PARTICIPANTS: Participants involved in this study were 514 asymptomatic patients with infertility. SETTING: The review was conducted in a tertiary care center. METHODS: The participants underwent a hysteroscopy and endometrial biopsy (EMB). Antibiotics were given for cases of CE. We investigated the prevalence of CE in patients starting assisted reproductive technologies (ART) as a primary outcome. Secondary outcomes were the clinical pregnancy rate (CPR) in the ART cycle after hysteroscopy, EMB, and antibiotic treatment in cases of CE; the cumulative CPR in the subsequent 2 years after hysteroscopy and EMB; the sensitivity and specificity of hysteroscopy as a screening tool compared to EMB as the "gold standard" for diagnosing CE. RESULTS: CE was identified in 2.8% of patients starting ART (11/393). CPRs did not differ significantly between patients with CE and the entire cohort of patients without CE in the subsequent ART cycle (OR: 0.43; 95% CI: 0.09-2.02) or in the 2 years after EMB (OR: 0.56; 95% CI: 0.16-1.97). In a matched control comparison (with matching for age, basal FSH, and cause of infertility), CPR in patients with CE did not differ in the subsequent ART cycle (OR: 0.39; 95% CI: 0.09-1.61); however, their CPR in the 2 years after EMB was significantly lower (OR: 0.22; 95% CI: 0.13-0.38). The sensitivity and specificity of hysteroscopy as a screening tool for diagnosing CE were 8.3% and 90.1%, respectively. LIMITATIONS: Due to our cohort's low CE prevalence, we could not detect significant differences in CPRs. CONCLUSION: CE is rare in our studied population of asymptomatic patients starting ART. Hysteroscopy cannot replace EMB for diagnosing CE.

Existence of chronic endometritis and its influence on pregnancy outcomes in infertile women with minimal/mild endometriosis.

OBJECTIVE: This study aimed to evaluate the prevalence of chronic endometritis (CE) in women with minimal/mild endometriosis and to analyze whether CE affects their pregnancy outcomes. METHODS: This retrospective study included 201 infertile women who were diagnosed with minimal/mild endometriosis after undergoing hysteroscopy combined with laparoscopy from January 2016 to December 2018. Immunohistochemistry was used to detect CD138 and CD38, which are specific markers of plasma cells in the endometrial stroma to diagnose CE. Subsequently, we investigated the prevalence of CE and the effects of CE on spontaneous cumulative pregnancy rate, live birth rate, and miscarriage rate within 24 months after surgery. RESULTS: The prevalence of CE in infertile women with minimal/mild endometriosis was 24.38%. Patients diagnosed with CE showed a significantly lower cumulative pregnancy rate and live birth rate compared with women without CE (46.51% vs. 71.13% [P = 0.004]; 44.19% vs. 63.38% [P = 0.025]). However, the rate of miscarriage in women with CE was also lower than in women without CE (0 vs. 7.04%, P = 0.074). CONCLUSION: Since CE had an adverse effect on cumulative pregnancy rate and live birth rate in infertile women with minimal/mild endometriosis, we suggested that diagnosis and treatment of CE may improve their pregnancy outcomes.

The combination of CD138/MUM1 dual-staining and artificial intelligence for plasma cell counting in the diagnosis of chronic endometritis.

OBJECTIVE: To investigate the utility of combination of CD138/MUM1 dual-staining (DS) and artificial intelligence (AI) for plasma cell (PC) counting in the diagnosis of chronic endometritis (CE). METHODS: Two hundred ninety-eight infertile women underwent endometrial biopsy were included. In 100 women, three successive sections were cut from each paraffin-embedded tissue block for CD138 immunohistochemical (IHC) single-staining (SS), MUM1 SS and CD138/MUM1 DS. The prevalence of CE and the sensitivity/specificity in the diagnosis of CE with different methods was studied. These sections diagnosed as CE with DS were collected to train artificial intelligence (AI) diagnostic system. In other 198 women, their tissue sections stained with CD138/MUM1 DS were used to test the AI system in the diagnosis of CE. RESULTS: CD138/MUM1 DS revealed that the cell membranes and nuclei of PCs were simultaneously labelled by CD138 and MUM1, respectively. The positive rate of ECs identified by CD138/MUM1 DS (38%, 38/100) was lower than CD138 SS (52%, 52/100) and MUM1 SS (62%, 62/100) (p < .05). The sensitivity, specificity and accuracy of CD138/MUM1 DS in the diagnosis of ECs reached 100%. The sensitivity, specificity and accuracy rates of AI diagnostic system of ECs were 100%, 83.3% and 91.4%, respectively. The 17 cases over-diagnosed as EC with the AI were corrected quickly by pathologists reviewing these false PC pictures listed by the AI. CONCLUSION: The combination of CD138/MUM1 DS and AI is a promising method to improve the accuracy and efficiency of CE diagnosis.

Vaginal cleansing before unscheduled cesarean delivery to reduce infection: a randomized clinical trial.

BACKGROUND: Cesarean delivery is the most performed major surgery among women, and surgical-site infections following a cesarean delivery are a significant source of postoperative morbidity. It is unclear if vaginal cleansing before a cesarean delivery decreases post-cesarean delivery infectious morbidity. OBJECTIVE: This study aimed to evaluate if preoperative vaginal cleansing with povidone-iodine among women undergoing a cesarean delivery after labor decreases postoperative infectious morbidity. STUDY DESIGN: This randomized clinical trial was conducted from August 3, 2015 to January 28, 2021, with 30 days of follow-up and the final follow-up completed on February 27, 2021. Patients met the inclusion criteria if they underwent a cesarean delivery after regular contractions with cervical dilation, rupture of membranes, or any cesarean delivery performed at >4 cm dilation. Participants were randomly assigned in a 1:1 ratio to either abdominal cleansing plus vaginal cleansing with 1% povidone-iodine or abdominal cleansing alone. The primary outcome was composite infectious morbidity including surgical-site infection, fever, endometritis, and wound complications within 30 days after the cesarean delivery. Secondary outcomes included individual components of the composite, length of hospital stay, postoperative hospitalization or outpatient treatment related to infectious morbidity, and empirical treatment for neonatal sepsis. RESULTS: A total of 608 subjects (304 vaginal cleansing group, 304 control group) were included in the intention-to-treat analysis. Patient characteristics were similar between groups. There was no significant difference in the primary composite outcome between the 2 groups (11.8% vs 11.5%; P=.90; relative risk, 1.0; 95% confidence interval, 0.7-1.6). Individual components of the composite and secondary outcomes were also not significantly different between the groups. Similar findings were observed in the as-treated analysis (11.3% vs 11.8%; P=.9; relative risk, 1.0; 95% confidence interval, 0.7-1.6). CONCLUSION: Vaginal cleansing with povidone-iodine before an unscheduled cesarean delivery occurring after labor did not reduce the postoperative infectious morbidity. These findings do not support the routine use of vaginal cleansing for women undergoing a cesarean delivery after labor.

Chronic endometritis positively correlates with the aggravation of intrauterine adhesions but has limited effects on reproductive prognosis with antibiotic application.

OBJECTIVE: To assess the effect of chronic endometritis (CE) diagnosed by CD138 staining on the aggravation of intrauterine adhesions (IUAs), and the reproductive prognosis after transcervical resection of adhesions (TCRA). METHODS: Sixty-three patients with severe IUAs (group A) and 119 patients with moderate IUAs (group B) were included in this retrospective study. TCRA and endometrial biopsy with CD138 staining were performed. Participants in each group were classified into two subgroups: CE group and NCE group (without CE). Patients were treated with a course of oral antibiotics for 2 weeks after TCRA. Embryo transfer would be performed if patients had embryos after operations. RESULTS: Increased incidence of CE was found in group A (18/63, 28.57%) compared with group B (18/119, 15.13%) (P = 0.030). No significant differences were found in the comparisons of chemical pregnancy rate, early miscarriage rate, or full-term pregnancy rate between the CE group and NCE group (P > 0.05), in either the subgroup analysis of group A and group B, or the total analysis. CONCLUSION: CE has a positive correlation with the aggravation of IUAs. CE did not have a negative impact on the reproductive prognosis of patients with moderate or severe IUAs after TCRA followed by antibiotic administration.

Retained pregnancy tissue after miscarriage is associated with high rate of chronic endometritis.

The objective of this study was to evaluate prevalence of chronic endometritis in a cohort of patients with retained pregnancy tissue (RPT) following miscarriage, with and without a history of recurrent pregnancy loss (RPL). In a cohort of our single academic fertility centre, we evaluated women with unexplained RPL (two or more losses) without evidence of RPT and women undergoing hysteroscopic resection of RPT following miscarriage. Endometrial samples underwent staining with H and E and CD138. A pathologist blinded to patient history recorded the number of plasma cells per 10 high power fields (HPF) and the presence or absence of endometrial stromal changes. Our main outcome measure was to measure the prevalence of chronic endometritis. Endometrial samples from 50 women with RPT following miscarriage and 50 women with unexplained RPL without evidence of RPT were reviewed. The prevalence of chronic endometritis was significantly higher in the RPT cohort (62% versus 30%). A multivariable regression demonstrated significantly higher odds of chronic endometritis in the RPT cohort, aOR 7.3 (95% CI 2.1, 25.5). We conclude that women with RPT following pregnancy loss have a high rate of chronic endometritis, suggesting that RPT is a risk factor for this disorder. Impact StatementWhat is already known on this subject? Known risk factors for chronic endometritis include a history of pelvic inflammatory disease, intrauterine polyps and fibroids. The aetiology for increased chronic endometritis among women with RPL is unknown.What do the results of this study add? The prevalence of chronic endometritis is significantly higher among women with retained pregnancy tissue (RPT) following miscarriage compared to women with RPL. These data presented suggest that RPT is associated with chronic endometritis among women with a history of miscarriage.What are the implications of these findings for clinical practice and/or further research? We suggest a pathologic evaluation for chronic endometritis be performed on all patients who undergo hysteroscopic resection of RPT following miscarriage. Our findings also suggest that a uterine cavity evaluation with hysteroscopy to evaluate for RPT may be reasonable in women with a history of miscarriage who are found to have chronic endometritis on endometrial biopsy. Further research is needed to determine if resection of retained tissue is sufficient to treat RPOC associated chronic endometritis, or if additional antibiotic treatment is necessary.

Multi-drug-resistant chronic endometritis in infertile women with repeated implantation failure: trend over the decade and pilot study for third-line oral antibiotic treatment.

PURPOSE: To evaluate the yearly prevalence and annual transition of multi-drug-resistant-chronic endometritis (MDR-CE) in infertile women with a history of repeated implantation failure (RIF) and to establish the third-line antibiotic treatment regimen against MDR-CE. METHODS: This retrospective/prospective cohort and pilot study included 3473 RIF women between April 2010 and September 2021. The endometrial stromal plasmacyte density index (ESPDI) was calculated in 3449 CD138-immunostained endometrial sections to evaluate CE. The microbiota in the vaginal secretions and endometrial fluid was compared between 17 patients with MDR-CE and 16 patients with antibiotics-sensitive CE. In a pilot study, oral moxifloxacin (400 mg/day, 10 days, n = 24) or azithromycin (500 mg/day, 3 days, n = 24) was administered to eligible patients with MDR-CE. RESULTS: From April 2010 to March 2020, CE was detected in 31.4% of RIF women and MDR was detected in 7.8% of CE. While the prevalence of CE was stable for a decade, MDR in CE increased steadily (OR 8.27, 95% CI 2.58-26.43, p trend < 0.001). The bacterial species/communities unique to MDR-CE were not found. The histopathologic cure rate of MDR-CE was similar between the moxifloxacin and azithromycin groups (79.2% vs 75.0%, OR 1.27, 95% CI 0.32-4.89, p value 0.73), as well as reproductive outcomes in subsequent embryo transfer cycles. CONCLUSION: In RIF women, MDR in CE increased over the decade. As a third-line treatment for MDR-CE, azithromycin may have a clinical advantage due to its shorter time administration periods. CLINICAL TRIAL NUMBER: ClinicalTrials.gov Identifier: UMIN-CTR 000029449/000031909.

Prevalence of and risk factors for chronic endometritis in patients with intrauterine disorders after hysteroscopic surgery.

OBJECTIVE: To identify the prevalence of and risk factors for chronic endometritis (CE) in patients with intrauterine disorders and the therapeutic efficacy of hysteroscopic surgery in the treatment of CE without antibiotic therapy. DESIGN: Prospective cohort study. SETTING: Hospital specializing in reproductive medicine. PATIENT(S): The study population consisted of 350 women with infertility, of whom 337 were recruited, who underwent hysteroscopic surgery between November 2018 and June 2021. Eighty-nine consecutive patients without intrauterine disorders were also recruited as controls. INTERVENTION(S): Endometrial samples were collected during the surgery for CD138 immunostaining for the diagnosis of CE. In women diagnosed with CE, endometrial biopsy was performed without antibiotic use in the subsequent menstrual cycle. MAIN OUTCOME MEASURE(S): Prevalence of and risk factors for CE in intrauterine disorders and therapeutic effects of hysteroscopic surgery on CE. RESULT(S): The prevalence of CE with ≥5 CD138-positive cells in women with no intrauterine disorder and with endometrial polyps, myomas, intrauterine adhesions (IUAs), and septate uterus was 15.7%, 85.7%, 69.0%, 78.9%, and 46.2%, respectively. A multivariate analysis revealed that CE was diagnosed significantly more often in the endometrial polyp (odds ratio, 27.69; 95% confidence interval, 15.01-51.08) and IUA groups (odds ratio, 8.85; 95% confidence interval, 3.26-24.05). The rate of recovery from CE with surgery in women with endometrial polyps, myomas, IUA, and septate uterus was 89.7%, 100%, 92.8%, and 83.3%, respectively. CONCLUSION(S): Endometrial polyp and IUA were risk factors for CE. Most CE cases with intrauterine disorders were cured with hysteroscopic surgery without antibiotic therapy, regardless of the type of intrauterine abnormalities.

Research update for the immune microenvironment of chronic endometritis.

Chronic endometritis (CE) is a persistent and subtle local inflammatory disease characterized by abnormal plasma cell infiltration in the endometrial stroma.The incidence of chronic endometritis is as high as 15-57.5% in women suffering from infertility, implantation failure of in vitro fertilization (IVF) and unexplained recurrent abortion. Many studies both at home and abroad have shown that CE can reduce the receptivity of endometrium and affect embryo implantation. According to the existing reproductive immunity research, the abnormality of immune cell subsets in endometrium is an important factors leading to pregnancy failure. The immune microenvironment in endometrium consists of immune cells and immune molecules, and their influence on embryo implantation can not be ignored. This review paper discusses the controversy of pathogenesis, diagnosis and treatment of CE from the perspective of immune microenvironment by referring to related literature at home and abroad, and investigates the possible ways to improve the diagnosis and treatment of CE.

Higher Chronic Endometritis Incidences within Infertile Polycystic Ovary Syndrome Clinical Cases.

Background: Clinical cases of a polycystic ovarian syndrome (PCOS) have prolonged subclinical inflammation. Hysteroscopy has revealed worsened chronic endometritis (CE), particularly endometrial diffuse hyperemia, in PCOS patients. However, the possible relationships between PCOS and CE remain largely unexplored. Methods: This retrospective-based investigation was conducted on 3336 infertile patients. The PCOS group consisted of 508 patients, while the non-POCS group consisted of 2828 individuals with normal ovarian function. Their clinical features and CE prevalence diagnosed with hysteroscopy were compared. The risk factors affecting the incidence of diffuse endometrial hyperemia were analyzed by binary logistic regression. Results: The PCOS cohort and the non-PCOS cohort showed marked variations in age, body mass index (BMI), infertility (primary, secondary), basal hormone level (bFSH, bLH, bT, and PRL), anti-Müllerian hormone (AMH), and CA125 (P < 0.05). The prevalence of CE in PCOS women was 41.73% (212/508), markedly higher than the 28.50% in the non-PCOS cohort (806/2828). Variations within diffuse endometrial hyperemia prevalence were especially marked (P < 0.05). Furthermore, we found that the variables of BMI, bLH, bT, and AMH correlated with diffuse endometrial hyperemia. Conclusions: CE prevalence was elevated in clinical cases of infertility associated with PCOS, and diffuse endometrial hyperemia was prevalent, as indicated by hysteroscopy. Furthermore, increased BMI, bLH, bT, and AMH levels all contribute to the risk of diffuse endometrial hyperemia.

Endometrial polyp is associated with a higher prevalence of chronic endometritis in infertile women.

OBJECTIVE: To assess the prevalence of chronic endometritis (CE) among infertile women with endometrial polyps (EP). METHODS: From June 2017 to October 2021, 583 patients in the polyp group (group A-group A1: single-polyp group, 322 patients; group A2: multiple-polyp group, 261 patients) and 4534 patients in the non-polyp group (group B) were included in this retrospective study. Hysteroscopic polypectomy was performed in group A. Endometrial biopsy and CD138 immunohistochemistry staining for specimens was carried out in all groups. RESULTS: Prevalence of CE was significantly higher in group A than in group B (45.28% vs. 27.94%, P < 0.001). A significantly higher prevalence of CE was found in group A1 and group A2 compared with group B (42.24% vs. 27.94%, P < 0.001; 49.04% vs. 27.94%, P < 0.001; respectively). No significant difference in the comparison of CE prevalence was found between group A1 and group A2. Similar results were achieved in the subgroup analysis among patients aged 40 years or older and patients younger than 40 years. CONCLUSION: EP, either single EP or multiple EP, positively correlates with CE. The prevalence of CE was similar between the single-polyp group and the multiple-polyp group.

Chronic endometritis: A prevalent yet poorly understood entity.

OBJECTIVE: To examine the prevalent understanding of and management approaches to chronic endometritis among obstetricians/gynecologists. METHODS: In a cross-sectional observational study, 262 members of national and international professional obstetrician/gynecologist societies were surveyed via anonymous electronic survey that investigated knowledge of the pathophysiology, diagnostic criteria, clinical implications, and treatment strategies for chronic endometritis. Statistical analyses of results were performed using Fisher's exact tests, chi square tests and odds ratios with 95% confidence intervals. A two-sided P < 0.05 was deemed statistically significant. RESULTS: Responses identified a concerning spectrum of deficiencies in the understanding of the pathophysiology of chronic endometritis, in awareness of clinical presentation of chronic endometritis, and in the understanding of methodology/ies that allow diagnosis of chronic endometritis. Heterogeneities in management approaches to chronic endometritis were apparent. CONCLUSION: Our findings underscore a need for targeted efforts to gain clarity on chronic endometritis and to establish evidence-based consensus for good clinical practice. In the absence of a clear understanding of chronic endometritis diagnosis, we posit that the prevalent inconsistencies are likely inflicting unquantified and underappreciated burdens on patients and healthcare systems. We propose consideration for a task force to examine existing literature and create standards for good practice for a prevalent condition.