Expression of HOXA10 and HOXA11 in the endometrium of infertile patients with chronic endometritis.

OBJECTIVE: The study aimed to evaluate the impact of CE on the expression of HOXA10 and HOXA11 during the late proliferative phase in the endometrium of infertile women. METHODS: A prospective, translational cohort study was conducted in partnership with the Hospital Universitário Antônio Pedro in Niterói and the Clínica Ginendo in Rio de Janeiro after approval by the Ethics Committee. The patients were selected to participate in the study after showing an indication for hysteroscopy. All participants were divided into three groups: infertile women with endometritis (n=10), infertile women without endometritis (n=17) and fertile women without endometritis (n=10). At hysteroscopy, two endometrial samples were obtaneid, with one sent for histopathological examination per the gynecologist's request and the other used for immunohistochemistry procedures to evaluate the expression of CD138, HOXA10 and HOXA11. CD138 was used to confirm the diagnosis of CE. The analysis of HOXA10 and HOXA11 was performed using the HScoring method for immunohistochemistry with polyclonal antibodies. RESULTS: Women with and without endometritis had lower HOXA10 and HOXA11 expression values than women in the control group (fertile women without endometritis). CONCLUSIONS: The expression of HOXA10 and HOXA11 during the proliferative phase is not significantly different between infertile women with endometritis and infertile women without endometritis. Translational studies with a larger number of patients should be performed.

Prevalence of chronic endometritis in infertile women undergoing hysteroscopy and its association with intrauterine abnormalities: A Cross-Sectional study.

OBJECTIVE: Chronic endometritis (CE) is an inflammatory condition with several different risk factors. We aimed to examine whether intrauterine abnormalities, such as endometrial polyps, submucosal myomas, intrauterine adhesions, or a septate uterus, were associated with an increased likelihood of developing chronic endometritis. METHODS: A cross-sectional study was conducted on 335 infertile women who underwent hysteroscopy surgery at the Ayatollah Taleghani Hospital Infertility Center, affiliated by Shahid Beheshti University of Medical Sciences, in 2022. All participants in the study underwent hysteroscopic surgery, which allowed for direct visualization of the intrauterine cavity, and endometrial biopsies were taken for further analysis. To characterize endometritis, plasma cell infiltration was assessed. Patients with ≥5 plasma cells observed in 10 high-power fields were defined as having chronic endometritis. RESULTS: Endometritis was observed in 51.3% of the patients, totaling 172 individuals. Logistic regression analysis revealed that patients with endometrial polyps had 5.2 times higher odds of developing endometritis compared to patients without polyps (95% CI = 2.9, 9.2) (p-value <0.001). Similarly, patients with intrauterine adhesions had a significant increase in the odds of endometritis (OR = 4.6, 95% CI = 2.1, 10.1) (p-value <0.001). CONCLUSIONS: Treatment or removal of endometrial abnormalities through hysteroscopic procedures may help to reduce the risk of chronic endometritis and improve fertility outcomes. Further research is necessary.

Prevalencia de endometritis crónica en mujeres infértiles establecida mediante histeroscopia y biopsia endometrial con CD138 / Prevalence of chronic endometritis in infertile women by hysteroscopy and endometrial biopsy with CD138

Resumen OBJETIVO: Determinar, mediante histeroscopia de evaluación y biopsia de endometrio, con análisis histológico endometrial e identificación de células plasmáticas con inmunohisdtoquímica con CD138 positiva, la prevalencia de endometritis crónica en pacientes infértiles. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, efectuado de marzo de 2016 a noviembre del 2021 en el Centro de Reproducción Asistida de Saltillo (CREAS), Coahuila, México, en pacientes que consultaron por infertilidad. El diagnóstico de endometritis crónica se estableció mediante histeroscopia y biopsia de endometrio con inmunohistoquímica CD138. Se analizaron la prevalencia y precisión diagnóstica de la histeroscopia y la biopsia de endometrio. Además, la relación entre las características histeroscópicas específicas y la endometritis crónica confirmada por biopsia con CD138 positiva. RESULTADOS: La prevalencia de endometritis crónica por biopsia de endometrio CD138 positiva en las 170 pacientes estudiadas fue de 36% (n = 62) y por histeroscopia del 48.8% (n = 83), esta última con una sensibilidad del 48.3%, especificidad del 50.9%, valor predictivo positivo y negativo del 36.1 y 63.2%, respectivamente. En relación con las características histeroscópicas, la hiperemia endometrial tuvo una relación estadísticamente significativa con la prevalencia de endometritis crónica (p-value = 0.008; RM = 0.357; IC95%: 0.14-0.81) y con ≥ 2 características sugerentes de endometritis crónica (p-value = 0.015; RM = 3.63; IC95%: 1.15-12.69). CONCLUSIONES: En el procedimiento diagnóstico de la paciente infértil es importante descartar la endometritis crónica. Para ello es decisivo recurrir a herramientas diagnósticas, como la histeroscopia y confirmar el diagnóstico con una biopsia de endometrio con inmunohistoquímica CD138 positiva para que de esta manera pueda dirigirse el tratamiento.

Abstract OBJECTIVE: To determine the prevalence of chronic endometritis in infertile patients by evaluating hysteroscopy and endometrial biopsy with endometrial histologic analysis and identification of plasma cells by CD138-positive immunohistochemistry. MATERIALS AND METHODS: Observational, retrospective study performed from March 2016 to November 2021 at the Center for Assisted Reproduction of Saltillo (CREAS), Coahuila, Mexico, in patients who consulted for infertility. Chronic endometritis was diagnosed by hysteroscopy and endometrial biopsy with CD138 immunohistochemistry. The prevalence and diagnostic accuracy of hysteroscopy and endometrial biopsy were analysed. The association between specific hysteroscopic features and chronic endometritis confirmed by CD138-positive endometrial biopsy was also investigated. RESULTS: The prevalence of chronic endometritis by CD138-positive endometrial biopsy in the 170 patients studied was 36% (n = 62) and by hysteroscopy 48.8% (n = 83), the latter with a sensitivity of 48.3%, specificity of 50.9%, positive and negative predictive values of 36.1 and 63.2%, respectively. In relation to hysteroscopic features, endometrial hyperemia had a statistically significant relationship with the prevalence of chronic endometritis (p-value = 0.008; RM = 0.357; 95%CI: 0.14-0.81) and with ≥ 2 features suggestive of chronic endometritis (p-value = 0.015; RM = 3.63; 95%CI: 1.15-12.69). CONCLUSIONS: In the diagnostic process of infertile patients, it is important to exclude chronic endometritis. It is crucial to use diagnostic tools such as hysteroscopy and to confirm the diagnosis by endometrial biopsy with positive CD138 immunohistochemistry in order to guide treatment.

A Rare Case of Non-IUD-Related Chronic Endometritis caused by Actinomyces Bacteria in a Postmenopausal Woman: A Case Report.

Pelvic actinomycosis is a rare condition, usually associated with intrauterine device (IUD) use. Its clinical presentation may vary from being asymptomatic to the mimicking of pelvic malignancy; it has been described as one of the most misdiagnosed diseases. A 78-year-old woman without a history of IUD use, arrived at our clinic complaining of chronic and intermittent postmenopausal bleeding associated with lower pelvic pain. An endometrial curettage was performed, and endometritis (caused by Actinomyces) identified. Treatment with intravenous piperacillin and tazobactam for 7 days, followed by 6 weeks of oral ampicillin, daily, decreased the bleeding and the pain. Although rare, it is important to consider Actinomyces-related endometritis as a differential diagnosis in cases of elderly woman with postmenopausal bleeding and without a history of IUD use.

Endometritis - Diagnosis,Treatment and its impact on fertility - A Scoping Review.

Endometritis is defined as an infection or inflammation of the endometrium. Endometritis is of two types: acute and chronic. Acute endometritis is the symptomatic acute inflammation of the endometrium, which upon examination with a microscope shows micro-abscess and neutrophil invasion in the superficial endometrium. One of its most common manifestations is postpartum endometritis. Chronic endometritis is a silent disease usually diagnosed on the workup of secondary amenorrhoea and infertility. An important cause of chronic endometritis is tuberculosis, especially in developing nations. Chronic and acute endometritis have been associated with poor reproductive outcomes. Worse outcomes have been reported for individuals with chronic endometritis. This is a scoping review of endometritis and its impact on fertility.

Normalization of endometrial histopathology and endometrial NK cells concentration predict successful pregnancy in repeated implantation failure.

OBJECTIVE: The primary objective was to establish the endometrial predictors of clinical pregnancy in a population of repeated implantation failure with oocyte donation after specific endometrial treatment. The secondary one was to evaluate reproduction outcomes in terms of Implantation rate (IR), Clinical pregnancy (CP), Live birth delivery rate (LBDR) and Prematurity, in relation to normalization or no-normalization of the predictors. METHODS: 66 patients were assigned to the study. We ran a Pipelle endometrial biopsy to investigate the endometrium lymphocyte population by Flow Cytometry and abnormal/normal patterns by histopathology in pre/post-treatment. We employed the binary logistic regression model to identify the predictors for CP. For the secondary objective, we assessed the clinical outcomes in function to the normalization or no normalization in post-treatment. RESULTS: Endometrial histopathology and endometrial NK cell counts resulted in CP predictors (Wald chi2 test (p=0.044 and 0.001)), respectively. We had a higher IR, CP and LBDR when both predictors were normalized in comparison with no normalization (p<0.001). There was a high percentage of prematurity in both normalized vs. non-normalized groups (34.4% (11/32) and 71.43% (5/7), respectively) without significant differences. CONCLUSION: Endometrial histopathology and endometrial NK cell counts showed that they are valid predictors of pregnancy outcome in repeated implantation failure after treatment. In post-treatment, the pregnancy outcomes were significantly higher in the presence of both normalized predictors. Pregnancy rates were zero in the no-normalization of both predictors. There was a high percentage of prematurity in both groups.

Regenerative therapy by endometrial mesenchymal stem cells in thin endometrium with repeated implantation failure. A novel strategy.

OBJECTIVE: Our primary objective was to evaluate the endometrial changes before and after the transfer of endometrial mesenchymal stem cells (enMSCs) in a population of thinned endometrium women, with absence or hypo-responsiveness to estrogen and repeated implantation failure (RIF). The secondary objective was to evaluate the clinical outcomes of the intervention in terms of clinical pregnancy (CP), early abortions, ongoing pregnancy and live birth delivery rate (LBDR) per in vitro fertilization (IVF) cycle. METHODS: A longitudinal and experimental study. The intervention was defined as "subendometrial inoculation of enMSCs," and the post-intervention changes were evaluated by the following variables: endometrial thickness (Eth), endometrial flow cytometry (enFC), endometrial histopathology (enHP) and endometrial immunohistochemistry (enIHQ). The variables were analyzed after the intervention (Post-treatment) regarding previous values (Pretreatment). RESULTS: Eth values before and after treatment with enMSCs were 5.24±1.24 mm vs. 9.93±0.77 (p=0.000), respectively. Endometrial Flow Cytometry showed significant differences in favor of Normalized variables in the post-treatment assessment, associated with the pretreatment, LT/Li, LB/Li, NK/Li, CD8/CD3+ and CD4/CD8 (p≤0.015), respectively. Only two variables Li/PC and CD4/CD3 had NS (p=0.167 and 0.118). A similar analysis was performed on enHP with an HP increase post-treatment (p=0.007). The CP rate was 79.31% (23/29), a live birth delivery rate per embryo transfer was 45.45% (10/22) and ongoing pregnancy 7/29 (24.14%). CONCLUSION: Subendometrial enMSCs inoculation produces a significant increase in endometrial thickness; normalize the enHP, enIHQ and enFC. As a result, IVF after treatment with enMSCs yields a higher rate of CP and LBDR.

Repeated implantation failure in oocyte donation. What to do to improve the endometrial receptivity?

OBJECTIVE: To determine the role of polyvalent endometrial treatment in patients undergoing IVF-ET who had recurrent implantation failure (RIF) in a program of oocyte donation (OD). The results were expressed in terms of live birth rate (LBR). Secondly analyze changes of endometrial leukocyte population evaluated by flow cytometer (FC) and histopathology. METHODS: Prospective study of a model-based control with analog abductive methodology. Over initial population of 75 patients with RIF in ovodonation, thirty cycles / patient of IVF/ET were selected in this study. A control group of 12 patients was established to variables FC. All patients were transferred to day 5-6 with a maximum of 2 expanded blastocysts with at least one of optimum quality. A versatile treatment was applied in all cases with both assessments in pre and postreatment. RESULTS: Chronic endometritis was diagnosed in 14/30 (46.7%) with endometrial identifying germs in 12/30 (40%) and 6/30 (20%) was associated with endometrial thinning. A significant increase in endometrial thickness associated with a decrease in abnormal histopathology and Li/PC was observed at postreatment in relation with a pretreatment (P=0.047 and P=0.002) respectively. An increase of uterine killer cells (Nku) was observed in postreatment in absence of pregnancy. CD4/CD3 was established with prognostic value when their values are close to those of the control group. CONCLUSION: Our findings demonstrate the reversibility of endometrial histological changes, both sonographics as immunological in RIF group under a polyvalent therapeutic; which is capable of modifying the immunology and endometrial histopathology and to obtain live birth.