Endometrite crônica e infertilidade / Chronic endometritis and infertility

A endometrite crônica (EC) é uma doença que, apesar de ainda pouco investigada, tem sido associada a resultados reprodutivos desfavoráveis. Estudos têm mostrado que a EC pode prejudicar a receptividade endometrial, levando a falhas de implantação e perdas gestacionais recorrentes. Os métodos padronizados para diagnóstico incluem histeroscopia, histologia para pesquisa de plasmócitos e cultura endometrial para identificação de agentes bacterianos. O tratamento com antibióticos para EC parece melhorar as taxas de gestação e nascidos vivos em pacientes com falhas de implantação e perdas gestacionais recorrentes sem causa conhecida. Esta publicação tem por objetivo fazer uma revisão da etiologia, fisiopatologia, diagnóstico e tratamento da EC, seu impacto no microambiente endometrial e sua associação com infertilidade. Esta revisão narrativa da literatura atualizada sintetiza os achados encontrados em bases de dados computadorizadas.(AU)

Chronic endometritis (CE) is a poorly investigated disease, which has been related to adverse reproductive outcomes. Published studies have shown that CE can impair endometrial receptivity, which is associated with implantation failure and recurrent pregnancy loss. The standard tools for diagnosis include hysteroscopy, histology to identification of plasma cells and endometrial culture for identification of bacterial pathogens. Effective antibiotic treatment for CE seems to improve the pregnancy and live birth rates in patients with implantation failure and unexplained recurrent pregnancy loss. This paper intends to provide an overview of etiology, pathophysiology, diagnosis and treatment of CE, its impact on endometrial microenvironment and its association with infertility. This narrative review of the current literature synthesizes the findings retrieved from searches in computerized databases.(AU)

The impact of HSF on endometrium

Summary Objective: We conducted the research in order to explore the impact of hydrosalpinx fluid (HSF) on endometrium. Method: HSF group: 261 patients with HSF scheduled to undergo laparoscopic surgery 3 to 7 days after menstruation in our center. Hysteroscopy would also be performed in order to observe the endometrial morphology during the surgery. Sixty (60) patients would be randomly selected for endometrial biopsy in order to detect the inflammatory cytokines TNF-a and IL-2 mRNA. Non-HSF group: 210 patients with no evidence of HSF due to chronic salpingitis or pelvic adhesion. IVF-ET treatment was performed after eliminating the factor of male infertility and hysteroscopy was conducted before the treatment. Fifty (50) patients underwent endometrial biopsy in order to detect TNF-a and IL-2 mRNA. Results: Hysteroscopy was performed in 261 patients with HSF and 210 patients without HSF. The incidence rate of endometritis manifestation among these two groups of patients was 37.2% (97/261) and 20.5% (43/210), respectively. The incidence rate of endometritis in the patients with HSF is significantly higher than in the patients without HSF (p<0.05). Sixty (60) patients from the HSF group and 50 patients from the non-HSF group were regrouped according to inflammatory and normal manifestation after the endometrial biopsy. There were 49 patients in the inflammatory manifestation group and 61 patients in the normal manifestation group. RT-PCR technology was adopted to detect the expression of inflammatory cytokines TNF-a and IL-2 mRNA in endometrial tissue. The level of TNF-a mRNA expression in endometrial tissues with inflammatory manifestation was higher than in normal endometrium (76.75±11.95 vs. 23.45±9.75, p<0.01). There are significant differences between them. The level of IL-2 mRNA expression in endometrial tissues with inflammatory manifestation was higher than that found in normal endometrium (80.56±13.35 vs. 35.12±8.35, p<0.01). There are significant differences between them. Conclusion: Chronic endometritis is related to HSF and may therefore affect endometrial receptivity.

A influência da endometrite crônica nas pacientes com falhas de implantação recorrentes após fertilização in vitro / The influence of chronic endometritis in patients with recurrent implantation failure after in vitro fertilizatio

A endometrite crônica é um processo inflamatório persistente na camada endometrial, geralmente causada por invasão bacteriana. É uma afecção mal definida quanto a critérios de diagnósticos e tratamento. Devido à sua discreta sintomatologia, a real prevalência da endometrite crônica na população em geral não é conhecida, mas estima-se que esteja entre 0,8 e 19%. A aplicação de protocolos para rastreamento da endometrite crônica em mulheres com falha de implantação de embriões de boa qualidade após fertilização in vitro FIV é controversa. Alguns serviços utilizam a histeroscopia em todas as pacientes antes de iniciar o tratamento de reprodução assistida; entretanto, não há consenso de que a efetividade da histeroscopia melhore o prognóstico das mulheres inférteis. Os achados sugerem que o impacto da endometrite crônica na fertilidade e nos resultados da FIV precisam de futuras investigações em estudos prospectivos randomizados.

Chronic endometritis is a persistent inflammation of the endometrial lining usually caused by bacteria invasion. It is a non-well defined pathology difficult to both diagnosis and treatment. Because of its subtle nature, the real prevalence of chronic endometritis in the general population is ill defined, but is estimated between 0.8 and 19%. The implementation of protocols for screening of women, who have recurrent implantation failure after IVF with good quality embryo, is controversial, but some services have been using hysteroscopy in every patient immediately prior to FIV. However, there is no consensus on the effectiveness of hysteroscopy in improving the prognosis of infertile women. The findings suggest that the impact of chronic endometritis on fertility and outcomes should be further investigated in prospective randomized studies.

Paracoccidioidomicose genital feminina: descriçäo de um caso clínico / Female genital paracoccidioidomycosis: report of a clinical case

A paracoccidioidomicose é doença sistêmica que atinge mais o sexo masculino do que o feminino. Modelos experimentais mostram maior sensibilidade dos machos do que as fêmeas à disseminaçäo da doença. A literatura médica é rica em relatos de casos de Pbmicose do trato genital masculino. A raridade da Pbmicose sistêmica na mulher à açäo hormoral tornou inusitada a descriçäo de um caso com envolvimento genital. Paciente de 57 anos, branca, procedente de Conchas (SP), queixando-se de dor abnominal há 10 anos, difusa, seguida de cólica periumbelical periódica, com diarréia e obstipaçäo alternadas. Piorou desse quadro e evoluiu para abdomem agudo cirúrgico. O anátomo patológico revelou Pbmicose no epiplon e ovário direito. A biópsia do endométrio mostrou endometrite crônica granulomatosa. A radiologia e a planigrafia revelaram nódulo parahilar direito. Os achados clínicos e laboratoriais permitiram explicar a provável origem do envolvimento genital