Diagnosis Of Chronic Endometritis Research Articles

Construction of deep learning-based convolutional neural network model for automatic detection of fluid hysteroscopic endometrial micropolyps in infertile women with chronic endometritis

Objective(s)Chronic endometritis (CE) is a localized mucosal inflammatory disorder associated with female infertility of unknown etiology, endometriosis, tubal factors, repeated implantation failure, and recurrent pregnancy loss, along with atypical uterine bleeding and iron deficiency anemia. Diagnosis of CE has traditionally relied on endometrial biopsy and detection of CD138(+) endometrial stromal plasmacytes. To develop a less invasive diagnostic system for CE, we aimed to construct a deep learning-based convolutional neural network (CNN) model for the automatic detection of endometrial micropolyps (EMiP), a fluid hysteroscopy (F-HSC) finding recognized as tiny protrusive lesions that are closely related to this disease. Study designThis is an in silico study using archival images of F-HSC performed at an infertility center in a private clinic. A total of 244 infertile women undergoing F-HSC on the days 6–12 of the menstrual cycle between April 2019 and December 2021 with histopathologically-confirmed CE with the aid of immunohistochemistry for CD138 were utilized. ResultsThe archival F-HSC images of 208 women (78 with EMiP and 130 without EMiP) who met the inclusion criteria were finally subjected to analysis. Following preprocessing of the images, half a set was input into a CNN architecture for training, whereas the remaining images were utilized as the test set to evaluate the performance of the model, which was compared with that of the experienced gynecologists. The sensitivity, specificity, accuracy, precision, and F1-score of the CNN model-aided diagnosis were 93.6 %, 92.3 %, 92.8 %, 88.0 %, and 0.907, respectively. The area under the receiver operating characteristic curves of the CNN model-aided diagnosis (0.930) was at a similar level (p > .05) to the value of conventional diagnosis by three experienced gynecologists (0.927, 0.948, and 0.906). ConclusionThese findings indicate that our deep learning-based CNN is capable of recognizing EMiP in F-HSC images and holds promise for further development of the computer-aided diagnostic system for CE.

CORRELATION RATIO OF CHRONIC ENDOMETRITIS WITH ANAMNESTIC FACTORS AND ULTRASOUND CHARACTERISTICS OF THE ENDOMETRIUM IN WOMEN OF REPRODUCTIVE AGE

The diagnosis of chronic endometritis is problematic because of its asymptomatic course and the need for invasive uterineprocedures to confi rm the diagnosis histologically. Therefore, it is important to identify factors that indicate a high risk of this condition. Aim: The aim of this study is to identify factors that have a statistically signifi cant correlation with the presence of CE in women of reproductive age and to validate them by histologic examination of the endometrium.Material and Methods. A retrospective analysis of 400 histories of women of reproductive age who underwent hysteroscopyand endometrial biopsy for histologic examination was performed. Histologically, 154 women (38.5 %) were found to havechronic endometritis (the group of women with chronic endometritis), while 246 women (61.5 %) were found to have otherconditions unrelated to chronic endometritis (the group of women without chronic endometritis). Analysis of anamnestic factors and ultrasound criteria associated with an increased likelihood of chronic endometritis was performed when comparing data from women in these groups. The strength of the relationship between these factors on the one hand and the development of chronic endometritis on the other hand was assessed by calculating the Kendall’s τ (tau) rank correlation coeffi cient. The strength of the relationship between the mentioned factor and CE was considered strong (+++) with a τ coeffi cient of 0.5 or higher, moderate (++) with a τ coeffi cient in the range of 0.2 to 0.499, weak (+) with a τ coeffi cient in the range of 0.1 to 0.199. A τ-coeffi cient value between 0 and 0.099 indicated no correlation between the factor and chronic endometritis.The study was conducted in accordance with the principles of patient- centered care, the requirements of the Tokyo Declaration of the World Medical Association, the international recommendations of the Helsinki Declaration of Human Rights, the Convention of the Council of Europe on Human Rights and Biomedicine, the laws of Ukraine, and the Code of Ethics of the Ukrainian Physician.The paper is an excerpt from the initiative scientifi c research project of the Department of Obstetrics and Gynecology No.2 at Poltava State Medical University, entitled «Optimization of approaches to the management of pregnancy in women at high risk of obstetric and perinatal pathology» (State registration number 0122U201228, duration: 10.2022-09.2027) in collaboration with the Department of Pathological Physiology at Poltava State Medical University.Results and Discussion. The determination of the correlation coeffi cient allowed us to identify the factors with the strongestassociation with chronic endometritis. Among them are 5 infectious factors: cervicitis in the past medical history (τ coeffi cient 0.625245229; p<0.0000000001); chronic infl ammation of the uterine appendages (τ coeffi cient 0.522536031; p<0.0000000001); sexually transmitted diseases in the past medical history (τ coeffi cient 0.547218916; p<0.0000000001); chronic urogenital infl ammatory diseases in the sexual partner (τ coeffi cient 0. 529314979; p<0.0000000001); previous multiple use of intrauterine contraception (τ-coeffi cient 0.502383401; p<0.0000000001); 4 symptomatic consequential factors: infertility in past medical history (τ-coeffi cient 0.683492482; p<0.0000000001); missed miscarriages in past medical history (τ-coeffi cient 0. 644489429; p<0.0000000001); recurrent early pregnancy loss (τ-coeffi cient 0.625942138; p<0.0000000001); abnormal uterine bleeding (τ-coeffi cient 0.650850348; p<0.0000000001); and 4 ultrasound criteria, such as the presence of local endometrial thickening in the form of a polyp (τ-coeffi cient 0.641820318; p<0. 0000000001); increased echogenicity of the endometrium (τ-coeffi cient 0.665249637; p<0.0000000001); heterogeneity of the endometrial echo structure with areas of increased and decreased echogenicity (τ-coeffi cient 0.693152163; p<0.0000000001); hyperechogenic structures in the basal layer of the endometrium (τ-coeffi cient 0.521658745; p<0.0000000001). In our opinion, the combination of an infectious or symptomatic factor with an ultrasound criterion indicates a high probability of chronic endometritis. In the absence of ultrasound signs, the combination of 1 infectious and 1 symptomatic- consequential factor indicates a high risk of chronic endometritis. To confirm the representativeness of this method, we analyzed endometrial biopsies obtained by curettage in 100 women with this combination of factors. The diagnosis was confi rmed histologically in 87 women. Conclusion. Our proposed assessment of high-risk criteria for chronic endometritis, based on the combination of infectious,symptomatic- consequential, and ultrasound criteria, allows predicting the presence of this pathology in 87 % of patients withoutтthe need for invasive interventions. This helps to improve patient selection for hysteroscopy and avoid unnecessary uterine interventions in the diagnosis of chronic endometritis in women planning pregnancy.

The role of CD138 immunohistochemical marker in the diagnosis of chronic endometritis: causes of female infertility

This article focused on “The role of CD138 immunohistochemical marker in the diagnosis of chronic endometritis: causes of female infertility”. Aims: The aim of the study was to assess the diagnostic efficacy of CD138 in identifying chronic endometritis among infertile patients with endometrial pathology and to examine the association between CE and various factors related to infertility. Methodology: A cross-sectional observational study exploring the utility of the CD138 immunohistochemical marker in diagnosing chronic endometritis and its association with infertility in a sample of 63 couples. The t-test, chi-square test and logistic regression was applied using SPSS 26. Results: The study examined infertility characteristics and chronic endometritis in 63 infertile woman with pathology of endometrium. Results also established a significant association between CE and CD 138 presence, suggesting CD 138 as a potential diagnostic marker for CE. Additionally, the age was identified as a notable factor linked to CE. Factors such as abortion history, intrauterine interventions, delivery experiences, and cervical pathology, mycoplasma infections were found to have a significant correlation with CE. The logistic regression indicated a lower likelihood of CE in certain infertility types. It also identified a significant association between increased CE odds and longer fertility duration, while specific causes of fertility had a modest impact. Overall, CD 138 demonstrated its diagnostic potential for CE, age was associated with CE, and certain factors correlated with CE, emphasising the complexity of CE etiology in infertility patients with endometrial patology. Scientific Novelty: A Gateway to Understanding Female Infertility Conclusion: In conclusion, the research findings underscored the significance of CD 138 as a diagnostic marker for chronic endometritis in infertility patients. The age emerged as a notable factor associated with CE, while specific qualitative factors like delivery history exhibited a correlations with CE status, warranting further investigation

International Endometrial Tumor Analysis (IETA) descriptors in the diagnosis of chronic endometritis

Objective: to compare the terms, definitions and measurement methods developed by the IETA group with the ultrasound criteria of chronic endometritis (CE) used in Russia.Material and methods. A retrospective cohort study of 158 reproductive age women with clinical and laboratory diagnosis of CE was carried out. Sonographic examination was performed in the early or middle proliferative phase (cycle day 4–10 days) with the use of Affiniti70 ultrasound system (Philips, the Netherlands) with a multifrequency 3D endocavitary probe. Uterine corpus volume, endometrial thickness and volume were measured, followed by percentage endometrial/uterine volume ratio calculation, the so-called adjusted endometrial volume. Qualitative analysis of grayscale imaging included assessment of endometrial structure and echogenicity; closure or separation of the endometrial layers; contour of endometrial midline; the presence of acoustic artifacts, such as reverberation in the presence of gas or liquid in the uterine cavity, described by a number of authors. Relevant IETA descriptions were searched when assessing all qualitative CE features. In parallel, a qualitative score analysis proposed by the IETA group was carried out.Timely preoperative diagnosis of endometrioic cyst (endometrioma), as well as deep endometriosis remains relevant. The aim of the study was to assess the diagnostic value of ultrasound in patients with endometriomas and assess the combination of them with other foci of external genital endometriosis. The study based on retrospective analysis of a date of 95 patients with ultrasound signs of ovarian endometriomas, who underwent examination in MedicoProfi LLC – Borisov Medical and Diagnostic Clinic (Krasnoyarsk) during the period from January 2019 to October 2023. All of patients underwent surgery , followed by morphological evaluation. In the vast majority of cases, it was possible to detect a combination of endometriomas with one or more foci of deep endometriosis. Superficial peritoneal endometriosis and adhesions were found on surgery in all cases when endometriomas appeared isolated on ultrasound. The results of the study showed: endometriomas combined with deep endometriosis in 96.8% of cases. Thus, ultrasound detection of endometrioma is a very reliable sign of deep endometriosis presence. The “kissing ovaries” symptom in bilateral endometriomas can be considered as an absolutely reliable sign of the uterosacral ligaments endometriosis with specificity of 100% and positive predictive value of 100%. The presence of the “kissing ovaries” sign should be depicted in the conclusion of the ultrasound protocol, since it highly suggestive to obliteration of the pouch of Douglas and involvement of adjacent organs (fallopian tubes, intestines, ureters, etc.) in the endometrioid infiltrates, which is extremely important for the surgery planning, as well as in patients with infertility. There is an obvious need to introduce the extended pelvic ultrasound protocol to the diagnostic algorithm for patients with suspected endometriosis, which will more accurately describe the disease extension.Results. The comparative analysis of endometrium description in CE indicates a similar measurement technique for endometrial and intrauterine lesions thickness, both proposed by the IETA group and used in our country. Most of the IETA descriptors for qualitative ultrasound findings may be used in CE diagnosis. However, there are no some significant ultrasound features for identifying the inflammation, such as marked and partially or completely thickened midline, as well as gas focuses within the endometrium or in the uterine cavity, in IETA description.Conclusion. Terminology standardization allows compare the results and perform multicenter studies followed by meta-analysis for the diagnosis of chronic endometritis, if researchers use the similar descriptors.

What is the Optimum Endometrium Needed for Implantation?

Implantation most critical step in reproduction. A complex process where blastocyst becomes intimately connected with maternal endometrium/decidua and requires; Competent embryo at blastocyst stage Receptive endometrium Synchronized dialogue between maternal and embryonic tissues Endometrial Changes for Implantation include architectural, morphological, cytochemical, molecular and genetic. These Changes Induce Endometrial receptivity, which is endometrial lining in a state of readiness for blastocyst implantation. It involves acquisition of adhesion ligands and loss of inhibitory components that may act as a barrier to an attaching embryo. Receptive endometrium is capable of selecting good quality embryos and reject the incompetent embryos. Endometrial Evaluation includes 1. Non-Invasive Assessment of Endometrial Receptivity by USG 2. Detection of abnormal Uterine cavity by 3D USG/SIS, HSG and Hysteroscopy 3. Diagnose Chronic Endometritis by hysteroscopy and Molecular tests? 4. Endometrial Microbiome by molecular tests 5. Endometrial asynchrony - Proteomics and transcriptomics 2D and 3D Ultrasound can Identify patients with poor implantation prognosis but has low predictive value in determining endometrial receptivity and IVF outcome. Ideal endometrial thickness for optimal outcome is between 7-14 mm. No Association was seen between clinical pregnancy rates (CPR) and endometrial pattern for women undergoing in IVF with fresh ET and FET. Minimum Endometrial Volume associated with pregnancy is 1.59 mL – 3D. But most pregnancies occur in volumes of 2-13 mL. Evaluation of endometrial volume is particularly useful in synechiae, adenomyosis and uterine anomalies. Vascularity demonstrated within Zone 3 or within Zones 3 and 4 prior to transfer is associated with good implantation rate. Presence of >3 peristaltic contractions of the sub endometrial myometrium/2 minutes interval on Day of hCG administration associated with poor implantation. Diagnosis of chronic endometritis is based on hysteroscopy, endometrial biopsy with plasma cells being identified histologically and specific treatment is determined based on microbial culture. Existence of non-Lactobacillus bacteria in the endometrium is correlated with negative impacts on reproductive function and should be considered as an emerging cause of implantation failure and pregnancy loss. Endometrial Receptivity Array (ERA) is validated for analysing the expression of 238 genes that are intimately related to endometrial receptivity. Abnormality in endometrial receptivity is displayed a specific gene expression profile. Intrauterine secretory profile directly linked to successful implantation and evaluation of endometrial fluid for cytokine, interleukin and growth factor secretions can be used to assess the endometrium. Conclusion: Identification of one or more of endometrial parameters that definitely indicate receptivity for implantation remains an elusive goal. None of the endometrial receptivity markers have sufficient discriminatory value to act as a diagnostic test for endometrial receptivity based on their ability to predict clinical pregnancy. Due to the dynamic, cyclic nature of the endometrium it may be difficult, to reliably assess endometrial function on the basis of a single test.

Correction: Hysteroscopic versus histopathological agreement in the diagnosis of chronic endometritis: results from a retrospective observational study

Correction: Hysteroscopic versus histopathological agreement in the diagnosis of chronic endometritis: results from a retrospective observational study

Chronic endometritis diagnosed using a cut-off of ≥5 CD138 plasma cells significantly affects the reproductive outcomes of frozen embryo transfer: a case-control study.

To investigate the clinical significance of a diagnosis of chronic endometritis (CE) made using a diagnostic cut-off of ≥1 or ≥5 CD138 plasma cells per high power field (HPF) in asymptomatic patients undergoing in vitro fertilization (IVF) with frozen embryo transfer (FET). In this retrospective case-control study, 1,865 patients underwent freeze-all-IVF treatment between January and December 2019, with 419 undergoing endometrial biopsies at oocyte retrieval. Of the 419 biopsy-patients, 301 have since undergone first FET. The processed endometrial biopsies of the 301 patients underwent immunohistochemical (IHC) examination with anti-CD138 to count CD138+ plasma cells per HPF. CE diagnosis was defined as 0 CD138 plasma cells (control-group), ≥1 CD138 plasma cells (CEcontrol-group) or ≥5 CD138 plasma cells (CEdisease-group) per HPF. Twenty-six (8.6%) patients were retrospectively diagnosed having ≥1 CD138 plasma cells, and five patients (1.7%) having ≥5 CD138 plasma cells (CEdisease-group) per HPF. The live birth and pregnancy loss rates of the three groups were 52.7% and 27.9%, 53.8% and 26.3% and 20.0% and 66.7%, respectively. The antral follicle count (AFC) of the three groups were 15.0 (9.0-22.0), 10.5 (7.75-15.25), and 6.0 (5.0-14.0), respectively. Asymptomatic patients diagnosed with CE with ≥5 CD138 plasma cells per HPF, had the lowest live birth and highest pregnancy loss rates, with these patients also having significantly reduced AFC.

Level of geneexpression of pro- and anti-inflammatory cytokines in the blood ofcows with chronic endometritis

The level of expression of genes of proinflammatory (IL-1α and IL-1β) and antiinflammatory (IL-10) cytokines in the blood of cows was studied on 20 animals, divided according to the principle of analogues into two groups: the first group (n=10) - clinically healthy cows, the second one (n=10) - diagnosed with chronic endometritis. Diagnosis of chronic endometritis was carried out on the basis of the results of transrectal examination and echographic data obtained using a portable ultrasound scanner. The experiment included cows 60 or more days after calving. It has been found that the level of expression of IL-1α, IL-1β in cows with chronic endometritis is by 1.92 and 4.61 times higher, respectively, than in clinically healthy animals, and the anti-inflammatory cytokine IL-10, on the contrary, is by 118.6 times lower. The dominance of proinflammatory cytokine gene expression over anti-inflammatory ones indicates the development of an inflammatory process in the uterus, which is confirmed by the results of histological studies of endometrial biopsy material. In clinically healthy animals, the integumentary epithelium is lined with cells of a prismatic or cubic shape, the endometrium is slightly infiltrated with neutrophils, lymphocytes and histiocytes. The uterine glands are presented in a significant amount, the glandular cells are integral, prismatic in shape. In the cows with chronic endometritis, desquamation of the integumentary epithelium was diagnosed, the cells of which in most cases are in a state of dystrophy and necrobiosis. The lumen of the uterine glands is narrowed, glandular cells are rejected into the lumen of the glands, which indicates a decrease in the functional activity of the organ. The endometrium looked edematous, abundantly infiltrated, predominantly with neutrophilic leukocytes and, to a lesser extent, with lymphoid cells, indicating the presence of inflammation in the uterine mucosa.

The Role of Plasma Cells as a Marker of Chronic Endometritis: A Systematic Review and Meta-Analysis.

Chronic endometritis (CE) is the persistent inflammation of the endometrial lining associated with infertility and various forms of reproductive failures. The diagnosis of CE is based on the histological evidence of stromal plasma cells; however, standardized methods to assess plasma cells are still lacking. In the present paper, we aimed to determine the most appropriate plasma cell threshold to diagnose CE based on pregnancy outcomes. Three electronic databases were searched from their inception to February 2022 for all studies comparing pregnancy outcomes between patients with CE and patients without CE. The relative risk (RR) of pregnancy, miscarriage, and/or live birth rates were calculated and pooled based on the plasma cell threshold adopted. A p-value < 0.05 was considered significant. Nine studies adopting different thresholds (1 to 50 plasma cells/10 HPF) were included. In the meta-analysis, we only found a significant association between miscarriage rate and a plasma cell count ≥ 5/10 HPF (RR = 2.4; p = 0.007). Among studies not suitable for meta-analysis, CE showed an association with worsened pregnancy only when high thresholds (10 and 50/10 HPF) were adopted. In conclusion, our study suggests that the presence of plasma cells at low levels (<5/10 HPF) may not predict worsened pregnancy outcomes. Based on these findings, a threshold of ≥5 plasma cells/10 HPF may be more appropriate to diagnose CE.

Chronic Endometritis in Patients with Failure of IVF

Background: Chronic endometritis (CE) is highly prevalent in patients with unexplained infertility. This study aimed to determine the associations between CE and infertility. Methods and Results: We performed a prospective study of 197 women with implantation failure and pregnancy loss after undergoing in vitro fertilization (IVF). The endometrium was examined with a hysteroscope, and a sample was taken for biopsy in areas suspected of having inflammation. Immunohistochemistry was performed for CD138 antibodies. Diagnostic criterion was more than 5 plasma cells per 10 high-power fields. Patients who were positive for CE were treated with antibiotics. Among the 197 patients in our study, 115(58.4%) were positive for CE. Regarding the success of CE treatment and pregnancy after treatment, among the 115 CD138-positive patients, 32 became pregnant without IVF after treatment, while another 43 had successful pregnancies and childbirth with IVF. Thus, with treated CE, a successful pregnancy and childbirth was detected in 65.2% of cases, including spontaneous pregnancies and IVF. Conclusion: Patients with infertility and those who have pregnancies lost in IVF have a high rate of CE. Failure to treat CE results in infertility and IVF failure. An efficient diagnosis and treatment of CE are important for a successful pregnancy.

Gynecopathology in the Diagnosis and Assessment of Chronic Endometritis

Objectives: To summarize the gynecopathology findings in the diagnosis and assessment of chronic endometritis (CE) and provide insights into the therapeutics of CE. Mechanism: Chronic endometritis (CE) refers to the inflammatory state of the endometrium, which might alter endometrial receptivity and impact embryo implantation. As a relatively asymptomatic disease, the diagnosis and assessment of CE mainly lies in endometrial biopsy and further morphological and functional examinations. The authors searched the electronic database with a combination of key terms including chronic endometritis, histopathology, hysteroscopy, microbiota, inflammation, vascularization, decidualization as well as autophagy and summarized the current findings.in the diagnosis and assessment of CE. Findings in Brief: Plasma cell infiltration with immune staining, hysteroscopic manifestations including swelling, hyperemia and micropolyps, and pathogenic diagnosis were the main criteria for diagnosing CE. Further assessment of CE revealed the release of proinflammatory cytokines, leukocyte infiltration, enhanced vascularization and autophagy. These factors all contribute to an inflammatory state of the endometrium and decreased flow reserve supplying the embryo, which lead to the pathway explaining implantation failure in CE patients. Conclusions: Gynecopathology plays an essential role in the diagnosis and assessment of CE. Understanding such methods can help to screen out asymptomatic patients and initiate proper treatment, which eventually promotes better knowledge of the relationship between CE and embryo implantation and a higher successful implantation rate.

Precision Medicine for Chronic Endometritis: Computer-Aided Diagnosis Using Deep Learning Model

Chronic endometritis (CE) is a localized mucosal infectious and inflammatory disorder marked by infiltration of CD138(+) endometrial stromal plasmacytes (ESPC). CE is drawing interest in the field of reproductive medicine because of its association with female infertility of unknown etiology, endometriosis, repeated implantation failure, recurrent pregnancy loss, and multiple maternal/newborn complications. The diagnosis of CE has long relied on somewhat painful endometrial biopsy and histopathologic examinations combined with immunohistochemistry for CD138 (IHC-CD138). With IHC-CD138 only, CE may be potentially over-diagnosed by misidentification of endometrial epithelial cells, which constitutively express CD138, as ESPCs. Fluid hysteroscopy is emerging as an alternative, less-invasive diagnostic tool that can visualize the whole uterine cavity in real-time and enables the detection of several unique mucosal findings associated with CE. The biases in the hysteroscopic diagnosis of CE; however, are the inter-observer and intra-observer disagreements on the interpretation of the endoscopic findings. Additionally, due to the variances in the study designs and adopted diagnostic criteria, there exists some dissociation in the histopathologic and hysteroscopic diagnosis of CE among researchers. To address these questions, novel dual immunohistochemistry for CD138 and another plasmacyte marker multiple myeloma oncogene 1 are currently being tested. Furthermore, computer-aided diagnosis using a deep learning model is being developed for more accurate detection of ESPCs. These approaches have the potential to contribute to the reduction in human errors and biases, the improvement of the diagnostic performance of CE, and the establishment of unified diagnostic criteria and standardized clinical guidelines for the disease.

Featured Cover

American Journal of Reproductive ImmunologyVolume 89, Issue 3 e13692 FEATURED COVERFree Access Featured Cover First published: 13 February 2023 https://doi.org/10.1111/aji.13692AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Graphical Abstract The cover image is based on the Original Article The combination of CD138/MUM1 dual-staining and artificial intelligence for plasma cell counting in the diagnosis of chronic endometritis by Zhongtang Xiong et al., https://doi.org/10.1111/aji.13671. Volume89, Issue3March 2023e13692 RelatedInformation

Структурний аналіз причин жіночого безпліддя у лікувальних закладах м. Харкова

Female infertility in the modern world remains an urgent problem that requires new algorithms for diagnosis and control of treatment. According to various authors, the first place among the causes of infertility in women is ovarian and menstrual disorders and chronic endometritis (CE). The purpose of the study is to analyze the causes of infertility in women according to the medical documentation of the “Prime-test” laboratory for the period 2014–2021, with confirmation of the diagnosis of CE by the immunohistochemistry (IHC) method. Materials and methods. Data from the medical records of patients who applied to the “Prime-test” laboratory after various gynecological interventions were studied. Female infertility was found in 521 cases. A complex histological and immunohistochemical study was conducted in 100 cases of CH. Invitrogen and eBioscience primary monoclonal antibodies were used. The results. The median age of patients with infertility was 35.7 years, with a median age of 30.45 years for patients diagnosed with CE. Ovarian-menstrual disorders (52.78%) are in the first place in the structure of the causes of infertility, in the second place (27.83%) are CE, and in the third place are infertility with an unknown cause (8.64%). The rest of the reasons accounted for a small number of cases. CE was confirmed histologically and by the IHC method in 100 cases, while the most informative marker in doubtful cases was CD138. Conclusions. Chronic endometritis is an understudied disease that requires optimization of the diagnostic and prognostic panel with the selection of the most informative markers and markers that will allow the most complete study of the state of the endometrium before and after treatment.

Establishment and verification of hysteroscopic scoring system for chronic endometritis in infertile patients.

To establish and verify a hysteroscopic scoring system for the diagnosis of chronic endometritis (CE) in infertile patients. A total of 238 infertile patients who underwent hysteroscopy and endometrial biopsy in the Reproductive Medicine Center, Shijiazhuang Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University from October 1 to December 31, 2019 were enrolled in the study. According to the results of CD138 immunohistochemistry, the patients were divided into CE group (n=73) and non-CE group (n=165). Univariate and binary logistic regression analyses were used to screen the risk factors of CE and a nomogram was establish for hysteroscopic scoring. Receiver operating characteristic (ROC) curve, calibration curve and Bootstrap resampling method were used to evaluate and verify the system. Univariate and binary logistic regression analyses showed that hyperemia area (HA) degree ≥2, micropolyps, polypoid hyperplasia of endometrium and history of ectopic pregnancy were independent risk factors for CE (all P<0.05). A nomogram was generated to establish a hysteroscopy scoring system based on the above four factors. The area under ROC curve of the hysteroscopy scoring system for predicting CE was 0.801 (95%CI:0.742-0.861), the sensitivity was 74.0% and the specificity was 73.9%. The calibration curve showed that the predicting value of the scoring system was highly consistent with the actual value. In the internal verification, the C-index was 0.7811. The predicting value of the verification group in the calibration curve was basically consistent with the actual value, indicating that the scoring system had good stability. The hysteroscopic scoring system composed of HA, micropolyp, polypoid hyperplasia of endometrium and history of ectopic pregnancy can effectively and intuitively predict CE, which is conducive to improving the diagnosis of CE.

Results of in vitro fertilization after diagnosis and treatment of chronic endometritis.

A significant cause of infertility is the inability of the embryo to implant. Endometritis is one of the major causes affecting embryo implantation. The present study addressed the diagnosis and effects of chronic endometritis (CE) treatment on pregnancy rates after in vitro fertilization (IVF). We conducted this retrospective study on 578 infertile couples treated with IVF. In 446 couples, we performed a control hysteroscopy with biopsy before IVF. In addition, we examined the visual aspects of the hysteroscopy and the results of the endometrial biopsies, followed by antibiotic therapy if necessary. Finally, the results of IVF were compared. Of the 446 cases studied, we diagnosed 192 (43%) with chronic endometritis, either by direct observation or based on the histopathological result. In addition, the cases diagnosed with CE we treated with a combination of antibiotics. The group diagnosed at CE and subsequently treated with antibiotic therapy had a significantly higher pregnancy rate after IVF (43.2%) than the group without treatment (27.3%). Hysteroscopic examination of the uterine cavity was particularly important for the success of IVF. The initial CE diagnosis and treatment were an advantage for the cases in which we performed the IVF procedures.

The alteration of intrauterine microbiota in chronic endometritis patients based on 16S rRNA sequencing analysis

BackgroundChronic endometritis (CE) is a disease of continuous and subtle inflammation occurring in the endometrial stromal area, which is often asymptomatic or present with non-specific clinical symptoms.MethodsThis study investigated the composition and distribution of the intrauterine microbiota of 71 patients who underwent hysteroscopy during the routine clinical inspection of infertility. Among them, patients who were diagnosed with chronic endometritis (CE) were allocated into CE group (n = 29) and others into non-CE group (n = 42). There was no significant difference in average age between the two groups (P = 0.19). Uterine flushing fluid was collected by the self-developed cervical trocar uterine cavity sampler and 16S rRNA sequencing was performed.ResultsThe alpha diversity in the CE group was significantly higher than that in the non-CE group (P < 0.05). Firmicutes (newly named Bacillota) were the dominant phylum in the non-CE group (72.23%), while their abundance was much lower in the CE group (49.92%), but there was no statistically significant difference between the two groups. The abundances of Actinobacteriota and Cyanobacteria in the CE group were significantly higher than those in the non-CE group (P < 0.05). At the genus level, the abundance of Lactobacillus dominated in all samples, which presented a significantly lower abundance in the CE group (40.88%) than that in the non-CE group (64.22%) (P < 0.05). Correspondingly, the abundance of non-Lactobacillus was higher in the CE group, among which Pseudomonas and Cutibacterium increased significantly (P < 0.01). Moreover, compared with the non-CE group, the pathways involved in arginine and proline metabolism and retinol metabolism were significantly enriched in the CE group (P < 0.05), while the metabolism of lipid and prenyltransferases were significantly decreased in the CE group (P < 0.05).ConclusionsA certain microbial community was colonized in the uterine cavity, which was dominated by Lactobacillus. The structure and distribution of intrauterine microbiota in the CE group were different from those in the non-CE group by showing a lower abundance of Lactobacillus, and a significantly higher abundance of Pseudomonas and Cutibacterium. Additionally, the microbial metabolism was altered in the CE group. This study elaborated the alteration of intrauterine microbiota in CE patients, which may contribute to the diagnosis of CE and provide a reference for antibiotic treatment of CE.

Endometriosis as an Infectious Disease: Association with Chronic Endometritis

Objectives: Recent studies focus on immunological, infectious, and inflammatory aspects of endometriosis. Meanwhile, chronic endometritis (CE) is an immunological, infectious, and inflammatory disorder of the eutopic endometrium with unusual stromal plasmacyte infiltration. Mechanism: In this review article, we aimed to gain a better understanding of the relationships between endometriosis and CE. Findings in Brief: Accumulating evidence supports the idea that CE is associated with infertility of unknown etiology, repeated implantation failure in an in vitro fertilization-embryo transfer program, recurrent pregnancy loss, as well as several perinatal/neonatal complications. Endometrial biopsy/histopathologic examinations and/or hysteroscopy are required to make a definitive diagnosis of CE. Conclusions: While endometriosis has been long considered a cause of infertility, CE is also an emerging issue that may reduce fecundity in women of reproductive age. Endometriosis and CE share characteristics of endometrial proliferative nature. The potential relationships between these two diseases of the uterine lining warrant future studies.

Prevalence of Chronic Endometritis in Unexplained Implantation Failure

Background: The actual load of chronic endometritis (CE) in the general population as well as implantation failure is still ill-defined, Aim of the study: was to assess incidence of CE at hysteroscopy and histology, in a cases with implantation failure at ICSI. Patients and methods: The International Islamic Center for Population Studies and Research at Al Azhar University performed this prospective observational cross-sectional research from 2017 to 2022.The study was conducted on 150 women with one unexplained implantation failure or more at ICSI. Results: Histopathological examination confirmed the diagnosis of CE in 55/66 cases suspected to have CE by hysteroscopy (True Positive), while 11 cases were found to be free from CE (False Positive). On the other hand, histopathological examination confirmed absence of CE in 82/84 negative cases by hysteroscopy (True Negative), while only two cases were found to have CE (False Negative). In our study, hysteroscopy is trustworthy CE diagnostic method for CE in unexplained implantation failure with sensitivity, specificity, accuracy, PPV and NPV as 96.5%, 88.17%, 91.3%, 83.3% and, 97.6% respectively. Conclusion: According to this research, hysteroscopy is a useful diagnostic tool in women with unexplained implantation failure as regard CE diagnosis. However, endometrial samples should be obtained during hysteroscopy to increase the diagnostic accuracy.

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

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). Two hundred ninety-eight infertile women underwent endometrial biopsy were included. In 100 women, three successivesections 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. 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. The combination of CD138/MUM1 DS and AI is a promising method to improve the accuracy and efficiency of CE diagnosis.