Presence Of Chronic Endometritis Research Articles

Nonlinear correlation between serum vitamin D levels and the incidence of endometrial polyps in infertile women.

Are serum vitamin D levels associated with the incidence of endometrial polyps (EPs) in infertile patients? Serum 25(OH)D levels were nonlinearly correlated with the incidence of EPs in infertile women. EPs are a common condition that may affect the receptivity of the endometrium in women of reproductive age. Vitamin D regulates cell proliferation and differentiation, apoptosis, angiogenesis, anti-inflammation, and immunomodulation, in addition to its well-known functions in balancing calcium and phosphorus. Previous studies have shown that vitamin D concentrations are associated with reproductive outcomes, and that low vitamin D levels are associated with the incidence of colorectal polyps and nasal polyps. There is little evidence regarding the relationship between EPs and serum vitamin D levels. We conducted a cross-sectional study using data from Guangdong Women and Children Hospital from January 2019 to October 2023, enrolling 3107 patients. A total of 3107 infertile patients who underwent hysteroscopy were included in this study; 642 patients had endometrial polyps and 2465 had a normal uterine cavity. Hysteroscopy findings included risk of EPs, polyp size, percentage of multiple polyps, and incidence of chronic endometritis (CE). Serum vitamin D were assessed by measuring total 25(OH)D using chemiluminescence. According to international guideline recommendations for vitamin D deficiency, patients were divided into two groups: the <50 nmol/l group and the ≥50 nmol/l group. Univariable and multivariable logistic regression models, stratified analyses, and smooth curve fitting were used to examine the relationship between serum 25(OH)D levels and risk of EPs. Of all patients, 23.8% (740/3107) were vitamin D deficient (<50 nmol/l). The incidence of EPs was significantly higher in the 25(OH)D < 50 nmol/l group than in the ≥50 nmol/l group (24.9% vs 19.3%; P = 0.001). However, there were no differences in polyp size, proportion of multiple polyps, and presence of CE between the two groups. After controlling for confounders, 25(OH)D ≥ 50 nmol/l (compared with <50 nmol/l) was negatively associated with risk of EPs (adjusted OR, 0.733; 95% CI, 0.598-0.898). Other variables that had an impact on polyp incidence included BMI, type of infertility, CA125, and CD138-positive plasma cells. In addition, a linear regression model between age and serum 25(OH)D levels showed a positive linear association. Subgroup analyses were performed for different age groups, and the risk of EPs was significantly higher in the 25(OH)D < 50 nmol/l group than in the ≥50 nmol/l group, both in the younger subgroup (23.8% vs 19.1%) and in the older subgroup (28.0% vs 19.9%). The smooth curve fitting model showed a nonlinear correlation between 25(OH)D levels and risk of EPs (nonlinear P-value = 0.020), with an optimal threshold of 51.8 nmol/l for 25(OH)D levels. Moreover, subgroup smooth curve fitting models showed a nonlinear correlation between 25(OH)D levels and polyp risk in patients aged <35 years (nonlinear P-value = 0.010), whereas a linear correlation between 25(OH)D levels and polyp risk was found in patients aged ≥35 years (nonlinear P-value = 0.682). Caution should be exercised in interpreting our findings as this is a correlational study and causality cannot be inferred from our results. In addition, because of strict inclusion and exclusion criteria, our results may not be generalizable to unselected populations, including premenopausal women or women of other races. This study demonstrated for the first time that vitamin D deficiency is an independent risk factor for the incidence of EPs in infertile patients. Identifying modifiable risk factors (e.g. vitamin D deficiency) can help in the development of new strategies for treating polyps or to protect against polyp development. Further clinical intervention trials and laboratory studies are needed to evaluate the effect of vitamin D on the development of EPs and to elucidate the mechanisms. The study was funded by the National Natural Science Foundation of China (82101718) and Natural Science Foundation of Guangdong Province, China (2022A1515010776). No competing interest was involved in this study. N/A.

Morphology of endometrial inflammatory changes in foci of endometriosis and adenomyosis

The high prevalence of endometriosis, its impact on menstrual and reproductive functions, obstetric complications, and the quality of life of women in the reproductive age determines the urgency of the problem.The objective: to assess the prevalence of inflammatory changes in foci of heterotopic endometrium in patients with endometriosis and adenomyosis.Materials and methods. 92 women of reproductive age – from 21 to 46 years old – who applied for surgical treatment for symptomatic adenomyosis (47 women – 1st group) and ovarian endometriosis (45 patients – 2nd group), and 30 practically healthy women of the same age (control group) were examined.Histological examination of adenomyosis and ovarian endometriosis biopsies was performed using a light microscope at magnifications of 40 and 100. For immunohistochemical examination, primary and secondary antibodies were used to determine CD34, CD68, and CD138 markers.Results. In patients with adenomyosis and ovarian endometriosis the following concomitant gynecological pathologies as uterine fibroids, endometrial hyperplasia, chronic endometritis, chronic abnormal uterine bleeding, the frequency of which is significantly higher in adenomyosis, were diagnosed. This may indicate the pathogenetic role of chronic inflammation in the development of these pathological conditions.In patients with adenomyosis the positive expression of CD68 in the epithelial component of heterotopias was determined in 8 (17.0±5.6%) women, and in 4 (8.9±4.2%) women with ovarian endometriosis, which indicated a low phagocytic activity. During the assessment of CD34 expression in vessel walls and the stromal component of endometrioid heterotopias, a positive reaction was determined in 16 (34.0±6.9%) patients with adenomyosis and in 10 (22.2±6.2%) patients with ovarian endometriosis, which reflects the processes of neoangiogenesis and the activity of the pathological process.Positive expression of CD138 in endometrioid heterotopias prevailed in the group of patients with adenomyosis – 12 (25.5±6.4%) cases versus 4 (8.9±4.2%) cases in the group of patients with ovarian endometriosis (p&lt;0.05). This confirmed the histological results and clinical data regarding the presence of chronic endometritis and isthmocele.Conclusions. The identified inflammatory changes, weak phagocytic activity and signs of neoangiogenesis in foci of heterotopic endometrium are more significant in patients with adenomyosis, which is confirmed by clinical and morphological data.

Role of vimentin in the morphogenesis of endometrial decidualization during pregnancy with IVF methods

BACKGROUND: Early reproductive loss is a complex problem, the solution of which requires a systematic approach to the study of the morphogenesis of gravid transformation. Violations of the morphofunctional characteristics of the endometrium are associated with chronic endometritis, which entails implantation pathology and the development of pregnancy, while formulating indications for the use of IVF methods. Chronic endometritis disrupts the differentiation of stromal cells and intermediate filaments with subsequent pathology of decidualization and gravid transformation. AIM: The aim of this study was to evaluate vimentin expression in decidual cells of the gravid endometrium in an undeveloped first-trimester pregnancy after IVF, depending on its transformation in patients with chronic endometritis. MATERIALS AND METHODS: Histological and immunohistochemical studies were performed on 40 samples of abortion material with normal chorionic villi karyotype from a non-developing pregnancy after IVF in patients with chronic endometritis and 15 samples of abortion material from a progressive pregnancy, surgically terminated at the woman’s request at similar terms. Two groups were formed — I group with a full-fledged gravid transformation in a non-developing pregnancy after IVF (n = 20) and II group with an incomplete gravid transformation in a non-developing pregnancy after IVF (n = 20). Histological examination was performed according to the standard procedure. Immunohistochemical study was performed using a one-step protocol with antigen unmasking. Primary monoclonal antibodies to vimentin (Clon V9, Diagnostic BioSystems Inc., Spain) were used at a 1 : 1000 dilution. Vimentin expression was evaluated in the compact layer of the gravid endometrium. RESULTS: A full-fledged gravid transformation of the endometrial stroma in the abortion material in study group I and the control group was represented by mature deciduocytes of the epithelioid type, round or polygonal in shape, with a light vesicular nucleus. With an incomplete gravid transformation, the compact layer of the gravid endometrium was represented by fibroblasts with varying degrees of cytoplasmic development, from mild changes to the formation of pre-decidual and immature decidual cells. A decrease in vimentin expression was verified in the gravid endometrium after IVF compared to the control group. In case of an incomplete gravid transformation, a decrease in vimentin expression was also verified compared to the control group and study group I. CONCLUSIONS: The presence of chronic endometritis in patients with infertility and chronic endometritis not only causes pathology of the original endometrium, but also disrupts decidualization, leading to reproductive loss with normal embryo karyotype.

Analysis of factors affecting the prognosis of patients with intrauterine adhesions after transcervical resection of adhesions

ObjectivesTo study the factors affecting the prognosis of patients with intrauterine adhesions (IUAs) after transcervical resection of adhesions (TCRA), analyze the reproductive outcome, and guide prognostic improvements. DesignProspective study. SubjectsOur study included 292 patients diagnosed with intrauterine adhesions who underwent follow-up office hysteroscopy at Shenyang Women's and Children's Hospital between June 2018 and June 2022. InterventionsPatients were divided into case (52 patients whose hysteroscopy results indicated the presence of intrauterine adhesions) and nocase (240 patients whose uterine cavity had returned to normal shape without obvious adhesion) groups based on the results of a 2-month follow-up hysteroscopy following transcervical resection of adhesions. Clinical data were collected and compared with various influencing factors, and the combined effect of these factors was assessed using multifactorial logistic regression analysis. A nomogram prediction model was constructed and internally validated based on multifactorial analysis. Main Outcome MeasuresIntrauterine re-adhesion observed at 2-months follow-up after transcervical resection of adhesions. ResultsPostoperative re-adhesion occurred in 52 of 292 patients with intrauterine adhesions. Multifactorial binary logistic regression analysis showed that intrauterine adhesion barrier gel reapplication 5 days after transcervical resection of adhesions was a protective factor while the preoperative American Fertility Society scores demonstrated that severe intrauterine adhesions and chronic endometritis were risk factors (P <0.05). The results of the multifactorial analysis were used to build a nomogram model, and the area under the curve value of the nomogram model for predicting postoperative recurrence was 0.914 (95% confidence interval: 0.864-0.956). The bootstrap method was subsequently used to resample 1,000 times for internal validation. The results showed that the internal validation C-index was 0.9135 and that the calibration curve and ideal curve were well-matched. ConclusionThe prognosis of patients with intrauterine adhesions after transcervical resection of adhesions is related to the severity of preoperative intrauterine adhesions, presence of chronic endometritis, and intrauterine adhesion barrier gel reapplication 5 days after transcervical resection of adhesions. Therefore, clinicians should monitor patients using targeted data to reduce recurrence risk after transcervical resection of adhesions and improve the prognosis of patients with intrauterine adhesions.

Уровень адипокинов и их ассоциация с хроническим эндометритом у женщин репродуктивного возраста

Objective. To evaluate serum concentrations of leptin and adiponectin and their association with chronic endometritis (CE) in reproductive-aged women. Patients and methods. The study included 198 reproductive-aged women who were recruited during general health checks. All patients underwent anthropometric (body mass index (BMI), body fat percentage) and instrumental (pelvic ultrasound, endometrial pipelle biopsy with CD138 immunohistochemistry) examinations, and serum leptin and adiponectin levels were determined. Non-parametric methods and logistic regression were used for statistical analysis. Results. The results of the examination of 121 women were analyzed, of whom 20 were subsequently excluded due to missing data on BMI values, serum leptin concentrations, and CD138 expression levels in the endometrial stroma. Patients were divided into two groups: 60 healthy women (control group) and 41 women with CE, between whom statistically significant differences in BMI (p = 0.012), leptin (p = 0.002) and adiponectin (p = 0.002) levels were determined. Following patients’ division into subgroups according to BMI, women with CE were found to have statistically significantly higher adiponectin levels (p = 0.01) in the subgroup with normal weight and lower leptin levels (p = 0.001) in the subgroup with BMI ≥25 kg/m2 compared to that in the control group. Relatively low leptin levels were a risk factor for CE (OR: 0.903 [0.843; 0.969], p = 0.004) in overweight and obese women. Conclusion. A significant association between serum leptin levels and the presence of CE was determined in overweight and obese women, but not in normal weight women. Key words: adiponectin, inflammation, leptin, overweight, body mass index, obesity, chronic endometritis

A case of discrepancy between three ERA tests in a woman with repeated implantation failure complicated by chronic endometritis

BackgroundEndometrial receptivity array (ERA) is used to determine the timing of embryo transfer (ET) synchronized with the window of implantation (WOI). The effectiveness and evaluation of ERAs in women with recurrent implantation failure remain controversial. We report the case of a patient with recurrent implantation failure that raises the issue of reproducibility of ERA tests.Case reportA 36-year-old Japanese woman with secondary infertility who had previously given birth failed to conceive after three frozen-thawed embryo transfer (FET) cycles. An ERA test was conducted to confirm the WOI. The first ERA test was performed 125 h after progesterone exposure. The laboratory reported that the endometrium was in a non-receptive (post-receptive) phase, and recommended retesting 101 h after progesterone exposure. A simultaneous chronic endometritis (CE) test showed a score of 3. After the antibiotics administration to treat CE, the second ERA test was performed after 101 h of progesterone exposure. The laboratory reported that the endometrium had not reached the WOI and estimated the WOI to be 113 ± 3 h after progesterone exposure. The third ERA test was performed 113 h after progesterone exposure. The laboratory reported that the endometrium was in a non-receptive (pre-receptive) phase and estimated the WOI to be 137 ± 3 h after progesterone exposure. A CE test performed at the same time as the second and third ERA tests showed a score of 1 for the collected endometrium. According to the third ERA test results, the vitrified-warmed blastocyst was transferred at 137 h of progesterone exposure. Pregnancy was achieved and the patient had an uncomplicated vaginal delivery at 39 weeks. One year later, another pregnancy was achieved after FET at 137 h of progesterone exposure, and the patient delivered at 33 weeks due to an unexpected membrane rupture.ConclusionBecause the results of the ERA test may vary in the presence of CE, CE should be diagnosed simultaneously with or before conducting ERA tests. If CE is diagnosed, ERA testing should be performed after treatment with antimicrobials or other drugs.

Structural, functional, and molecular mechanisms of endometrial transformation in habitual pregnancy failure

Introduction. Habitual pregnancy failure (HPF) has long been a pressing problem of modern medicine and is characterized by multiple pathogenetic mechanisms of early pregnancy termination. The aim of the study was to examine the expression of estrogen, progesterone, progesterone-induced blocking factor and stromal cell factor-1 receptors in endometrial biopsy specimens from patients with HPF. Materials and methods. Histological and immunohistochemical studies were performed on 75 endometrial biopsies: 50 endometrial biopsies were taken from patients with HPF and chronic endometritis with no more than three pregnancies, and 25 endometrial biopsies were taken from conditionally healthy patients. Endometrial biopsy was performed on days 19 to 22 of the menstrual cycle. Histological examination of endometrial biopsy specimens was performed according to the standard technique with hematoxylin and eosin staining. The expression of estrogen receptor (ER), progesterone receptor (PR), progesterone-induced blocking factor (anti-PIBF), and stromal cell factor-1 (anti- SDF-1) was assessed by immunohistochemistry. Results. In patients with HPF, the endometrium corresponded to the middle stage of the secretion phase in 32 % of cases. Immunohistochemical study in patients with HPF verified multifocal decrease of estrogen and progesterone receptor expression in the stromal component in 82 % of cases. Assessment of PIBF and SDF-1 expression in the glands and stroma of the endometrial mid-stage secretion phase in patients with HPF revealed a statistically significant decrease compared to the control group. Discussion. The presence of chronic endometritis in patients with HPF leads to impaired endometrial secretory transformation, decreased expression of estrogen and progesterone receptors in the endometrial stroma, and decreased expression of PIBF and SDF-1 in the glands and endometrial stroma. The results of the study suggest the need for pathogenetic therapy of chronic endometritis and pregravidarial preparation in patients with HPF. Conclusion. Regardless of the completeness of endometrial transformation, desynchronosis of the receptor profile, altered expression of immunological markers (PIBF and SDF-1) against the background of chronic endometritis, and structural and molecular disturbances serve as factors of early pregnancy loss.

Evaluation of the factors influencing labor outcomes in women with a history of abdominal delivery

BACKGROUND: The rapid increase in the frequency of caesarean sections has led to the emergence of a special group of patients with a uterine scar who want to give birth through the natural birth canal. Repeated operative delivery is associated with high risks of both intraoperative and postoperative complications, therefore, every year the number of women with a uterine scar who prefer natural childbirth is growing.&#x0D; AIM: The aim of this study was to create a model that allows, based on a comprehensive assessment of risk factors, for predicting the outcome of childbirth in women with a history of abdominal childbirth.&#x0D; MATERIALS AND METHODS: We carried out a retrospective analysis of 173 birth histories of women with a uterine scar after a previous caesarean section, delivered in the Chita City Maternity Hospital in 20212022. Three groups of individuals were designed for the study: Group 1 included 110 women delivered by caesarean section in a planned manner; Group 2 comprised 20 women delivered by caesarean section during childbirth, while Group 3 consisted of 43 women who gave birth through the natural birth canal. The groups were comparable in terms of nationality, age, material and social conditions of the patients. On the eve of delivery, all patients underwent general clinical and obstetric ultrasound examination, with the anamnesis details clarified. The data obtained were processed statistically using the IBM SPSS Statistics version 25.0.&#x0D; RESULTS: Using binary logistic regression, a model was developed to predict the outcome of childbirth through the natural birth canal in women with a uterine scar, which takes into account statistically significant indicators such as gestational age, estimated fetal weight, parity, and the presence of chronic endometritis and weakness of labor activity in history. The sensitivity of the developed prognostic model is 0.86, the specificity being 0.70. The area under the ROC curve is 0.87 (95% confidence interval 0.780.96; p 0.001).&#x0D; CONCLUSIONS: The comprehensive analysis of risk factors allows for predicting the outcome of natural childbirth in women with a uterine scar, which in the future will optimize the tactics of their delivery and prevent the development of complications in childbirth for the mother and fetus.

192. Finding validity in proposed hysteroscopic findings of chronic endometritis

Purpose: To evaluate the proposed criteria in a large sample and in additional subgroups in order to test the validity of the hysteroscopic features widely-accepted as suggestive of CE, Method(s): All patients (n: 2675) underwent outpatient hysteroscopy, with the vaginoscopic approach technique. Hysteroscopic features such as, stromal oedema, diffuse or focal hyperaemia, “strawberry aspect”, micropolyposis and endometrial polyps, are often indicate the presence of chronic endometritis. All hysteroscopic features, alone and in combination were applied in 7 (seven) different subgroups of the sample: total sample, women in reproductive age, women with infertility issues/IVF screening, women with history of recurrent miscarriages, menopausal women, and women with hysteroscopic indication of Abnormal Uterine Bleeding (AUB) in women of reproductive age and postmenopausal bleeding (PMB).

Accuracy of office hysteroscopy in the diagnosis of chronic endometritis

Background: To test the accuracy of office hysteroscopy in the diagnosis of chronic endometritis (CE) as compared to histopathological diagnosis. Methods: This prospective cohort study was conducted in a private hospital from July 2018 to January 2020. 220 infertile women were scheduled for first attempt of intracytoplasmic sperm injection (ICSI). Patients ranging in age from 20–40 with history of primary infertility scheduled for ICSI for the first time were included, while patients with chronic diseases, severe vaginal bleeding, previous failed ICSI, polycystic ovary syndrome (PCOS), or endometriosis were excluded. All patients received postmenstrual office hysteroscopy to rule out the presence of CE; at the same setting, endometrial biopsy was taken and sent for histopathological examination. Results: 174 cases (79.1%) were diagnosed as CE at hysteroscopy, while 162 (73.6%) cases were positive at histopathology. 99.4% of the cases presented with hyperaemia, followed by oedema in 74.7% and micro-polypi in 58.6% of cases with CE. There was a significant difference between the hysteroscopic and the histopathologic diagnosis of CE (p &lt; 0.001). The sensitivity, specificity, and positive and negative predictive values of hysteroscopy were 93.83%, 62.07%, 87.36% and 78.26% respectively. Conclusions: Office hysteroscopic evaluation is relatively accurate on its own but can be further confirmed by CD138 staining.

A PROTON PUMP INHIBITOR ALTERS THE pH OF THE HUMAN UTERINE CAVITY

To present two cases of increased pH of the uterine cavity after taking lansoprazole, an oral proton pump inhibitor (PPI). Case study. We examined infertile women to see whether chronic endometritis (CE) existed, through assessment of endometrial plasma cells (CD138 immunostained cells) and uterine microbiota by sequencing the 16S ribosomal RNA gene (Varinos Inc., Japan). CE was diagnosed applying the criteria (>5.15/10xmm2) reported by Liu et al. (1). We also examined the intrauterine pH directly on the endometrial surface using a Portal pH Meter (Japan Asch Inc., Japan) that has been utilized for the esophageal mucosa of esophagitis (2). We have reported in ESHRE annual meeting 2020 that intrauterine pH is weakly acidic (5.58±0.59) and it increases in the case of CE (6.67±0.39). Patient 1: A 44-year-old infertile woman noticed changes of her vaginal discharge after taking orally lansoprazole 30 mg for reflux esophagitis. Her initial intrauterine condition had been normal with pH: 6.3, Lactobacillus: 97%, and CD138-positive cells: 1.7/10xmm2. After PPI intake for a month, her intrauterine pH rose to 7.0, which suggested existence of CE. Therefore, we collected the endometrial tissue again and performed microbiota and pathological tests: Lactobacillus was 99% and CD138-positive cells were 1.6/10xmm2, which did not indicate CE histologically and bacterially. After discontinuing PPI, her intrauterine pH dropped to 6.7 with Lactobacillus: 97% and CD138-positive cells: 2.0/10xmm2. Patient 2: A 47-year-old woman, whose initial uterine pH had been 6.4, noticed a change of odor of vaginal discharge after taking PPI (lansoprazole 30 mg daily) for gastric ulcer. Her intrauterine pH rose to 7.1 with Lactobacillus :9.1% and CD138-positive cells: 0.7/10xmm2. After discontinuation of PPI, her intrauterine pH dropped to 6.2 with no CD138-positive cells, but Lactobacillus was 2.60%. We experienced two cases in which the pH of uterine cavity increased while taking oral PPI. We have reported that the uterine luminal pH in human is weakly acidic (around 6.0) and that the pH increases in the presence of CE or abnormal endometrial microbiota. In animals, such as mice (3) and mares (4), the uterine luminal pH is acidic at the time of implantation, and the acidic environment in the uterus is considered to be important for embryo implantation, and the vacuolar H + -ATPase pump, which is a type of proton pump, is expressed in the endometrium at the time of implantation in bovine (5) and mice (2), but there have been no reports in humans. These 2 cases which we presented here suggest that some proton pumps are also expressed in the endometrium and acidify the uterine cavity in humans, which could control the intrauterine environment independently of inflammation or microbiota.

O-143 Characterization of vaginal and endometrial microbiome in patients with chronic endometritis (CE)

Abstract Study question Could vaginal and endometrial microbiome by sequencing 16S rRNA be comparable to classic diagnostic methods or immunohistochemistry CD138 for diagnosis of chronic endometritis? Summary answer A characteristic endometrial and vaginal microbiome is present in patients with chronic endometritis. An abnormal vaginal microbiome correlates with the presence of chronic endometritis. What is known already Chronic endometritis is a disease characterized by persistent inflammation of the endometrial lining. Currently, histopathological evaluation by immunohistochemistry CD138 marker is most common diagnostic method for CE. Microbiome analysis based on subunit 16S rRNA sequencing is a fast tool that can enable the identification of pathogenic microorganisms associated with CE. The main bacteria at vaginal and endometrial level belong to genus Lactobacillus, producers of lactic acid that allows maintaining acidic pH of vagina and acts as barrier against pathogens. Investigations on the effect of an abnormal endometrial and vaginal microbiome could improve assisted reproductive technologies. Study design, size, duration This is a observational pilot study (60 patients and 120 samples). The study population consists of patients attending to our fertility clinic for frozen euploid embryo transfer (FET) from May 2017 to May 2019. Preimplantation Genetic Testing of aneuploidy (PGT-A) was performed at blastocyst stage using Veriseq (Illumina). The inclusion criteria to be meet by patients were: age between 18 and 50 years, own or donated oocytes and use of ICSI. Participants/materials, setting, methods Cohort study with sixty patients undergoing assisted reproductive treatment (TRA) with their own or donated gametes and PGT-A Vaginal and endometrial samples were taken in the cycle prior to embryo transfer. The vaginal and endometrial microbiome was analyzed by mass sequencing of the V3V4 region of 16S rRNA. Bioinformatics analysis was performed using QIIME2 and MicrobiomeAnalyst packages. Alpha, beta diversity and taxonomic characterization were compared with positive and negative CD138 groups for chronic endometritis (CE). Main results and the role of chance Different bacterial communities were detected when vaginal and endometrial samples were analyzed in patients with and without endometritis diagnosed with CD138 immunohistochemistry. In patients with endometritis, a higher alpha diversity index tendency was found in vaginal samples (p = 0.15 for the Shannon index) and significant differences in endometrial samples (p = 0.01 for the Shannon index). In the beta diversity analysis, no significant differences were observed between the groups established as per the diagnosis of endometritis. Vaginal and endometrial samples from women with endometritis showed a microbiome pattern not dominated by Lactobacillus spp. Relative abundance analysis identified the genera Ralstonia and Gardnerella in endometrial sample, and the genera Streptoccoccus and Ureaplasma in vaginal sample of patients diagnosed with CD138 for endometritis. Comparing endometrial and vaginal samples CD138 positive diagnosed for endometritis, alpha diversity (p = 0.06 for the Shannon index and p = 0.08 for the Simpson index) and beta diversity (p &amp;lt; 0.001) showed significant differences. Relative abundance identified the genera Lactobacillus (p = 3.76E-4), Ralstonia (p = 8.19E-4), Delftia (p = 0.004) and Anaerobacillus (p = 0.004) in these sample groups. Limitations, reasons for caution The main limitation of this study is the small sample size. Larger studies including a higher number of samples are needed to confirm the different microbiome pattern observed at the vaginal and endometrial levels in correlation with chronic endometritis. The microbiome pattern has not been analyzed after treatment of CE. Wider implications of the findings Our findings suggest the existence of a characteristic vaginal and endometrial microbiota in patients with chronic endometritis. Different genera and species were identified in patients with and without endometritis depending on whether the sample was endometrial or vaginal. An abnormal vaginal microbiome appears to be strongly correlated with chronic endometritis. Trial registration number Not Applicable

Clinical and anamnestic data and morphofunctional characteristics of the endometrium in women with uterine developmental anomalies

BACKGROUND: Uterine developmental anomalies have a negative impact on the implementation of female reproductive function, leading to a high risk of reproductive failures, premature birth, placental insufficiency, intrauterine growth retardation syndrome, labor anomalies and postpartum bleeding. The presence of both structural anomalies themselves and the high frequency of reproductive failures leads to repeated intrauterine interventions, which are considered as a premorbid background for the endometrial pathology development. Despite the combined causes of reproductive failure, morphological studies of the endometrium in women with various uterine anomalies are scarce.&#x0D; AIM: The aim of this study was to evaluate the clinical and anamnestic data and morphological characteristics of the endometrium in women with uterine anomalies and reproductive failures in the anamnesis.&#x0D; MATERIALS AND METHODS: We examined 123 women with uterine developmental anomalies (49 patients with an arcuate uterus, 38 patients with a uterine septum, 16 patients with a bicornuate uterus, 10 patients with an unicornuate uterus, 10 patients with dimetria). Standard clinical and laboratory work-up, hysteroscopy with endometrial biopsy and laparoscopy were performed in all patients. Histological and immunohistochemical examination of the endometrium was carried out according to the standard technique with assessment of the relevant receptor profile (estrogen and progesterone receptors) and pro-inflammatory markers (CD8+, CD20+, CD4+, and CD138+).&#x0D; RESULTS: Clinical and anamnestic data evaluation in patients with uterine anomalies revealed menstrual abnormalities, commonly, dysmenorrhea. Regardless of the type of uterine anomaly, a high incidence of pelvic inflammatory disease, endometriosis and a high frequency of reproductive failures were found. The morphological structure of the endometrium with uterine anomalies was characterized by a higher frequency of endometrial hyperplasia, impaired secretory transformation and the presence of chronic endometritis.&#x0D; CONCLUSIONS: Patients with a variety of uterine developmental anomalies are characterized by menstrual irregularities, a high incidence of gynecological pathology and reproductive failures. There is no association between pathognomonic signs of endometrial morphofunctional abnormalities and the type of uterine anomaly; however, they are similar to those seen in recurrent miscarriages and infertility of various origins.

Hysteroscopic detection of chronic endometritis: Evaluating proposed hysteroscopic features suggestive of chronic endometritis

PurposeTo evaluate the proposed criteria in a large sample and in additional subgroups in order to test the validity of the hysteroscopic features widely-accepted as suggestive of CE. Method(s)All patients (n: 2675) underwent outpatient hysteroscopy, with the vaginoscopic approach technique. Hysteroscopic features such as, stromal oedema, diffuse or focal hyperaemia, “strawberry aspect”, micropolyposis and endometrial polyps, are often indicate the presence of chronic endometritis. All hysteroscopic features, alone and in combination were applied in 7 (seven) different subgroups of the sample: total sample, women in reproductive age, women with infertility issues/IVF screening, women with history of recurrent miscarriages, menopausal women, and women with hysteroscopic indication of Abnormal Uterine Bleeding (AUB) in women of reproductive age and postmenopausal bleeding (PMB). From each case, endometrial samples were obtained and immunohistochemistry, identifying CD-138, was applied in order to diagnose CE. Result(s)A total of 2675 patients were included of which, 1444 women were found with at least one of the proposed hysteroscopic features mentioned above. Stromal oedema, focal or diffuse hyperaemia and “strawberry aspect” in combination with micropolyposis demonstrated higher rates of diagnostic accuracy in the detection of CE correlated to histologic confirmation. Micropolyposis, stromal oedema, focal or diffuse hyperaemia and “strawberry aspect” offer great diagnostic accuracy in the hysteroscopic detection of Chronic Endometritis, regardless reproductive status and/or clinical presentation. Endometrial polyps are not valid hysteroscopic features in cases of suspected CE. Conclusion(s)Diagnostic hysteroscopy can accurately diagnose cases of CE, based on stromal oedema, focal or diffuse hyperaemia and “strawberry aspect”, in combination with micropolyposis. In subgroups of infertile women, higher diagnostic accuracy based on the hysteroscopic features mentioned, was more likely to be achieved. Whether endometrial polyps are suggestive of CE, when identified during office hysteroscopy, remains controversial.

Relationship of chronic endometritis with chronic deciduitis in cases of miscarriage

BackgroundThe presence of chronic deciduitis (CD) was determined in patients diagnosed with or without chronic endometritis (CE) before pregnancy.ObjectiveTo study the effect of CE on decidua in cases of miscarriage.MethodsDecidual tissue was obtained from the patients who miscarried at the first pregnancy within a year after the diagnosis of the presence or absence of CE. The number and distribution pattern of plasma cells stained with CD138 in decidual tissue in 10 high-power fields (HPFs) was examined. The prevalence of CD diagnosed with four different grade; grade 0, no plasma cell in 10 HPFs, thus Non-CD;grade 1, rare single plasma cells; grade 2, rare clusters or more than 5 single cells total; and grade 3, many plasma cells with more than 5 clusters, were examined and compared between Non-CE and CE.ResultsThe incidence rate of CD of grade2 + 3 was significantly higher in CE than Non-CE (53.8%; 7/13 vs. 0%; 0/13, P < 0.01). Presence of clusters or a number of plasma cells in 10 HPFs of decidua showed a sensitivity of 53.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 68.4% for the diagnosis of CE.ConclusionPresence of clusters of plasma cells or five or more of plasma cells in decidua was found in more than half of CE, but not found in Non-CE. When CD with cluster or five or more of plasma cells is confirmed histologically in miscarriage decidual tissue, the presence of CE before the pregnancy should be suspected.

Clinical and immunological aspects of early reproductive losses in patients with adenomyosis

Aim. To evaluate the clinical and immunological features of the early gestational period in patients with adenomyosis.Materials and methods. The study included 110 patients with first spontaneous pregnancy in 6–9 weeks. 75 pregnant women with a history of grade 1 adenomyosis were divided into two groups: group 1 comprised 43 patients with a threatened miscarriage, group 2 included 32 patients without a threat of pregnancy termination. Group 3 (control) included 35 pregnant women without a burdened history with a physiological pregnancy course. The cytokine profile of peripheral blood and cervical mucus was studied, as well as the level of LL-37 (cathelicidin) antimicrobial peptide.Results. A pro-inflammatory shift of the cytokine balance as well as increased pro-angiogenic activity, determined by the VEGF-R2 / VEGF-A ratio, were observed in pregnant women with grade 1 adenomyosis during a physiologically ongoing pregnancy in the 1st trimester. A threatened miscarriage in the presence of adenomyosis is accompanied by statistically significant changes in the cytokine profile, a decrease in pro-angiogenic activity and an increased level of LL-37 in cervical mucus.Conclusion. Pregnancy with adenomyosis of the 1st degree, in the absence of other risk factors, is complicated by a threatened miscarriage in more than half of cases. The revealed clinical and immunological aspects of early reproductive losses require further in-depth study, since these signs may indicate the presence of chronic endometritis in patients with adenomyosis not determined by non-invasive research methods.

Ефективність лікування безпліддя методом запліднення in vitro за наявності хронічного ендометриту

Ефективність лікування безпліддя методом запліднення in vitro за наявності хронічного ендометриту

MORPHOLOGICAL FEATURES OF UTERINE POLYPS IN FEMALES OF REPRODUCTIVE AGE

According to modern views based on evidence-based medicine, the concept of "poly-endometrium" is defined as a benign, exophytic nodophilic formation of the uterine mucus that consists of glands and stroma, predominantly fibrous, containing a "tangle" of thick-walled blood vessels.&#x0D; The aim of the study – to learn the morphological features of tissues of polyps of the body of the uterus and endometrium with the establishment of the role of inflammatory factor in the pathogenesis of hyperproliferative changes in women of reproductive age.&#x0D; Materials and Methods. The article presents the results of a survey of 62 patients of reproductive age with polyps in the body of the uterus. The presence of the glandular component in 79.03 % of cases, fibrotic polyps – 12.9 %, and micro-polyps – 8.06 % were determined, respectively. The combination of polyps with non-atypical endometrial hyperplasia was detected in 80 % of patients with micro-polyposis, in 63.6 % of women – with glandular-cystic polyps of the uterine body, in 44.4 % of the examined – with glandular-fibrous endometrial polyps and in 37.5 % of patients – with fibrous polyps. Immunohistochemically, CD138 expression was detected both in the tissues of the polyps of the uterus and adjacent endometrial tissues in 43.5 % of cases, which became a marker of the chronic endometritis in the part of the surveyed, which formed the basis of the pathogenetic approaches in the treatment of such a pathology. For processing data standard procedures using Microsoft Excel were used. The research was conducted in the Laboratory of Pathomorphology of the Department of O. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the National Academy of Medical Sciences of Ukraine, head of the department – Corresponding Member of the National Academy of Medical Sciences of Ukraine, Professor T. Zadorozhna.&#x0D; Results and Discussion. In clinical analysis of complaints of polyps of the body of the uterus, clinical manifestations in the form of menstrual cord disturbance were 13 (20.97 %) patients, in 11 (17.74 %) patients there were no complaints about the desired pregnancy, at the same time as 38 (61.29 %) women were asked to carry out a preventive examination, which does not contradict the results of other researchers. During the morphological study, we established the following features of the polyps of the body of the uterus in women of reproductive age: the most frequently tested polyps of the body of the uterus, which had the glandular component – in 49 (79.03 %) cases, of which the glandular-cystic structure was found in 22 (35.48 %) of patients, the glandular-fibrous structure was in 27 (43.55 %) patients, approximately the same values ​​were found in fibrous polyps of the body of the uterus – 8 (12.90 %) of women and micropolymers of endometrium – in 5 (8.06 %) cases respectively. We found that in all groups of patients with polyps in the body of the uterus, there were signs of non-atypical hyperplasia of the endometrium. It should be noted that, according to literature, endometrial polyps larger than 15 mm were associated with hyperplasia. The above data is an important indication that the unidirectional determination of the positive expression of the CD138 inflammatory marker, both in the tissue of the polyp of the uterus and in the endometrial tissue, indicates the unity of the inflammatory factor in the pathogenesis of hyperproliferative processes and proves the significant role of the inflammatory process in the development of its pathological conditions and justifies the necessity take into account this fact in approaches to the tactics of patient management.&#x0D; Conclusions. The results of the conducted morphological and immunohistochemical research indicate that the basis of the formation of polyps of the body of the uterus is the inflammatory process, which is confirmed morphologically with the presence of chronic endometritis and a positive reaction to CD138. The study of pathogenetic mechanisms for the formation of endometrial pathology is a key factor in the development of methods for correction of these pathological processes, which thus allows to increase the efficiency of treatment and preserve reproductive health.

Rehabilitation therapy as a component of the complex approach to the treatment of chronic forms the pelvic inflammatory disease in women

Issues of treatment and rehabilitation patients with pelvic's inflammatory diseases are still remain highly relevant, so relapses and chronic inflammation processes are worsen the prognosis for generative function in women, which is an important social and economic problem in modern time. Purpose of the study. Monitoring the effectiveness of therapeutic measures of rehabilitation step in chronic forms of this disease. Materials and methods. We examined 110 patients who handled to the clinic for women with complaints about the absence of pregnancy, of which a survey group was formed. The duration of pelvic inflammatory desiase (PID) in patients of the examination group did not exceed 2 years. The age of the patients was 25-35 years old. In patients of the examination group, according to clinical, laboratory and ultrasound ultrasound, laparoscopy, hysteroscopy and morphological findings, PID was verified including the presence of chronic endometritis and other endometrial pathology (for example, endometrial polyp, simple endometrial hyperplasia). Results. The rehabilitation stage of treatment (6 months) in patients with PID was aimed at restoring the morphofunctional potential of the tissue and eliminating the effects of secondary injuries, which include the restoration of hemodynamics and activity of the endometrial receptors. This stage of treatment is extremely important, especially for reproductive disorders. At this stage, the patients of the examination group were given hormone therapy and treatment with vasoactive drug (dipyridamole). The obtained results testified to the significance of the restoration of the vascular blood flow of the uterus and the functional layer of the endometrium. Conclusion. Rehabilitation therapy in patients with PID was primarily aimed at restoring the functional ability of the endometrium. Hormone therapy was a priority role, but at modern time, role of the vasoactive drugs that affect the blood flow in the uterus is emphasized. One of these drugs is dipyridamole, which contributes to the formation of collaterals (bypass paths) in ischemic zones. The results indicate that at the end of the 6-month rehabilitation phase, than of a three-layer endometrium was diagnosed (according to ultrasound on day 8-10 of the cycle) in 85 (77.27±4.00%) patients in the examination group.

Клінічне значення хронічного ендометриту у жінок зі зниженою відповіддю на стимуляцію яєчників у програмі екстракорпорального запліднення

The objective: determination of the frequency of detection, risk factors, diagnostic criteria for chronic endometritis in poor responders patients in ART cycles with the study of the effectiveness of the proposed regimens for the treatment of this pathological condition. Materials and methods. A clinical study of the diagnosis of chronic endometritis in in poor responders patients have been conducted to develop individual approaches to overcoming infertility in a given cohort of women, taking into account not only the ovarian reserve, but also the endometrial status, assessed by clinical, instrumental and laboratory research methods, for achievement of successful implantation and ongoing pregnancy. The control group of women included 93 patients with infertility, a normal ovarian response to stimulation and lack of criteria for bad defendants. Results. As a result of a study conducted in poor responders patients, there is a significant percentage of the presence of chronic endometritis, which greatly complicates the overcoming of infertility. Risk factors for the occurrence of this pathological condition are genital tract infections, surgical intervention, intrauterine manipulations. Diagnostic criteria for chronic endometritis in women with infertility are micropolips, stomach edema, local and diffuse congestion of the endometrium during hysteroscopic examination and high expression of the imunohistochemical marker CD-138. Conclusion. The treatment protocol of the first line of chronic endometritis – docxicillin 100 mg 2 times a day 14 days, neomycin sulfate 35 000 MU, polymyxin B sulfate 35 000 MU, nystatin 100 000 MU for 1 suppositirium 1 time per day for 10 days and diclofenac 100 mg rectally for 5 days – is effective in 67.5% of cases . In patients who are resistant to previous antibiotic therapy, the second line treatment regimen is – сefotaxime 2.0 i /v 1 time per day, gentamycin 80 mg 3 times a day in / m, metronidazol 100 ml per day i / v, and diclofenac 100 mg rectally once daily for 7 days – the effectiveness of the treatment of chronic endometritis reached 79.1% of the cases. Key words: chronic endometritis, infertility, poor responders, ART.