Endometrial Microbiota in Infertile Women With and Without Chronic Endometritis as Diagnosed Using a Quantitative and Reference Range-Based Method

Background: Chronic endometritis is a pathology of continuous and hidden inflammatory process characterized by the infiltration of plasma cells into the endometrial stroma. Transvaginal bi-dimensional ultrasonography is in need to be evaluated in prediction of chronic endometritis in women with delayed pregnancy or infertility as a non-invasive, cheap, acceptable, and safe tool of diagnosis. Previously, 3D ultrasonography had been described as a novel for diagnosis of chronic endometritis and correlation of the images with hysteroscopic view results. Objectives were to predict the presence of chronic endometritis in infertile women during their reproductive age through examination of the uterine cavity by 2D and 3D transvaginal sonography to elicit proposed ultrasonographic signs of endometritis.Methods: This observational prospective study took place at Shatby university hospital, Alexanderia universtiy and was done on two hundred infertile women. Women were assigned for ultrasonographic evaluation as a part of pre-treatment assessment. Detailed history was taken from all the patients included in the study. General examination and routine laboratory investigations were done according to hospital protocol. All patients were asked to do ultrasound examination immediately postmenstrual and at the time of ovulation. We used 2D transvaginal ultrasound to predict chronic endometritis, we searched for 1) presence of persistent endometrial focal or diffuse thickening postmenstrual, 2) presence of focal echogenic foci in the triple line endometrium during ovulation. The 3D ultrasonography was done as confirmatory examination. Office hysteroscopy as the main method for diagnosis of endometritis was performed to all patients either after menses if the first sign was detected or at the time of ovulation if the second sign was detected.Results: The combination of persistent endometrial shreds and/or endometrial focal thickening or echogenicity can significantly predict presence of endometritis as the sensitivity and specificity of the combination were 94.90 and 81.37, respectively.Conclusions: Bi-dimensional ultrasonography done to infertile women at 2 phases of the menstrual period can predict the presence of chronic endometritis as a subtle cause of infertility and might be an indication for hysteroscopic evaluation for these patients.

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Faculty Opinions recommendation of Abnormal pattern of lymphocyte subpopulations in the endometrium of infertile women with chronic endometritis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1160453.620816 ◽

2009 ◽

Author(s):

Raffaele Sciorsci ◽

Annalisa Rizzo

Keyword(s):

Lymphocyte Subpopulations ◽

Chronic Endometritis ◽

Infertile Women ◽

Abnormal Pattern

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Altered Transcriptional Regulation of Cytokines, Growth Factors, and Apoptotic Proteins in the Endometrium of Infertile Women with Chronic Endometritis

American Journal of Reproductive Immunology ◽

10.1111/aji.12076 ◽

2013 ◽

Vol 69 (5) ◽

pp. 509-517 ◽

Cited By ~ 41

Author(s):

Cinzia Di Pietro ◽

Ettore Cicinelli ◽

Maria R. Guglielmino ◽

Marco Ragusa ◽

Marco Farina ◽

...

Keyword(s):

Transcriptional Regulation ◽

Growth Factors ◽

Chronic Endometritis ◽

Infertile Women ◽

Apoptotic Proteins

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Clinical and Anamnestic, Immunological, Echographic, and Hysteroscopic Features of Chronic Endometritis Associated with Impaired Reproductive Function

Annals of the Russian academy of medical sciences ◽

10.15690/vramn927 ◽

2018 ◽

Vol 73 (1) ◽

pp. 5-15

Author(s):

A. I. Ishenko ◽

A. L. Unanyan ◽

E. A. Kogan ◽

T. A. Demura ◽

J. M. Kossovich

Keyword(s):

Immunohistochemical Analysis ◽

Reproductive Technologies ◽

Main Group ◽

Reproductive Age ◽

High Expression ◽

Control Group ◽

Women Of Reproductive Age ◽

Chronic Endometritis ◽

Infertile Women ◽

Subgroup Ii

Background: The widespread prevalence of infertility, the low effectiveness of assisted reproductive technologies (ART), and the high incidence of chronic endometritis (CE) in infertile women determine the relevance of the considered problem. The aim of the study was to determine the clinical and anamnestic, laboratory, and instrumental features of CE associated with infertility and unsuccessful IVF cycles in women of reproductive age. Materials and methods: The study enrollred 150 women of reproductive age with morphologically established CE (main group, n=120) and without CE (control group, n=30). A subgroup I of the main group included 64 patients with infertility and IVF failures, a subgroup II – 56 fertile women. In addition to anamnesis collection and identification of CE clinical features, all patients underwent infectious screening, immunological and immunohistochemical analysis, ultrasound examination of pelvic organs with dopplerometry, and office hysteroscopy. A comparative analysis of the data obtained from subgroups of the main group was conducted. Results: Histological study of endometrial pipelle-biopsy specimens on the 7−10th day of the cycle revealed CE in all patients of the main group. We found prevalence of mean duration of CE in the subgroup I relative to subgroup II ― 5.5±0.06 years and 2.4±0.07 years, respectively (p0.001). Infectious screening showed that 58 (90.6%) patients of the I subgroup had sterile endometrial seeding which was 16.9 times higher than in subgroup II (p0.0001). Immunological analysis determined the presence of AEAT in all patients of the subgroup I, 43 of which (67.2%) were above 265 U/ml, while 51 (91.1%) of subgroup II had no AEAT (p0.001). Immunohistochemical analysis of the endometrium on the 18th−24th day of the cycle established high expression of CD16 , CD20 , CD56 , and HLA-DRII in 58 (90.6%) patients of the subgroup I, whereas in 54 patients (96.4%) of II subgroup high expression of CD16 and CD20 with low amount of CD56- and HLA-DRII-positive cells was registered (p0.001). We determined prognostically significant clinical and anamnestic risk factors predisposing to the development of infertility in patients with CE (p0,05). We revealed certain echographic, dopplerometric, and hysteroscopic criteria of CE demonstrating the critical disruption of endometrial receptivity in infertile women. Conclusion: Most patients (90.6%) with infertility had autoimmune component of CE characterized by prolonged (more than 5 years) course, high serum level of AEAT, sterile endometrial crops, and high expression of inflammation markers CD16 , CD20 , CD56 and HLA-DRII .

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