scholarly journals Chronic endometritis in in vitro fertilization failure patients

2020 ◽  
Vol 3 (2) ◽  
pp. 175-181
Author(s):  
Elnashar Afaf T ◽  
Sabry Mohamed
Keyword(s):  
Plasma Cells ◽  
Abnormal Uterine Bleeding ◽  
Inflammatory Cells ◽  
Endometrial Biopsy ◽  
Assisted Reproduction Technique ◽  
Chronic Endometritis ◽  
Vitro Fertilization ◽  
Asymptomatic Patients ◽  
Trial Failure

Introduction: Chronic endometritis (CE) is a common cause of infertility in asymptomatic patients and its diagnosis and treatments improved assisted reproduction technique outcome in most of the specialized centers. Diagnosis of CE in endometrial biopsy by Hematoxylin and Eosin (H&E) stain is hard to identify chronic inflammatory cells from the stroma and the use of plasma cells-specific stains is helpful. Aim of the work: Evaluation of the use of CD138 in the identification of plasma cells in endometrial biopsy of patients with previous IVF trial failure. Material and methods: Hysteroscopic and curettage endometrial biopsies from fifty-five females with previous IVF trial failure were stained with H&E and CD138 immunostaining for detection of plasma cells. Results: Plasma cells were identified in 52.7% of cases by H&E and in 6/55 by CD138 immunostaining. CD138 is more sensitive in detecting plasma cells in endometrial biopsy than H&E stain. There was a significant statistical correlation between CE and abnormal uterine bleeding, abortion and primary infertility (p > 0.5). Conclusion: Diagnosis of CE is helpful in infertility patients with IVF trial failure to improve the outcome of the maneuver. CD138 is more sensitive for plasma cells specially in endometrial biopsies than H&E.

Routine Syndecan-1 Immunohistochemistry Aids in the Diagnosis of Chronic Endometritis

2004 ◽  
Vol 128 (9) ◽  
pp. 1000-1003 ◽  
Author(s):  
Ilene B. Bayer-Garner ◽  
Jennifer A. Nickell ◽  
Soheila Korourian
Keyword(s):  
Plasma Cells ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Endometrial Polyp ◽  
Chronic Endometritis ◽  
Underlying Malignancy ◽  
Proliferative Endometrium ◽  
Exogenous Progesterone ◽  
Secretory Endometrium

Abstract Context.—Chronic endometritis is reportedly observed in 3% to 10% of women undergoing endometrial biopsy for abnormal uterine bleeding. The diagnosis of chronic endometritis rests on the identification of the plasma cells. Their identification may be obscured by a mononuclear cell infiltrate, plasmacytoid stromal cells, abundant stromal mitoses, a pronounced predecidual reaction in late secretory endometrium, menstrual features, or secondary changes due to exogenous progesterone treatment prior to the biopsy. Syndecan-1 is a proteoglycan that is found on the cell surface of plasma cells and keratinocytes. Immunohistochemistry stains for this antibody may facilitate diagnosis of chronic endometritis. Objective.—To determine whether or not routine syndecan-1 immunohistochemistry will aid in the diagnosis of chronic endometritis. Design.—Immunohistochemistry stains for syndecan-1 were performed on 3 levels of 47 endometrial biopsies from patients with abnormal uterine bleeding. None of the patients had endometrial hyperplasia or an underlying malignancy. Clinical correlation and follow-up was attempted in 20 cases that showed evidence of plasma cells by syndecan-1 by immunohistochemistry. Results.—Plasma cells were identified in 20 cases, 7 of which were initially diagnosed as chronic endometritis. The remaining 13 positive cases were diagnosed as tubal metaplasia (1), secretory endometrium (4), proliferative endometrium (4), menstrual endometrium (1), endometrial polyp (1), secretory endometrium with endometrial polyp (1), and endometrial polyp with exogenous hormone effect (1) based on the original hematoxylin-eosin section. Conclusions.—Syndecan-1 may be a useful adjunct in the diagnosis of chronic endometritis. Approximately half of the cases of chronic endometritis responded to an antibiotic regime; thus, this diagnosis is important and may potentially obviate the need for surgical intervention.

scholarly journals Evaluation of Endometrium for Chronic Endometritis by Using Syndecan-1 in Abnormal Uterine Bleeding

2012 ◽  
Vol 4 (02) ◽  
pp. 069-073 ◽  
Author(s):  
Vidyavathi Kannar ◽  
Harendra Kumar Malligere Lingaiah ◽  
Venigalla Sunita
Keyword(s):  
Plasma Cells ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Endometrial Polyps ◽  
Chronic Endometritis ◽  
Proliferative Endometrium ◽  
Stromal Edema ◽  
Clinically Significant ◽  
Mononuclear Infiltrate

ABSTRACT Context: Chronic endometritis is a condition observed in 3-10% of women with abnormal uterine bleeding (AUB). Diagnosis depends upon the histological detection of plasma cells within the inflammatory infiltrate in the endometrium. Plasma cells on H and E may be obscured by a mononuclear infiltrate, plasmacytoid stromal cells, abundant stromal mitosis, a pronounced predecidual reaction, menstrual features or secondary changes due to exogenous progesterone treatment prior to biopsy. Aims: The objective of this study was to determine utility of syndecan-1 in diagnosis of chronic endometritis in patients with AUB, and to see if any of the secondary histologic features in endometrial biopsy, correlated with the presence of plasma cells on immunohistochemistry (IHC). Materials and Methods: Fifty endometrial biopsies with a clinical diagnosis of AUB were taken. Endometrium in proliferative phase, secretory phase, endometrial polyps, and disordered proliferative endometrium were studied for the presence of plasma cells. IHC was done using syndecan-1. The secondary histologic features of chronic endometritis like gland architectural irregularity, spindled stroma, stromal edema and hemorrhage with the presence of plasma cells was statistically analysed. Values of P < 0.05 were considered as significant. Results: Plasma cells were seen in 11 (69%) of DPE, 8 (66%) of PEB, and 1 (7%) of normal proliferative endometrium and in 2 (40%) of secretory endometrium. Presence of stromal breakdown showed a significant association with plasma cells (P = 0.02) whereas gland architecture irregularity (P = 0.28), stromal edema (P = 0.71) and spindled stromal (P = 0.72) did not show a significant association. Conclusions: Plasma cells were significantly present in AUB patients. Syndecan-1 maybe helpful in unusual cases, where chronic endometritis is suspected as the cause of clinically significant ongoing abnormal bleeding.

scholarly journals CHRONIC ENDOMETRITIS AS A FACTOR OF FAILURE ATTEMPT IN ASSISTED REPRODUCTIVE TECHNOLOGIES

2019 ◽  
pp. 13-21
Author(s):  
O. V. Onysko ◽  
О. О. Korchynska ◽  
Stefania Andrashchikova ◽  
Sylvia Zhultakova ◽  
Alena Shlosserova
Keyword(s):  
Plasma Cells ◽  
Assisted Reproductive Technologies ◽  
Proteolytic Enzymes ◽  
Uterine Cavity ◽  
Reproductive Function ◽  
Reproductive Technologies ◽  
Careful Study ◽  
Chronic Endometritis ◽  
Vitro Fertilization

Increase in frequency of disorders of women's reproductive function justifies a careful study of the underlying pathological processes. In recent years, increased attention in solving fertility problems is paid to endometrial pathology when chronic endometritis plays an important role. Current worksarefeeding an in-depth study of the etiology and pathogenesis of chronic endometritis. However, results of research pose new questions with an imaginary comprehensive study of this problem. Chronic endometritis is one of the causes of infertility and may play a role in certain complications of pregnancy and childbirth (30.3 % in patients with repeated failures of in vitro fertilization, 9.3 % with recurrent miscarriages, 9.8 % in infertility). Clinically, chronic endometritis is often asymptomatic or accompanied by nonspecific symptoms such as pelvic pain, dyspareunia, abnormal uterine bleeding, and discharges. Previously, scientists considered the uterine cavity as a sterile container. But a team of Spanish scientists sought to test for the presence of intrauterine microflora, which differs from the vaginal. As a result, the study of endometrial fluid and vaginal samples from the same patients revealed different bacterial compositions. Microflora in the intrauterine fluid was classified as Lactobacillus, and women with non-lactobacillary flora of the endometrium had a significantly lower frequency of implantation. At the initial stage of endometrial inflammation is an activation of neutrophils and macrophages, increased cytokines synthesis, extracellular matrix degradation by proteolytic enzymes. Disorders of microcirculation and sclerotic processes in the area of ​​injury lead to the ischemia and tissue hypoxia, which activates the processes of sclerosis and angiogenesis. Chronization of the process increases the expression of chemokines and adhesion molecules, that is lead to migration of B-lymphocytes from the bloodstream and their differentiation into plasma cells, increases the activity of matrix metalloproteinases, changes local expression of estrogen and progesterone receptors. Lack of a pronounced specific clinical picture of chronic endometritis, its later detection causes impaired reproductive function. Untimely diagnosis and treatment of chronic endometritis has significant consequences in terms of the possibility of implantation of a fertilized egg in the programs of assisted reproductive technologies.

scholarly journals Introducing intrauterine antibiotic infusion as a novel approach in effectively treating chronic endometritis and restoring reproductive dynamics: a randomized pilot study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Konstantinos Pantos ◽  
Mara Simopoulou ◽  
Evangelos Maziotis ◽  
Anna Rapani ◽  
Sokratis Grigoriadis ◽  
...  
Keyword(s):  
Fertility Restoration ◽  
Statistical Significance ◽  
Antibiotic Administration ◽  
Oral Antibiotic ◽  
Treatment Rate ◽  
Chronic Endometritis ◽  
Vitro Fertilization ◽  
Significant Difference ◽  
Antibiotic Infusion

AbstractThe chronic nature of Chronic Endometritis (CE) along with the challenging management and infertility entailed, call for cutting-edge therapeutic approaches. This study introduces the novel treatment of intrauterine antibiotic infusion (IAI) combined with oral antibiotic administration (OAA), and it assesses respective performance against the gold standard treatment of OAA. Data sourced herein reports on treatment efficiency and fertility restoration for both patients aiming to conceive naturally or via In Vitro fertilization. Eighty CE patients, 40 presenting with recurrent implantation failure, and 40 with recurrent pregnancy loss, were enrolled in the IVF and the natural conception arm respectively. Treatment was subjected to randomization. Effectively treated patients proceeded with either a single IVF cycle or were invited to conceive naturally over a 6-month period. Combination of IAI and OAA provided a statistically significant enhanced effectiveness treatment rate (RR 1.40; 95%CI 1.07–1.82; p = 0.01). No statistically significant difference was observed regarding the side-effects rate (RR 1.33; 95%CI 0.80–2.22; p = 0.52). No statistically significant difference was observed for either arm regarding live-birth rate. Following an intention-to-treat analysis, employment of IAI corresponds to improved clinical pregnancy rate-albeit not reaching statistical significance. In conclusion, complimentary implementation of IAI could provide a statistically significant enhanced clinical treatment outcome.

The scattered puzzle effect: implantation disorders in chronic endometritis

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 93-100
Author(s):  
Victor E. Radzinsky ◽  
Mekan R. Orazov ◽  
Liliia R. Toktar ◽  
Liudmila M. Mihaleva ◽  
Pavel A. Semenov ◽  
...  
Keyword(s):  
Uterine Cavity ◽  
Special Role ◽  
Inadequate Response ◽  
Chronic Endometritis ◽  
Vitro Fertilization ◽  
Endometrial Cells ◽  
Adverse Pregnancy ◽  
Relationship Of

Chronic endometritis (CE) is defined as a state of inflammation localized in the endometrium, accompanied by edema, dissociated maturation of epithelial cells and fibroblasts, increased stromal density and the presence of plasma cell infiltrate in it. The connection between chronic inflammation in the endometrium and infertility deserves special attention. Inadequate response of immunocompetent endometrial cells, including impaired synthesis of proinflammatory cytokines, dysreceptiveness, disorders of proliferation and differentiation processes are the main links in the formation of infertility in patients with CE. Despite the fact that the presence of a normocenosis of the uterine cavity today is not in doubt this is a physiological norm, persistent bacterial infection of the endometrium is still called the main etiopathogenetic factor of CE and, therefore, the main point of application of therapeutic agents. Nevertheless, a number of works have emphasized the special role of not bacterial, but viral etiology of endometritis, especially in the context of infertility developing against this background. It seems that the role of viral endometrial infection in adverse pregnancy outcomes and in vitro fertilization programs is underestimated. Further research is needed to clarify the relationship of viral infection as a trigger of implantation failure in infertile women with CE.

Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization

2010 ◽  
Vol 93 (2) ◽  
pp. 437-441 ◽  
Author(s):  
Erika B. Johnston-MacAnanny ◽  
Janice Hartnett ◽  
Lawrence L. Engmann ◽  
John C. Nulsen ◽  
M. Melinda Sanders ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Implantation Failure ◽  
Recurrent Implantation Failure ◽  
Chronic Endometritis ◽  
Vitro Fertilization ◽  
Frequent Finding

scholarly journals Efecto De La Estimulación Endometrial En La Tasa De Exito En Pacientes Sometidas A Fertilización In Vitro [Effect Of Endometrial Stimulation On Success Rate In Patients Submitted To In Vitro Fertilization ]

2020 ◽  
Vol 24 (2) ◽  
Author(s):  
Lorna M Frazer Moreira ◽  
Felipe A Morales Martinez ◽  
María E. Monrreal Alanís ◽  
Otto H. Valdés Martinez ◽  
Cesar D. Castro Reyes ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Success Rate ◽  
Endometrial Biopsy ◽  
Clinical Pregnancy ◽  
Vitro Fertilization ◽  
The Third ◽  
Endometrial Injury ◽  
Group 2 ◽  
Vitro Effect

<h1><em>Resumen </em></h1><p><em>Introducción</em>: A pesar de los avances en las técnicas de reproducción asistida, la tasa de éxito en fertilización in vitro (FIV) sigue siendo modesta. La lesión endometrial, mediante histeroscopía o biopsia, previo a un ciclo de FIV, ha sido propuesta como una técnica que aumenta la probabilidad de implantación exitosa y embarazo en mujeres sometidas a FIV. <em>Objetivo</em>: Estudiar el efecto de la estimulación endometrial en la tasa de éxito de FIV. <em>Métodos</em>: Se realizó un estudio unicéntrico observacional, en pacientes sometidas a su primer ciclo de FIV. Se incluyeron mujeres entre las edades de 18-40 años que planeaban someterse a FIV con sus propios ovocitos sin exposición reciente a procedimientos disruptivos uterinos. Las pacientes elegibles se dividieron en 3 grupos. El primer grupo incluyó las que se sometieron a una histeroscopía diagnóstica previa a su ciclo de FIV, el segundo grupo incluyó aquellas que se sometieron a biopsia endometrial con cánula de Pipelle previo al ciclo de FIV y el tercer grupo incluyó a las pacientes sin intervención endometrial. <em>Resultados</em>: Se estudiaron un total de 68 pacientes (10 en el grupo 1, 27 en el grupo 2 y 31 en el grupo 3). La tasa de embarazo clínico fue estadísticamente similar en los tres grupos (33.3% para el primer grupo, 15.7% para el segundo y 16.6% para el tercero, p = 0.93). <em>Conclusión</em>: La estimulación endometrial antes del primer ciclo de FIV no ofreció beneficios adicionales en relación con implantación exitosa y/o tasas clínicas de embarazo. </p><p align="left">Palabras clave: lesión endometrial, fertilización in vitro, implantación, infertilidad, nacido vivo</p><p align="left"> </p><h1>Abstract</h1><p><em>Background</em>: Despite advances in assisted reproduction techniques, the in vitro fertilization (IVF) success rate still remains modest. Endometrial injury, through hysteroscopy or biopsy, prior to an IVF cycle, has been proposed as a technique that increases the likelihood of successful implantation and pregnancy in women undergoing IVF. <em>Aim and Objective</em>: To study the effect of endometrial stimulation on the success rate of IVF. <em>Methods</em>: An ambispective observational unicentric study was conducted in patients undergoing their first IVF cycle. Women between the ages of 18-40 who planned to undergo IVF with their own oocytes without recent exposure to uterine disruptive procedures were included. Eligible patients were divided into 3 groups. The first group included those who underwent a diagnostic hysteroscopy prior to their IVF cycle, the second group included those who underwent endometrial biopsy with a Pipelle cannula prior to the IVF cycle and the third group included patients without endometrial intervention. <em>Results</em>: A total of 68 patients were studied (10 in group 1, 27 in group 2 and 31 in group 3). The clinical pregnancy rate was statistically similar in the three groups (33.3% for the first group, 15.7% for the second group and 16.6% for the third group, p = 0.93). <em>Conclusion</em>: Endometrial stimulation before the first IVF cycle did not offer additional benefits in relation to successful implantation and / or clinical pregnancy rates</p><p align="left">Keywords: endometrial injury, in vitro fertilization, implantation, infertility, live birth</p>*****

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