Chronic endometritis (CE) is a condition involving the breakdown of the peaceful co-existence between microorganisms and the host immune system in the endometrium. A majority of CE cases produce no noticeable signs or mild symptoms, and the prevalence rate of CE has been found to be approximately 10%. Gynecologists and pathologists often do not focus much clinical attention on CE due to the time-consuming microscopic examinations necessary to diagnose CE, its mild clinical manifestations, and the benign nature of the disease. However, the relationship between CE and infertility-related conditions such as repeated implantation failure and recurrent miscarriage has recently emerged as an area of inquiry. In this study, we reviewed the literature on the pathophysiology of CE and how it may be associated with infertility, as well as the literature regarding the diagnosis and treatment of CE. In addition, we discuss the value of hysteroscopic procedures in the diagnosis and treatment of CE.
PMID 28090456 28090456 DOI 10.5653/cerm.2016.43.4.185 10.5653/cerm.2016.43.4.185
Cite this article
Park, H. J., Kim, Y. S., Yoon, T. K., & Lee, W. S. (2016). Chronic endometritis and infertility. Clinical and experimental reproductive medicine, 43(4), 185-192. https://doi.org/10.5653/cerm.2016.43.4.185
Park HJ, Kim YS, Yoon TK, Lee WS. Chronic endometritis and infertility. Clin Exp Reprod Med. 2016;43(4):185-192. doi:10.5653/cerm.2016.43.4.185
Park, Hyun Jong, et al. "Chronic endometritis and infertility." Clinical and experimental reproductive medicine, vol. 43, no. 4, 2016, pp. 185-192.
Intrauterine insemination (IUI) is the first line treatment for conditions such as unexplained or mild male factor infertility. Endometrial thickness (EMT) is an important indicator for predicting pregnancy outcomes in in-vitro fertilization. However, published data about whether EMT has a predictive capacity for success in IUI is controversial, and most studies suggest that endometrial thickness is not associated with IUI success, which limits its use in IUI. This was a single center retrospective cohort study that included women undergoing IUI cycles from January 2007 to June 2021. We categorized EMT into thin (<7 mm), medium (7-14 mm), and thick (>14 mm) groups. For all IUI cycles, we computed adjusted odds ratios (aORs) and 95% confidence intervals (CIs) using Generalized Estimating Equation Regression Models. For first IUI cycles specifically, we applied both Inverse Propensity Score Weighted Regression Adjustment Models and Propensity Score Matching Analyses to compare fertility outcomes. Moreover, we computed the predicted probability of primary outcomes for continuous EMT in mm using restricted cubic splines, allowing for non-linear relationships. This cohort included 13103 IUI cycles involving 7609 women. Across all cycles, live birth rates were lower in the thin EMT group (11.0%) and higher in the thick EMT group (16.9%), compared to the medium EMT group (13.5%)-aOR 0.82 (95% CI 0.67-0.998) for thin EMT and aOR 1.22 (95% CI 1.02-1.45) for thick EMT. The results were consistent when analyzing first cycles only. Restricted cubic spline analysis revealed a linear positive gradient that suggests a progressive increase in live birth rates with increasing EMT. In natural or Letrozole with or without Human Menopausal Gonadotropin stimulated IUI cycles, EMT on trigger day is a significant predictor of live birth, with thin EMT associated with reduced success rates. EMT measurements could serve as a useful marker in IUI treatment.
This systematic review and meta-analysis aims to evaluate the impact of chronic endometritis (CE) and its therapy on in vitro fertilization (IVF) outcome. Additionally, we aim to investigate whether various degrees of CE severity may exert a different effect on IVF outcome. Ongoing-pregnancy rate/live-birth-rate (OPR/LBR), clinical-pregnancy rate (CPR), and miscarriage rate (MR) were calculated. A total number of 4145 patients (from ten studies) were included. Women with CE had lower OPR/LBR (OR 1.97, p = 0.02) and CPR (OR 2.28, p = 0.002) compared to those without CE. CE cure increased OPR/LBR (OR 5.33, p < 0.0001) and CPR (OR 3.64, p = 0.0001). IVF outcome was comparable between women with cured CE and those without CE (OPR/LBR, p = ns). Women with severe CE had lower OPR/LBR (OR 0.43, p = 0.003) and CPR (OR 0.40, p = 0.0007) compared to those mild CE. Mild CE showed no influence on the IVF outcome as compared to women without CE (OPR/LBR, p = ns). Based on this data analysis, CE significantly reduces OPR/LBR and CPR in women undergoing IVF. Importantly, CE resolution after antibiotic therapy may improves IVF outcome, leading to similar OPR/LBR and CPR as compared to unaffected patients. The negative effects of CE on IVF outcome may be restricted to severe disease, whereas mild CE may have no influence on IVF success.
Chronic endometritis (CE) and endometrial polyps (EPs) are common conditions in reproductive age women. CE is an infectious disorder of the endometrium characterized by signs of chronic inflammation at hysteroscopic and histological analyses. EPs are abnormal endometrial growths containing glands, stroma and blood vessels projecting from the lining of the uterus. During the last years, different authors have investigated the correlation between CE and EPs, with controversial results. The aim of this study was to summarize available evidence on the potential correlation between CE and EPs.
Systematic literature review and meta-analysis. Observational-studies were identified by searching electronic databases from their inception to September 2021. Only studies on pre-menopausal women were included. Statistical analysis was performed using MedCalc 16.4.3 (Ostend, Belgium) and Review Manager version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration). The summary measures were reported as pooled proportion or odds ratio (OR) with 95% confidence interval (CI). The primary outcome was to evaluate the prevalence of CE in women with EPs. The secondary outcome was to determine the prevalence of CD-138-positive EPs among EPs. Tertiary outcomes were to compare the prevalence of CE in women with EPs versus women with a non-polypoid endometrium and to compare the prevalence of CE in women with a single EP versus women with multiple EPs. Eight observational studies (n = 3225 patients) were included in quantitative synthesis. Pooled prevalence of CE among women with EPs was 51.35% (95% CI, 27.24-75.13%). Pooled proportion of CD-138-positive EPs among EPs was 70.73% (95% CI, 55.73-83.68%). Women with EPs showed higher prevalence of CE compared to women without EPs (OR 3.07, 95% CI 1.59-5.95). Women with ≥3 EPs had higher prevalence of CE then women with a single EP (OR 3.43, 95% CI 1.83-6.46). In pre-menopausal women, CE and EPs may have a dependent relationship and may represent two consequent steps of a common pathological process.
We herein summarise the evidence concerning the impact of sperm DNA fragmentation in various clinical infertility scenarios and the advances on sperm DNA fragmentation tests. The collected evidence was used to formulate 41 recommendations. Of these, 13 recommendations concern technical aspects of sperm DNA fragmentation testing, including pre-analytical information, clinical thresholds and interpretation of results. The remaining 28 recommendations relate to indications for sperm DNA fragmentation testing and clinical management. Clinical scenarios like varicocele, unexplained infertility, idiopathic infertility, recurrent pregnancy loss, intrauterine insemination, in vitro fertilisation/intracytoplasmic sperm injection, fertility counselling for men with infertility risk factors and sperm cryopreservation have been contemplated. The bulk evidence supporting the recommendations has increased in recent years, but it is still of moderate to low quality. This guideline provides clinicians with advice on best practices in sperm DNA fragmentation testing. Also, recommendations are provided on possible management strategies to overcome infertility related to sperm DNA fragmentation, based on the best available evidence. Lastly, we identified gaps in knowledge and opportunities for research and elaborated a list of recommendations to stimulate further investigation.