Antibiotic therapy versus no treatment for chronic endometritis: a case-control study

Cicinelli, Ettore; Resta, Leonardo; Loizzi, Vera; Pinto, Vincenzo; Santarsiero, Carla Mariaflavia; Cicinelli, Rossana; Greco, Pantaleo; Vitagliano, Amerigo

doi:10.1016/j.fertnstert.2021.01.018

Cited by 46 publications

(43 citation statements)

References 24 publications

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“…In this regard, recent studies raised important questions about the clinical meaningfulness of < 5 endometrial plasma cells per high-power field in women suffering from infertility. However, these results are still not conclusive and a precise cutoff of plasma cells for performing CE diagnosis has not been established yet [32][33][34].…”

Section: Study Limitationsmentioning

confidence: 99%

MUM-1 immunohistochemistry has high accuracy and reliability in the diagnosis of chronic endometritis: a multi-centre comparative study with CD-138 immunostaining

Cicinelli

Haimovich

Ziegler

et al. 2021

J Assist Reprod Genet

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Purpose The current gold standard for chronic endometritis (CE) diagnosis is immunohistochemistry (IHC) for CD-138. However, IHC for CD-138 is not exempt from diagnostic limitations. The aim of our study was to evaluate the reliability and accuracy of MUM-1 IHC, as compared with CD-138. Methods This is a multi-centre, retrospective, observational study, which included three tertiary hysteroscopic centres in university teaching hospitals. One hundred ninety-three consecutive women of reproductive age were referred to our hysteroscopy services due to infertility, recurrent miscarriage, abnormal uterine bleeding, endometrial polyps or myomas. All women underwent hysteroscopy plus endometrial biopsy. Endometrial samples were analysed through histology, CD138 and MUM-1 IHC. The primary outcome was to evaluate the diagnostic accuracy of MUM-1 IHC for CE, as compared with CD-138 IHC. Results Sensitivity and specificity of CD-138 and MUM-1 IHC were respectively 89.13%, 79.59% versus 93.48% and 85.03%. The overall diagnostic accuracy of MUM-1 and CD-138 IHC were similar (AUC = 0.893 vs AUC = 0.844). The intercorrelation coefficient for single measurements was high between the two techniques (ICC = 0.831, 0.761-0.881 95%CI). However, among CE positive women, MUM-1 allowed the identification of higher number of plasma cells/hpf than .80] vs 5.05 [SD 3.37]; p = 0.017). Additionally, MUM-1 showed a higher inter-observer agreement as compared to CD-138. Conclusion IHC for MUM-1 and CD-138 showed a similar accuracy for detecting endometrial stromal plasma cells. Notably, MUM-1 showed higher reliability in the paired comparison of the individual samples than CD-138. Thus, MUM-1 may represent a novel, promising add-on technique for the diagnosis of CE.

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Section: Study Limitationsmentioning

confidence: 99%

MUM-1 immunohistochemistry has high accuracy and reliability in the diagnosis of chronic endometritis: a multi-centre comparative study with CD-138 immunostaining

Cicinelli

Haimovich

Ziegler

et al. 2021

J Assist Reprod Genet

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“…The relationship between chronic endometritis and reproductive outcomes such as recurrent miscarriage and recurrent implantation failure has been evaluated in previous studies, and some studies have been performed for use of antibiotic treatment. [ 22 23 24 25 26 ] However, there are limited studies about the relationship between chronic endometritis and uterine fibroids. As in this study authors assessed the association between chronic endometritis and uterine fibroids, further studies assessing the cause and effect relationships are recommended, so that if chronic endometritis is associated with uterine fibroids, medical treatment of chronic endometritis may reduce the rates of myomectomy and hysterectomy surgeries.…”

Section: Introductionmentioning

confidence: 99%

The association between chronic endometritis and uterine fibroids

Etezadi

Kabodmehri

Sharami

et al. 2022

Journal of Family Medicine and Primary Care

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Background: Some studies reported the association between fibroids with uterine inflammation. By considering this hypothesis, the formation and recurrence of uterine fibroids can be prevented by diagnosis and treatment of inflammation, and complications and costs can be reduced. This study aimed to evaluate the association between chronic endometritis and uterine fibroids in non-menopausal women. Materials and Methods: This prospective case-control study was performed on non-menopausal women referred to Al-Zahra Hospital in Rasht during April 2019-April 2020. Non- menopausal women of reproductive age (20-55 years old) with abnormal uterine bleeding who were candidates for hysteroscopy based on medical history and ultrasound reports were included in this study. The case group with fibroids were divided into two groups of intramural and subserosal myoma group and submucosal group based on the location of fibroids. The control group was patients with abnormal uterine bleeding complaints and no uterine fibroid. Endometrial specimens were examined by a pathologist for histological and immunochemistry assessments. In interpreting the results of endometrial biopsy, a positive result was indicated by the presence of one or more plasma cells per 10 high power field. Data were gathered by a form including age, parity, history of recurrent miscarriage, patient’s complaint (abnormal uterine bleeding), hysteroscopic results (submucosal myoma-polyp-normal), uterine histology (polyp, endometritis, and hyperplasia) and prevalence of chronic endometritis based on plasma cell in the biopsy. Data were analyzed by SPSS software version 21. Data were reported by descriptive statistics including number, percent, mean and standard deviation. The normality of quantitative data was assessed by the Kolmogorov- Smirnov test. Mann-Whitney U test, Chi-square and Fisher exact tests were used to compare groups and logistic regression was used to control the effect of confounders. Results: The incidence of chronic endometritis was 39% (38 out of 97) and a higher incidence of chronic endometritis was noted in the case group than the control group (46% vs. 31%), No significant difference was observed between the two groups ( P > 0.05). However, the incidence of chronic endometritis in women with submucosal myoma was higher than the intramural and subserosal groups (64% vs. 37%) ( P = 0.04). To control the effect of age on the rate of chronic endometritis in both groups, no significant effect was observed in logistic regression. Conclusions: The results showed the overall incidence of chronic endometritis was higher than previous studies and also the incidence was higher and more significant in women with submucosal myoma than in the intramural and subserosal group. As in this study, authors assessed the association between chronic endometritis and uterine fibroids, further studies assessing...

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“…micropolyps, focal/ diffuse hyperemia, hemorrhagic spots). In this respect, we previously had found considerable inconsistency between the diagnoses of CE achieved by CD-138 immunohistochemistry and those obtained by hysteroscopy (4).…”

mentioning

confidence: 97%

Consistent evidence on the detrimental role of severe chronic endometritis on in vitro fertilization outcome and the reproductive improvement after antibiotic therapy: on the other hand, mild chronic endometritis appears a more intricate matter

Cicinelli

Vitagliano

2021

Fertility and Sterility

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Antibiotic therapy versus no treatment for chronic endometritis: a case-control study

Cited by 46 publications

References 24 publications

MUM-1 immunohistochemistry has high accuracy and reliability in the diagnosis of chronic endometritis: a multi-centre comparative study with CD-138 immunostaining

MUM-1 immunohistochemistry has high accuracy and reliability in the diagnosis of chronic endometritis: a multi-centre comparative study with CD-138 immunostaining

The association between chronic endometritis and uterine fibroids

Consistent evidence on the detrimental role of severe chronic endometritis on in vitro fertilization outcome and the reproductive improvement after antibiotic therapy: on the other hand, mild chronic endometritis appears a more intricate matter

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