Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link

Cicinelli, Ettore; Trojano, Giuseppe; Mastromauro, Marcella; Vimercati, Antonella; Marinaccio, Marco; Mitola, Paola Carmela; Resta, Leonardo; Ziegler, Dominique de

doi:10.1016/j.fertnstert.2017.05.016

Cited by 104 publications

(80 citation statements)

References 42 publications

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“…From these recent findings, it is presumed that a worsening of IUMC and a higher occurrence of endometritis could occur in women with endometriosis after GnRHa treatment. These findings of the association between endometriosis and chronic endometriosis were supported by two recently published reports …”

Section: Intrauterine Microbial Colonization After Treatment With An supporting

confidence: 85%

Bacterial contamination hypothesis: a new concept in endometriosis

Khan

Fujishita

Hiraki

et al. 2018

Reprod Medicine & Biology

114

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BackgroundEndometriosis is a multifactorial disease that mainly affects women of reproductive age. The exact pathogenesis of this disease is still debatable. The role of bacterial endotoxin (lipopolysaccharide, LPS) and Toll‐like receptor 4 (TLR4) in endometriosis were investigated and the possible source of endotoxin in the pelvic environment was examined.MethodsThe limulus amoebocyte lysate test was used to measure the endotoxin levels in the menstrual fluid and peritoneal fluid and their potential role in the growth of endometriosis was investigated. Menstrual blood and endometrial samples were cultured for the presence of microbes. The effect of gonadotrophin‐releasing hormone agonist (GnRHa) treatment on intrauterine microbial colonization (IUMC) and the occurrence of endometritis was investigated.Main findings (Results)Lipopolysaccharide regulates the pro‐inflammatory response in the pelvis and growth of endometriosis via the LPS/TLR4 cascade. The menstrual blood was highly contaminated with Escherichea coli and the endometrial samples were colonized with other microbes. A cross‐talk between inflammation and ovarian steroids or the stress reaction also was observed in the pelvis. Treatment with GnRHa further worsens intrauterine microbial colonization, with the consequent occurrence of endometritis in women with endometriosis.ConclusionFor the first time, a new concept called the “bacterial contamination hypothesis” is proposed in endometriosis. This study's findings of IUMC in women with endometriosis could hold new therapeutic potential in addition to the conventional estrogen‐suppressing agent.

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Section: Intrauterine Microbial Colonization After Treatment With An supporting

confidence: 85%

Bacterial contamination hypothesis: a new concept in endometriosis

Khan

Fujishita

Hiraki

et al. 2018

Reprod Medicine & Biology

114

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“…We considered the characteristics of eutopic endometrium in endometriosis and reported the association between endometriosis and CE in patients with benign gynecologic disease for the first time. This association was also shown in infertile patients …”

Section: Epidemiology and Clinical Featuressupporting

confidence: 70%

“…This association was also shown in infertile patients. 69 The relationship between CE and infertility has recently emerged as an important clinical challenge. In fact, 2.8-56.8% of infertile women, 15,70-72 14-67.5% of women with RIF, 8,30,72-75 and 9.3-67.6% of women with recurrent pregnancy loss are diagnosed with CE.…”

Section: Epidemiology and Clinical Featuresmentioning

confidence: 99%

Review: Chronic endometritis and its effect on reproduction

Kimura

Takebayashi

Ishida

et al. 2019

J of Obstet and Gynaecol

196

144

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Aim Chronic endometritis (CE) is a disease of continuous and subtle inflammation characterized by the infiltration of plasma cells in the endometrial stromal area. Although the clinical significance of CE has been thought in clinical practice for a long time because it is either asymptomatic or presents with subtle symptoms, recent studies have shown the potential adverse effects of CE on fertility. In the present review, we focus on the concept, diagnosis, etiology, pathophysiology, diagnosis, impact on reproduction and treatment for it to understand CE. Methods The published articles were reviewed. Results The prevalence of CE has been found to be 2.8–56.8% in infertile women, 14–67.5% in women with recurrent implantation failure (RIF), and 9.3–67.6% in women with recurrent pregnancy loss. Microorganisms are thought to be a main cause of CE, since antibiotic treatment has been reported to be an effective therapy for CE. Common bacteria are frequently detected in the uterine cavity of CE patients by microbial culture. In CE endometrium, the prevalence of immune cells and decidualization has been reported to be modified, and these modifications are thought to adversely affect fertility. The gold standard for the diagnosis of CE is the histological detection of plasma cells in the stromal area of the endometrium in endometrial specimens, although universally accepted criteria for the diagnosis of CE have not been determined. The treatment currently thought to be most effective for the recovery of fertility in CE is administration of oral antibiotics. Patients whose CE has been cured have been reported to have a higher ongoing pregnancy rate, clinical pregnancy rate, and implantation rate compared with patients with persistent CE. Conclusion CE greatly affects implantation and impairs fertility. Antibiotic administration is an effective therapeutic option. Pregnancy rate in in vitro fertilization is improved when CE is cured by antibiotic.

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“…Inflammatory changes that originated in the eutopic endometrium also may affect the cells that backflow through the tubes, thus playing a role in initiating and/or perpetuating the inflammatory process that prevails in the pelvic cavity. We recently reported a markedly increased incidence of chronic endometritis (CE) present in >40% of women with endometriosis (5). This observation supports the hypothesis that pelvic inflammation might originate in the uterus, at least in certain cases.…”

Section: A Toxic Pelvic Cavitysupporting

confidence: 64%