Impact of chronic endometritis on endometrial receptivity analysis results and pregnancy outcomes

Abstract

Background The aim of this study is to evaluate the relationship between chronic endometritis (CE) and a personalized window of implantation (WOI), identified by results of endometrial receptivity analysis (ERA), and pregnancy outcomes following embryo transfer (ET) based on the ERA outcomes. Methods The single‐center, cross‐sectional study was designed. The study population consisted of 101 infertile women who underwent endometrial sampling between June 2018 and February 2020. We recruited 88 patients who underwent ERA testing and immunohistochemistry of the plasma cell marker CD138 to diagnose CE within 3 months of testing. Subjects were divided into three groups as follows: 33 without CE (non‐CE group); 19 with untreated CE at ERA testing (CE group); and 36 successfully treated for CE before ERA testing (cured‐CE group). CE diagnosis was defined as ≥5 CD138‐positive plasma cells per 10 random stromal areas at ×400 magnification. Results In non‐CE, CE, and cured‐CE groups, the numbers of CD138‐positive cells were 0.7 ± 1.0, 28.5 ± 30.4, and 1.3 ± 1.3, respectively (p < .001). The rates of “receptive” endometrium in non‐CE and cured‐CE groups were 57.6% (19 women) and 50.0% (18 women), respectively; however, in the CE group, this rate was significantly lower than the other two groups (p = .009) at only 15.8% (3 women). After CE were treated prior or posterior to the ERA test in cured‐CE or CE groups, the clinical pregnancy rates at the first ET in non‐CE, CE, and cured‐CE groups were 77.8% (21/27 cycles), 22.2% (4/18 cycles), and 51.7% (15/29 cycles), respectively (p < 0.001). Conclusion CE had detrimental effects on the individual WOI, leading to embryo–endometrial asynchrony; therefore, diagnosis and treatment of CE should be done before ERA testing.

Extracellular superoxide produced by Enterococcus faecalis reduces endometrial receptivity via inflammatory injury

“…The interaction of these molecular markers leads to decidualization, receptive endometrial changes, embryo implantation, and blastocyst differentiation. Moreover, recent studies have shown that CE is associated with decreased expression of endometrial receptivity markers, and may adversely affect endometrial decidualization and the formation of optimal window of implantation 2 . As shown in this study, superoxide‐producing E .…”

“…Among women diagnosed with unexplained recurrent miscarriage or repeated implantation failure, the prevalence of CE can be as high as 66% 14 . In the IVF cycle, pregnancy outcomes can be significantly improved when patients recovered from CE 2 …”

“…Endometritis induces apoptosis and detachment of endometrial epithelial cells, eventually, leading to infertility. In addition, recent studies have shown that CE is associated with decreased expression of genes related to endometrial receptivity and decidualization, which may cause adverse effects on endometrial decidualization and formation of optimal window of implantation 2 …”

Investigating dual drug loaded PLGA nanocarriers for improved efficacy in endometritis therapeutics

“…The pathway via which PLGA nanomaterials have reformed delivery of drugs has been discussed in several studies [17,22]. In addition, amoxicillin and vancomycin have been reported to be used for treatment of chronic endometritis although individually [23].…”

Novel approaches to the management of recurrent pregnancy loss: The OPTIMUM (OPtimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu) treatment strategy

“…To analyze the efficacy of the OPTIMUM treatment strategy, 100 pregnancies in 90 women in the OPTIMUM group and 46 pregnancies in 41 women in the control group were recruited Our treatment protocol for CE without intrauterine disorders was described previously. 38 Women underwent endometrial sampling during the luteal phase. When CE was diagnosed, patients received oral doxycycline (Vibramycin ® tablets; Pfizer Japan Inc., Tokyo, Japan), 100 mg twice a day for 2 weeks as the first choice.…”