The application of low-frequency ultrasound for the comprehensive treatment and rehabilitation of the patients presenting with chronic endometritis

Abstract

The incidence of chronic endometritis remains rather high despite considerable progress in reproductive medicine including the advent of the new methods for assisted reproduction; the pregnancy rate after the treatment of this condition is still unacceptably low. It implies the necessity of the careful preparation of endometrium for the implantation of the embryo especially in women with a history of unsuccessful outcomes of the IVF treatment. It calls for the development of the efficient therapeutic modalities for the management of chronic endometritis and restoration of the normal reproductive function; their introduction into the therapeutic algorithm remains equally relevant. The characteristic features of chronic endometritis include blood circulatory disorders in the vessels of the uterus and in the pelvic vascular basin, changes of local immunity in the endometrium concomitant with the activation of cellular and humoral responses of inflammation in the form of enhanced leukocyte infiltration and increased production of cytokines. The long duration of such a process results in the development of fibrosis that, in its turn, leads to chronic tissue hypoxia, potentiation of inflammation, and disruption of decidualization that hampers successful implantation. The article shows the possibility of using low-intensity ultrasound for the treatment and rehabilitation of the patients presenting with chronic endometritis. The data concerning the primary biophysical processes developing in the tissues under the influence of ultrasound are discussed. The therapeutic effects and their underlying mechanisms and described. The physiotherapeutic treatment considerably improved vascular hemodynamics in the pelvic basin and produced trophotropic, defibrosing, and anti-inflammatory effects. The clinical data giving evidence of the high effectiveness of the application of intrauterine ultrasound cavitation provide a basis for the recommendation to include this physical factor in the existing algorithms for the pre-gravid preparation of the women presenting with disorders of the reproductive function and chronic endometritis.

The impact of chronic endometritis on endometrial fibrosis and reproductive prognosis in patients with moderate and severe intrauterine adhesions: a prospective cohort study

“…Major literature reports consider the following aspects: trauma, inflammation, fibrosis imbalance, decreased neovascularization, and changes in the expression of related cytokines (6). The characteristic features of CE include blood circulatory disorders in the vessels, changes of local immunity in the endometrium, and increased production of cytokines (28). It results in the development of fibrosis that, in turn, leads to chronic tissue hypoxia and potentiation of inflammation (28).…”

“…The characteristic features of CE include blood circulatory disorders in the vessels, changes of local immunity in the endometrium, and increased production of cytokines (28). It results in the development of fibrosis that, in turn, leads to chronic tissue hypoxia and potentiation of inflammation (28). Therefore, we hypothesized that CE may affect endometrial fibrosis by affecting the steady state of endometrial fibrosis in patients with IUAs.…”

Chronic endometritis positively correlates with the aggravation of intrauterine adhesions but has limited effects on reproductive prognosis with antibiotic application

“…This indicates that CE was associated with IUA severity. Blood circulatory disorders of vessels and increased secretion of some cytokines in endometrium were found in patients with CE 18 . The transforming growth factor‐β1/Smad signaling pathway is a classical signaling pathway for fibrosis 19–21 .…”

“…Blood circulatory disorders of vessels and increased secretion of some cytokines in endometrium were found in patients with CE. 18 The transforming growth factor-β1/Smad signaling pathway is a classical signaling pathway for fibrosis. [19][20][21] It can inhibit the degradation of extracellular matrix.…”

“…Lower expression of ανβ3, a strong-evidence marker of endometrial receptivity, was found in patients with both IUAs and CE. 18 The expression of estrogen receptors and progesterone receptors was also aberrant, and this could negatively affect embryo in patients with CE. 23 CE negatively affects endometrial receptivity, and it could result in an unsatisfactory reproductive prognosis.…”