The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology

Moreno, Inmaculada; Cicinelli, Ettore; García-Grau, Iolanda; Gonzáléz-Monfort, Marta; Baù, Davide; Vilella, Felipe; Ziegler, Dominique de; Resta, Leonardo; Valbuena, Diana; Simón, Carlos

doi:10.1016/j.ajog.2018.02.012

Cited by 205 publications

(186 citation statements)

References 46 publications

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“…Moreover, the presence of nine pathogens was evaluated by real‐time PCR in endometrial samples from patients assessed for CE by CD138 immunostaining. Similar detection rates of the pathogens were observed in CE and non‐CE patients (24/40 vs 14/25) . These results suggest inconsistency in the detection of the microorganisms inside the uterine cavity in CE.…”

Section: Etiologysupporting

confidence: 74%

“…Similar detection rates of the pathogens were observed in CE and non-CE patients (24/40 vs 14/25). 47 These results suggest inconsistency in the detection of the microorganisms inside the uterine cavity in CE. Therefore, the main issue of CE is thought to be the interaction between microorganisms and endometrial immunity rather than just the presence of microorganisms in the endometrium.…”

Section: Concept Of Cementioning

confidence: 99%

“…59 In subsequent studies, 84 other groups reported that office hysteroscopy had low sensitivity for the detection of histological CE. 8,47,63,84 The sensitivity of hysteroscopic diagnosis may depend on the clinician's experience.…”

Section: Diagnosismentioning

confidence: 99%

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Review: Chronic endometritis and its effect on reproduction

Kimura

Takebayashi

Ishida

et al. 2019

J of Obstet and Gynaecol

167

119

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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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Section: Etiologysupporting

confidence: 74%

Section: Concept Of Cementioning

confidence: 99%

See 1 more Smart Citation

Review: Chronic endometritis and its effect on reproduction

Kimura

Takebayashi

Ishida

et al. 2019

J of Obstet and Gynaecol

167

119

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“…Moreno et al reported that the adverse effect of NLDM on pregnancy was more evident in participants presenting dominant Gardnerella and Streptococcus genera. Bacteria which is reported to be responsible for chronic endometritis (CE), such as Enterococcus , Enterobacteriaceae , Streptococcus , Staphylococcus , Gardnerella , Mycoplasma , Ureaplasma , Chlamydia , and Neisseria , may have adverse effects on implantation. But the mechanism of how the pathogenic bacteria affect the embryo implantation is still not clear.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, CE is diagnosed by hysteroscopy, histology, CD‐138 immunostaining, and microbial culture, alone or in a combination of those methods. Recently, a report demonstrated that a molecular microbiology method using next‐generation sequencing may be a faster and better diagnostic tool for the determination of CE compared to three diagnostic methods, with a high degree of concordance with these three classical methods altogether . However, the diagnostic criteria of CE have not yet been established .…”

Section: Discussionmentioning

confidence: 99%

A pilot study and case reports on endometrial microbiota and pregnancy outcome: An analysis using 16S rRNA gene sequencing among IVF patients, and trial therapeutic intervention for dysbiotic endometrium

Kyono

Hashimoto

Kikuchi

et al. 2018

Reprod Medicine & Biology

101

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PurposeThe present study aimed to analyze the pregnancy outcomes of IVF patients presenting Lactobacillus‐dominated microbiota (LDM) or non‐Lactobacillus‐dominated microbiota (NLDM) of their endometrium and to report cases who were treated for NLDM concurrently with antibiotics and prebiotic/probiotic supplements in a Japanese infertile population.MethodsNinety‐two IVF patients were recruited from August 2017 to March 2018. Endometrial fluid samples for sequencing were collected using an IUI catheter. The bacterial status of the endometrium and the pregnancy outcomes were analyzed. For cases with NLDM, antibiotics and prebiotics/probiotics were administered according to their individual microbial conditions.ResultsForty‐seven cases (51.1%) presented LDM and 45 cases (48.9%) presented NLDM at initial analysis. Nine Patients with NLDM were treated by antibiotics and prebiotics/probiotics, and successfully became Lactobacillus‐dominant. Pregnancy rates by single vitrified‐warmed blastocyst transfers were higher in the LDM group (58.9% per patient and 36.3% per FBT) than in the NLDM group (47.2% per patient and 34.7% per FBT) but not significantly different.ConclusionThe results of this study could not necessarily prove the clear benefit of establishing Lactobacillus‐dominated endometrium in terms of pregnancy outcome, but there is significance in searching for endometrial microbial status of infertile patients and recovering Lactobacillus‐dominated endometrium might benefit implantation.

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Chronic endometritis: A prevalent yet poorly understood entity

Margulies

Flores

Parkash

et al. 2021

Intl J Gynecology & Obste

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Objective To examine the prevalent understanding of and management approaches to chronic endometritis among obstetricians/gynecologists. Methods In a cross‐sectional observational study, 262 members of national and international professional obstetrician/gynecologist societies were surveyed via anonymous electronic survey that investigated knowledge of the pathophysiology, diagnostic criteria, clinical implications, and treatment strategies for chronic endometritis. Statistical analyses of results were performed using Fisher's exact tests, chi square tests and odds ratios with 95% confidence intervals. A two‐sided P < 0.05 was deemed statistically significant. Results Responses identified a concerning spectrum of deficiencies in the understanding of the pathophysiology of chronic endometritis, in awareness of clinical presentation of chronic endometritis, and in the understanding of methodology/ies that allow diagnosis of chronic endometritis. Heterogeneities in management approaches to chronic endometritis were apparent. Conclusion Our findings underscore a need for targeted efforts to gain clarity on chronic endometritis and to establish evidence‐based consensus for good clinical practice. In the absence of a clear understanding of chronic endometritis diagnosis, we posit that the prevalent inconsistencies are likely inflicting unquantified and underappreciated burdens on patients and healthcare systems. We propose consideration for a task force to examine existing literature and create standards for good practice for a prevalent condition.

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The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology

Cited by 205 publications

References 46 publications

Review: Chronic endometritis and its effect on reproduction

Review: Chronic endometritis and its effect on reproduction

A pilot study and case reports on endometrial microbiota and pregnancy outcome: An analysis using 16S rRNA gene sequencing among IVF patients, and trial therapeutic intervention for dysbiotic endometrium

Chronic endometritis: A prevalent yet poorly understood entity

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