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

Abstract

Objective: To study the effect of chronic endometritis (CE) diagnosed by CD138 immunohistochemical (IHC) staining on endometrial fibrosis and reproductive prognosis in patients with moderate or severe intrauterine adhesions (IUAs). Design: Prospective cohort study (Canadian Task Force classification II-2). Setting: University-affiliated hospital. Patient(s): One hundred sixty-seven women with moderate to severe IUAs. Intervention(s): Transcervical resection of adhesions (TCRA) and endometrial biopsy were performed in all patients. According to results of IHC staining with anti-syndecan-1 antibodies to identify CD138 cells, participants were classified into two groups: 78 patients with CE (CE group) and 89 women without CE (NCE group). IHC staining for fibrosis markers transforming growth factor beta 1, antifibrosis markers matrix metalloproteinase 9, and endometrial receptivity marker integrin alpha v beta 3 was later applied to all tissue samples. Main Outcome Measure(s): Endometrial fibrosis, endometrial receptivity, and reproductive prognosis. Result(s): CE diagnosed by CD138 IHC staining has a high incidence, 46%, in moderate and severe IUAs. In the CE group, the expression of transforming growth factor beta 1 was higher than that in the NCE group, and the expression of matrix metalloproteinase 9 and alpha v beta 3 was lower than that in the NCE group. The pregnancy rate and live birth rate in the NCE group were higher than those in the CE group (42.7% vs. 31.5%, 26.9% vs. 17.9%). Conclusion(s): CE may affect the endometrial fibrosis homeostasis in IUAs. Women with CE were more likely to experience recurrence of adhesions and had poorer reproductive outcomes.

Exosomes Derived from Adipose Mesenchymal Stem Cells Restore Functional Endometrium in a Rat Model of Intrauterine Adhesions

“…Currently, the preferred treatment is hysteroscopic surgery for adhesion removal combined with hormone therapy, especially estrogen therapy, to stimulate endometrial regeneration and prevent recurrent adhesion [3]. However, severe and dense IUA is a real therapeutic challenge with poor prognosis: The recurrence rate could be up to 62.5% in severe IUA [4], and the pooled pregnancy rate is only 22.5% to 33.3% [5], indicating that IUA can cause serious harm to female reproductive health [6]. Therefore, in cases of moderate or severe IUA, patients with reproductive requirements are more eager for effective treatment.…”

Chronic endometritis: pathogenesis, diagnosis, management and associated infertility

“…Предполагается, что хроническое воспаление способствует развитию и рецидивированию синдрома Ашермана. Согласно полученным данным, ХЭ был диагностирован у 46,28% пациенток с умеренными и тяжелыми внутриматочными спайками на основании ИГХ исследования образцов эндометрия [31]. В настоящее время механизм возникновения и рецидива внутриматочных синехий неясен.…”

“…В частности, активируется сигнальный путь TGF-β1, который участвует в модуляции заживления ран и восстановления тканей и считается классическим в формировании фиброза [32]. TGF-β1 может ингибировать деградацию внеклеточного матрикса, выступая антагонистом MMP-9, протеолитического фермента, способного разлагать компоненты внеклеточного матрикса, уменьшая, таким образом, его отложение [31].…”

Inflammation and uterine fibrosis: the possible role of chronic endometritis

“…In other scaring processes (e.g., postsurgical skin scarring developing over an underlying infection, such as an osteomyelitis), infection has been recognized as a cause of excessive fibrous scarring and keloid formation (2). In this context it is thus sound to study whether a chronic inflammation process affecting the endometriumsuch as, notably, chronic endometritis (CE)-might affect the risk of uterine fibrosis, as Liu et al have done (3).…”