Variation of diagnostic criteria in women with chronic endometritis and its effect on reproductive outcomes: A systematic review and meta-analysis

Huang, Weiguo; Liu, Bo; He, Yanni; Xie, Yiran; Liang, Ting; Bi, Yin; Yuan, Lifang; Qin, Aiping; Wang, Yao; Yang, Yihua

doi:10.1016/j.jri.2020.103146

Cited by 28 publications

(29 citation statements)

References 27 publications

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“…CE, on the other hand, is usually asymptomatic or oligosymptomatic. CE has been linked with adverse reproductive outcomes including RIF and RPL ( Huang et al , 2020 ). Our search retrieved one paper that focused on endometritis (acute and chronic) ( Disep et al , 2004 ) and seven papers focused solely on CE ( Toth et al , 2007 ; Kitaya and Yasuo, 2010a ; Kitaya et al , 2014 ; Liu et al , 2018 ; Parks et al , 2018 ; Cicinelli et al , 2019 ; Song et al , 2019 ).…”

Section: Resultsmentioning

confidence: 99%

The role of endometrial B cells in normal endometrium and benign female reproductive pathologies: a systematic review

Shen

O’Donnell

Leon

et al. 2021

Human Reproduction Open

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STUDY QUESTION What are the similarities and differences in endometrial B cells in the normal human endometrium and benign reproductive pathologies? SUMMARY ANSWER Endometrial B cells typically constitute less than 5% of total endometrial CD45+ lymphocytes, and no more than 2% of total cells in the normal endometrium, and while their relative abundance and phenotypes vary in benign gynaecological conditions current evidence is inconsistent. WHAT IS KNOWN ALREADY B cells are vitally important in the mucosal immune environment and have been extensively characterised in secondary lymphoid organs and tertiary lymphoid structures (TLSs), with the associated microenvironment germinal centre. However, in the endometrium, B cells are largely overlooked, despite the crucial link between autoimmunity and reproductive pathologies and the fact that B cells are present in normal endometrium and in benign female reproductive pathologies, scattered or in the form of lymphoid aggregates (LAs). A comprehensive summary of current data investigating B cells will facilitate our understanding of endometrial B cells in the endometrial mucosal immune environment. STUDY DESIGN, SIZE, DURATION This systematic review retrieved relevant studies from four databases (MEDLINE, EMBASE, Web of Science Core Collection, CINAHL) from database inception until November 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS The search strategy combined the use of subject headings and relevant text words related to ‘endometrium’, ‘B cells’ and B cell derivatives such as ‘antibody’ and ‘immunoglobulin’. Non-benign diseases were excluded using cancer related free-text terms, and searches were limited to English language and human subjects. Only peer-reviewed research papers were included. Each paper was graded as ‘Good’, ‘Fair’, or ‘Poor’ quality based on the NEWCASTLE-OTTAWA quality assessment scale. Only ‘Good’ quality papers were included. MAIN RESULTS AND THE ROLE OF CHANCE Twenty-seven studies met the selection criteria and were included in this review: 10 cross-sectional studies investigated B cells in the normal endometrium; and 17 case-control studies compared the characteristics of endometrial B cells in control and benign female reproductive pathologies including endometritis, endometriosis, infertility, abnormal uterine bleeding, endometrial polyps and uterine fibroids. In all studies, B cells were present in the endometrium, scattered or in the form of LAs. CD20+ B cells were more abundant in patients with endometritis, but the data were inconsistent as to whether B cell numbers were increased in endometriosis and patients with reproductive pathologies. LIMITATIONS, REASONS FOR CAUTION Although only “good” quality papers were included in this systematic review, there are variations in patients’ age, diagnostic criteria for different diseases and sample collection time among included studies. Additionally, a large number of the included studies only used immunohistochemistry as the identification method for endometrial B cells, which may fail to provide an accurate representation of the numbers of endometrial B cells. WIDER IMPLICATIONS OF THE FINDINGS Histological studies found that endometrial B cells are either scattered or surrounded by T cells in LAs: the latter structure seems to be under hormonal control throughout the menstrual cycle and resembles TLSs that have been observed in other tissues. Further characterisation of endometrial B cells and LAs could offer insights to endometrial B cell function, particularly in the context of autoimmune-associated pathologies such as endometriosis. Additionally, clinicians should be aware of the limited value of diagnosing plasma cell infiltration using only CD138. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Finox Biotech. The authors have no conflicts of interests to declare. PROSPERO REGISTRATION NUMBER This systematic review was registered in PROSPERO in January 2020 (PROSPERO ID: CRD42020152915).

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Section: Resultsmentioning

confidence: 99%

The role of endometrial B cells in normal endometrium and benign female reproductive pathologies: a systematic review

Shen

O’Donnell

Leon

et al. 2021

Human Reproduction Open

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“…Long-term treatments seem more beneficial compared to shortterm antibiotic courses (Huang et al, 2020b).…”

Section: Antibiotics For Chronic Endometritismentioning

confidence: 99%

“…As a result, GH has been demonstrated to be a mediator toward endometrial thickening, being rather appealing as a research intervention for women with thin endometrium (Lan et al, 2019). The evidence supporting GH for treating infertile women stems mainly from studies focusing on poor ovarian responders, mainly due to the parallel action that GH exerts on the ovary (Altmäe and Aghajanova, 2019;Huang et al, 2020b). So far, only one randomized trial has been published studying the GH-impact on women with RIF (Altmäe et al, 2018).…”

Section: Growth Hormone (Gh)mentioning

confidence: 99%

“…All the studies published so far are non-randomized thus producing low level of evidence. Two recent meta-analyses have summarized the existing results, supporting antibiotic treatment as an approach to improve reproductive outcomes in women with RIF (Vitagliano et al, 2018b;Huang et al, 2020b). Additionally, it is highlighted that a stringent approach in setting the diagnosis may reveal lower CE incidences and reproductive outcomes compared to approaches with broader diagnostic criteria (Huang et al, 2020b).…”

Section: Antibiotics For Chronic Endometritismentioning

confidence: 99%

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Approaches to Improve Endometrial Receptivity in Case of Repeated Implantation Failures

Makrigiannakis

Makrygiannakis

Vrekoussis

2021

Front. Cell Dev. Biol.

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Repeated implantation failures are a constant challenge in reproductive medicine with a significant impact both on health providers and on infertile couples. Several approaches have been proposed so far as effective; however, accumulative data have clarified that most of the treatment options do not have the evidence base for a generalized application to be suggested by the relevant societies. Implantation failures are attributed to either poor quality embryos or to defected endometrial receptivity. The current review aims to summarize in a systematic way all the new trends in managing RIF via interference with endometrial receptivity. The authors focus mainly, but not exclusively, on endometrial injury prior to embryo transfer and endometrial priming with autologous cells or biological agents. To this direction, a systematic search of the Pubmed database has been conducted taking into account the emerged evidence of the last two decades. All the suggested interventions are herein presented and analyzed in terms of reproductive outcomes. It is evident that properly powered and designed randomized trials are needed to support a new standard approach in RIF treatment that will safely be incorporated in national and international guidelines.

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“…A recent systematic review by Huang et al found variation in the incidence (OR: 2.96; 95% CI: 1.13-6.44), clinical pregnancy rate (OR: 1.83; 95% CI: 1.18-2.8), and live birth rate (OR: 2.08; 95% CI: 1.43-3.02) in women with CE when a broader diagnostic criteria was applied compared with a stricter diagnostic criteria. 79 A summary of diagnostic techniques used for CE in reproductive health is given in ►Table 3. This effect has created uncertainty within the literature on the role CE plays in RIF/RM, and in addition the burden of CE may vary between RIF and RM, with a Canadian study suggesting a prevalence of 14% in RIF compared with 27% in RM.…”

Section: Diagnosis Of Chronic Endometritismentioning

confidence: 99%

Immunological Testing in Assisted Reproductive Technology

Odendaal

Quenby

2021

Semin Reprod Med

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Fetal implantation requires carefully orchestrated involvement of the maternal immune system. Aberrant function within implantation has been suggested as a cause of implantation failure. The emergence of immunological theories of miscarriage has led to immunological testing as an adjuvant treatment in assisted reproductive technology; however, it remains controversial, with mixed evidence both for immunological cause and the benefits of immunological testing. Literature on common methods of immunological testing within assisted reproductive technology is reviewed including those of peripheral and uterine natural killer cells, chronic endometritis, and T-helper cells cytokine ratio. There is little consensus in the evidence on immunological testing in the context of recurrent implantation failure. The field is limited by a lack of uniformity in approach to testing and heterogeneity of the pathophysiological cause. Nevertheless, the maternal immune system is heavily involved in implantation and the new era of personalized medicine ensures that a more defined approach to immunological testing will be achieved.

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Variation of diagnostic criteria in women with chronic endometritis and its effect on reproductive outcomes: A systematic review and meta-analysis

Cited by 28 publications

References 27 publications

The role of endometrial B cells in normal endometrium and benign female reproductive pathologies: a systematic review

The role of endometrial B cells in normal endometrium and benign female reproductive pathologies: a systematic review

Approaches to Improve Endometrial Receptivity in Case of Repeated Implantation Failures

Immunological Testing in Assisted Reproductive Technology

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