Hysteroscopic Evaluation of Chronic Endometritis Incidence in Unexplained Infertile Women with Recurrent Implantation Failure: Six Years Experience

Year 2022, , 64 - 70, 22.04.2022

Nur Dokuzeylül Güngör , Tuğba Gürbüz , Arzu Yurci

https://doi.org/10.46332/aemj.878832

Cited By: 1

Abstract

Purpose: To evaluate histeroscopically-proved chronic endometritis (CE) incidence in unexplained infertility cases with recurrent implantation failure (RIF).
Materials and Methods: This cross-sectional retrospective study was done on 529 participants who attended our hospital's infertility clinic from January 2014 to August 2020. The participants were at the age of 18-39 years. We divided the subjects into two groups, i.e., unexplained infertile patients with RIF (Group:1; n:187) and unexplained infertile patients without RIF (Group:2; n:342).
Results: The women had a mean age of 31.6 ±5.1 years. Hysteroscopic findings were as follows:14 (2.6%) had chronic endomet-ritis, 19 (3.6%) had polyps, and 496 (93.8%) had no pathological findings. Age, BMI, AMH level, total dose of gonadotropin, duration of stimulation, number of retrieved oocytes, Metaphase II (MII), and Pronucleus (PN) showed no significant difference between the two groups. Also, infertility type (P=0.09) and smoking(P=0.5) were not statistically different between the two gro-ups. In addition, the two groups showed no statistically significant difference in polyps (p=0.8) and CE (p=0.1), while the two groups showed a statistically significant difference in endometrial pathology (p<0.001).
Conclusion: In this study, it was shown that those with RIF did not show a higher incidence of CE, but endometrial pathologies were increased in this group of patients. So hysteroscopy should be done in RIF patients with unexplained infertility.

Keywords

chronic endometritis, hysteroscopy, recurrent implantation failure, unexplained infertility

Supporting Institution

NONE

Thanks

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Tekrarlayan İmplantasyon Başarısızlığı Olan Açıklanamayan İnfertilite Olgularında Kronik Endometrit Sıklığının Histeroskopik Olarak Değerlendirilmesi: Altı Yıllık Deneyim

Abstract

Amaç: Tekrarlayan implantasyon başarısızlığı (TİB) olan açıklanamayan infertilite olgularında histeroskopik kronik endometrit (KE) insidansının değerlendirilmesi.
Araçlar ve Yöntem: Bu kesitsel retrospektif çalışmaya, Ocak 2014-Ağustos 2020 tarihleri arasında hastanemizin tüp bebek kliniğine başvurmuş olan 529 katılımcı dahil edilmiştir. Katılımcıların yaşları 18-39 aralığında değişmektedir. Katılımcılar, TİB olan açıklanamayan infertil olguları (Grup:1; n:187) ve TİB olmayan açıklanamayan infertil olguları (Grup:2; n:342) olmak üzere iki gruba ayrılmıştır.
Bulgular: Kadınların ortalama yaşı 31.6± 5.1 olup, katılımcılara ait ortalama vücut kitle indeksi (VKİ) 24.6± 2.5 olarak hesaplanmıştır. Histeroskopik bulgular ise şu şekildedir: 14 katılımcıda (%2.6) kronik endometritis, 19 katılımcıda (%3.6) polip bulunurken, katılımcıların 496'sında (%93.8) patolojik bulguya rastlanmamıştır. İki grup arasında yaş, VKİ, AMH seviyesi, toplam gonadotropin dozu, stimülasyon süresi, kazanılan oosit sayısı, MII ve PN bakımından istatiksel olarak anlamlı farklılık bulunmadığı görülmüştür. Yine, iki grup arasında, infertilite tipi (p=0.09) ve sigara kullanımı (p=0.5) bakımından istatistiksel olarak anlamlı bir fark bulunmamaktadır. Ancak test sayısı bakımından iki grup arasında istatistiksel olarak anlamlı bir farklılık (p=0.000) tespit edilmiştir. Ayrıca, iki grup arasında KE (p=0.1) ve polip (p=0.8) bakımından istatistiksel olarak anlamlı farklılık bulunmamış olup, endometriyal patoloji varlığı bakımından iki grup arasında istatistiksel olarak anlamlı farklılık (p<0.001) söz konusudur.
Sonuç: Bu çalışma, TİB olan kadınların daha yüksek KE insidansına sahip olmadığını, fakat bu hasta gruplarında endometriyal patolojilerin sayısının arttığını ortaya koymuştur. Bundan dolayı, açıklanamayan infertilitesi olan TİB hastalarında histeroskopi işleminin yapılması gerekmektedir. 

Keywords

açıklanamayan infertilite, histeroskopi, kronik endometrit, tekrarlayan implantasyon başarısızlığı

References

• 1. Puente E, Alonso L, Laganà AS, Ghezzi F, Casa-rin J, Carugno J. Chronic endometritis: old prob-lem, novel insights and future challenges. Int J Fertil Steril. 2020;13(4):250-256.
• 2. Sfakianoudis K, Simopoulou M, Nitsos N, et al. Successful implantation and live birth following autologous platelet-rich plasma treatment for a patient with recurrent implantation failure and chronic endometritis. In Vivo. 2019;33(2):515-521.
• 3. Kimura F, Takebayashi A, Ishida M, et al. Chro-nic endometritis and its effect on reproduction. J Obstet Gynaecol Res. 2019;45(5):951-960.
• 4. Kitaya K, Matsubayashi H, Takaya Y, et al. Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with re-peated implantation failure. Am J Reprod Immu-nol. 2017;78(5): e12719.
• 5. Greenwood SM, Moran JJ. Chronic endometritis: morphologic and clinical observations. Obstet Gynecol. 1981;58(2):176-184.
• 6. Park HJ, Kim YS, Yoon TK, Lee WS. Chronic endometritis and infertility. Clin Exp Reprod Med. 2016;43(4):185-192.
• 7. Kitaya K, Yasuo T. Aberrant expression of selec-tin E, CXCL1, and CXCL13 in chronic endomet-ritis. Mod Pathol. 2010;23(8):1136-1146.
• 8. Cicinelli E, Matteo M, Trojano G, et al. Chronic endometritis in patients with unexplained inferti-lity: prevalence and effects of antibiotic treatment on spontaneous conception. Am J Reprod Im-munol. 2018; 79(1):e12782.
• 9. McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic en-dometritis and recurrent pregnancy loss. Fertil and Steril. 2015;104(4):927-931.
• 10. Takebayashi A, Kimura F, Kishi Y,et al. The as-sociation between endometriosis and chronic en-dometritis. PLoS One. 2014;9(2):e0088354.
• 11. Bashiri A, Halper KI, Orvieto R. Recurrent Imp-lantation Failure-update overview on etiology, di-agnosis, treatment, and future directions. Reprod Biol Endocrinol. 2018;16(1):1-8.
• 12. Bouet PE, El Hachem H, Monceau E, Gariépy G, Kadoch IJ, Sylvestre C. Chronic endometritis in women with recurrent pregnancy loss and recur-rent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil and Steril. 2016;105(1):106-110.
• 13. Cicinelli E, Matteo M, Tinelli R, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate af-ter antibiotic therapy. Hum Reprod. 2015;30(2):323-330.
• 14. Kitaya K, Tada Y, Hayashi T, Taguchi S, Funabi-ki M and Nakamura Y: Comprehensive endomet-rial immunoglobulin subclass analysis in infertile women suffering from repeated implantation fai-lure with or without chronic endometritis. Am J Reprod Immunol. 2014;72 (4):386-391.
• 15. Zhang Y, Xu H, Liu Y, et al. Confirmation of chronic endometritis in repeated implantation fai-lure and success outcome in IVF‐ET after intra-uterine delivery of the combined administration of antibiotic and dexamethasone. Am J of Reprod Immunol. 2019;82 (5):e13177.
• 16. Griffith OW, Chavan AR, Protopapas S, et al. Embryo implantation evolved from an ancestral inflammatory attachment reaction. Proc. Natl. Acad. Sci. 2017;114 (32):E6566-6575.
• 17. Bhurke A, Kannan A, Ma O, et al. A hypoxia-induced Rab pathway regulates embryo implanta-tion by controlled trafficking of secretory granu-les. Proc Natl Acad Sci. 2020;117(25):14532-14542.
• 18. Yu M, Qin H, Wang H, et al. N-glycosylation of uterine endometrium determines its receptivity. J. Cell. Physiol. 2020;235(2):1076-1089.
• 19. West RC, Ming H, Logsdon DM, et al. Dynamics of trophoblast differentiation in peri-implantation-stage human embryos. Proc. Natl. Acad. Sci. 2019;116(45): 22635-22644.
• 20. Cha J, Sun X & Dey SK. Mechanisms of implan-tation: strategies for successful pregnancy. Nat. Med. 2012; 18(12):1754-1767.
• 21. Franasiak JM. Chronic endometritis is associated with an altered microbiome, but what about tre-atment and clinical outcomes?. Fertil Steril. 2019;112(4):649-650.
• 22. Vitagliano A, Noventa M, Gizzo S. Autoimmu-nity, systemic inflammation, and their correlation with repeated implantation failure and recurrent miscarriage: is chronic endometritis the missing piece of the jigsaw?. Am J Reprod Immunol. 2017;77(1):1-2.
• 23. Vitagliano A, Saccardi C, Noventa M, et al. Ef-fects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and me-ta-analysis. Fertil Steril. 2018;110(1):103-112.
• 24. Valle R.F.: "Development of hysteroscopy from a dream to a reality and its linkage to the present and future". J. Minim. Invasive Gynecol. 2007;14:407.
• 25. Richlin SS, Ramachandran S, Shanti A, et al. Gly-codelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps: implica-tions for implantation. Hum Reprod. 2002;17(10):2742-2747.
• 26. Maia H Jr, Pimentel K, Silva TM, et al. Aromata-se and cyclooxygenase-2 expression in endomet-rial polyps during the menstrual cycle. Gynecol Endocrinol. 2006;22(4):219-224.
• 27. Ben-Nagi J, Miell J, Yazbek J, et al. The effect of hysteroscopic polypectomy on the concentrati-ons of endometrial implantation factors in uterine flushings. Reprod Biomed Online. 2009;19(5):737-744.
• 28. Rackow BW, Jorgensen E, Taylor HS. Endomet-rial polyps affect uterine receptivity. Fertil Steril. 2011;95(8):2690-2692.
• 29. Munro, MG Uterine polyps, adenomyosis, lei-omyomas, and endometrial receptivity. Fertility and Sterility. 2019;111(4):629-640.
• 30. Huang W, Liu B, He Y, et al. Variation of diag-nostic criteria in women with chronic endometri-tis and its effect on reproductive outcomes: A systematic review and meta-analysis. J Reprod Immunol. 2020;140: 103146.
• 31. Song D, Li TC, Zhang Y, et al. Correlation between hysteroscopy findings and chronic en-dometritis. Fertil Steril. 2019;111(4):772-779.
• 32. Kitaya K, Takeuchi T, Mizuta S, Matsubayashi, H Ishikawa T Endometritis: new time, new con-cepts. Fertil Steril. 2018;110(3):344-350.
• 33. Cicinelli E, Resta L, Nicoletti R, et al. Detection of chronic endometritis at fluid hysteroscopy. J Minim Invasive Gynecol. 2005;12(6):514-518.
• 34. Kushnir VA, Solouki S, Sarig‐Meth T, et al. Sys-temic inflammation and autoimmunity in women with chronic endometritis. Am J Reprod Immu-nol. 2016;75(6): 672-677.
• 35. Matteo M, Cicinelli E, Greco P, et al. Abnormal pattern of lymphocyte subpopulations in the en-dometrium of infertile women with chronic en-dometritis. Am J Reprod Immunol. 2009;61(5):322-329.
• 36. Altmäe S, Mendoza‐Tesarik R, Mendoza C, Mendoza N, Cucinelli F, Tesarik J. Effect of growth hormone on uterine receptivity in women with repeated implantation failure in an oocyte donation program: a randomized controlled trial. J Endocr Soc. 2018;2(1):96‐105.
• 37. Saxtorph MH, Hallager T, Persson G, et al. As-sessing endometrial receptivity after recurrent implantation failure: a prospective controlled co-hort study. Reprod Biomed Online. 2020;41(6):998-1006.
• 38. Liu Y, Chen X, Huang J, et al. Comparison of the prevalence of chronic endometritis as determined by means of different diagnostic methods in women with and without reproductive failure. Fertil. Steril. 2018;109(5):832-839.
• 39. Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril. 2010;93(2):437–441.
• 40. Tanacan A, Mumusoglu S, Yaralı H, et al. The ef-fect of performing hysteroscopy prior to the first in vitro fertilization (IVF) cycle on live birth rate. Gynecol Endocrinol. 2019;35(5):443-447.