Lviv clinical bulletin 2020, 1(29): 8-12

https://doi.org/10.25040/lkv2020.01.008

Effectiveness of in Vitro Fertilization Treatment in the Presence of Chronic Endometritis

L. Markin1, L. Sehedii2

1Danylo Halytsky Lviv National Medical University

2Human Reproduction Clinic ʺAlternatyvaʺ

Introduction. For today, reproductive disorders are an urgent problem not only in Ukraine, but all over the world. Finding out the causes of these conditions is a prerequisite for improving existing treatments. Unfortunately, even using the latest advances in reproductology, it is still not possible to help all patients who go to reproductive medicine clinics to become pregnant and have a healthy full-term baby. There are a lot of ongoing research to improve the effectiveness of in vitro fertilization (IVF) treatment. Chronic endometritis (CE) has been the subject of scientific research for many years. Today, there are various methods of diagnosis of CE. They include ultrasound examination, hysteroscopy, histological and immunohistochemical staining for CD138 detection in endometrial tissue. It remains relevant to determine the effectiveness of infertility treatment in the presence of CE in case of in vitro fertilization treatment.

The aim of the study. To determine the effectiveness of in vitro fertilization treatment in the presence of chronic endometritis.

Materials and methods. A retrospective analysis of 150 case histories of women aged 23 to 41 years treated for infertility was conducted at the Alternative Human Reproduction Clinic. In 89 (59.3 %) patients the pregnancy did not occur after the first treatment cycle of IVF. To find out why pregnancy did not occur, hysteroscopy during the follicular phase of the menstrual cycle was performed in 58 patients (group I) before continuing IVF treatment. 31 patients (group II) refused to undergo diagnostic hysteroscopy. All patients of group I underwent hysteroscopy with biopsy of the endometrium, followed by histological and immunohistochemical examination with determination of CD138.

Results. Using immunohistochemical examination, the presence of CD138 was detected in 33 (56.9 %) patients of group I, despite the fact that hysteroscopically CE was diagnosed in only 20 (34.5 %) women in the same group. All 33 patients with verified CE were assigned appropriate antibacterial treatment. To control the effectiveness of the treatment, histological examination of the endometrium by pipel biopsy during the follicular phase of the menstrual cycle was performed. The absence of CD138 was recorded in 28 (84.8 %) of the 33 patients after treatment. In 25 (43.1 %) patients of group I, CE were not diagnosed.

For the second IVF attempt, a frozen embryo transfer was performed in all cases.

Clinical pregnancy was diagnosed in 19 (67.8 %) of 28 successfully treated patients with CE, 14 (56.0 %) of 25 who had no abnormal endometrial changes during hysteroscopy and 13 (41.9 %) of the 31 who were not diagnosed with hysteroscopy after the first negative attempt of IVF.

Conclusions. The incidence of abnormal endometrial changes during hysteroscopy in women with impaired implantation remains high. Conducting an immunohistochemical staining of the endometrium with the determination of a marker of plasma cells CD138 significantly increases the accuracy of verification of chronic endometritis. The effectiveness of in vitro fertilization treatment was positively affected by the elimination of pathological changes in the endometrium, namely, chronic endometritis detected during hysteroscopy and immunohistochemical examination.

References

  1. Gavrilyuk AM. The role of HLA antigens in impaired reproductive function of a woman. Medical Aspects of Woman’s Health. 2010;2:42-49. (Russian)
  2. Dobrokhotova YE, Sukhyh GT, Ozerova RI. Infectious-immunological aspects of undevelopedp regnancy: opportunities for cytokine therapy in the rehabilitation programin theearlypost-abortionperiod (literature review). Problems of Reproduction. 2006;1:15-20. (Russian)
  3. Dranik GM. Immunology of reproduction. Clinical immunology and allergology. Kyiv: Health; 2006. 552-582.(Ukrainian)
  4. Kovalenko YA, Krutova VA, Naumova NV, Chuprinenko LM. Effectiveness of an extracorporeal fertilization and embryo transfer program in women with chronic non-specific endometritis. Kuban Scientific Medical Journal. 2017;24(6):59-64. (Russian) https://doi.org/10.25207/1608-6228-2017-24-6-59-64
  5. 5. Sukhyh GT, Shurshalina AB. Chronic endometritis. Guidance. Moskow: GEOTAR-Media; 64 p. (Russian)
  6. Schmidt AA, Zamyatin CA, Gonchar IS, Korovin AE, Gorodnyuk AE, Kotsur AB. The epidemiology of infertility in Russia and abroad. Clinical Pathophysiology. 2019;25(1):9-12. (Russian)
  7. Cicinelli E, Trojano G, Mastromauro M, Vimercati A, Marinaccio M, Mitola PC, Resta L, deZiegler D. Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link. Fertil Steril. 2017;108(2):289-295. https://doi.org/10.1016/j.fertnstert.2017.05.016
  8. Haggerty CL, Peipert JF, Weitzen S, Hendrix SL, Holley RL, Nelson DB, et al. Predictors of Chronic Pelvic Pain in an Urban Population of Women With Symptoms and Signs of Pelvic Inflammatory Disease. Sex Transm Dis. 2005;32(5):293-299. https://doi.org/10.1097/01.olq.0000162361.69041.a5
  9. McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril. 2015;104(4):927-931. https://doi.org/10.1016/j.fertnstert.2015.06.044
  10. Radzinsky VE,Kostin IN, PetrovYuA, Polina ML, Gasanova BM. Diagnostic significance of chronic endometritis macrotypes differentiation among women with reproductive losses. Gynecol Endocrinol. 2017;33(1 suppl):36-40. https://doi.org/10.1080/09513590.2017.1399697
  11. Romero R, Espinoza J, Mazor M. Can endometrial infection/inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization? Fertil Steril. 2004;82(4):799-804. https://doi.org/10.1016/j.fertnstert.2004.05.076
  12. Takebayashi A, Kimura F, Kishi Y, Ishida M, Takahashi A, Yamanaka A et al. The association between endometriosis and chronic endometritis. PLoSOne. 2014;9(2):e88354. https://doi.org/10.1371/journal.pone.0088354