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Hue HJ, Choi H, Lee HK, Lee JR, Jee BC, Choo CW, Kim SK. Prevalence and confounders of chronic endometritis diagnosed using CD138 in patients with recurrent implantation failure. Clin Exp Reprod Med 2024; 51:163-169. [PMID: 38263588 PMCID: PMC11140256 DOI: 10.5653/cerm.2023.06170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/16/2023] [Accepted: 11/09/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE This retrospective study aimed to investigate the prevalence of chronic endometritis, diagnosed using CD138 immunohistochemistry, among infertile women and to assess the association between chronic endometritis and recurrent implantation failure (RIF). METHODS In total, 266 patients who underwent hysteroscopy due to infertility between 2019 and 2020 were included in the analysis. Of these, 136 patients with RIF and 130 non-RIF patients were included in the study. CD138 immunohistochemistry test results, blood biomarkers (including natural killer cells, white blood cells, and the lymphocyte-to-neutrophil ratio), and data on pregnancy outcomes were obtained. If the CD138 test yielded a positive result, the patients received antibiotic treatment. RESULTS The overall proportion of CD138-positive patients was 32.7% (87/266). The CD138 positivity rate was not related to the number of cycles with implantation failure. In the RIF patient group, no significant associations were found between CD138 positivity and peripheral blood markers. The clinical pregnancy rates were similar between infertile women treated with antibiotics for chronic endometritis and those without chronic endometritis. CONCLUSION To improve the pregnancy rate in infertile patients, it may be helpful to combine CD138 testing with other laboratory tests and administer antibiotic treatment if the result is positive.
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Affiliation(s)
- Hye Jeong Hue
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyunji Choi
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun Kyoung Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Woo Choo
- Department of Obstetrics and Gynecology, Seoul Maria Fertility Hospital, Seoul, Republic of Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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2
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Gothe JP, de Mattos AC, Silveira CF, Malavazi KC. Exploring Natural Killer Cell Testing in Embryo Implantation and Reproductive Failure: An Overview of Techniques and Controversies. Reprod Sci 2024; 31:603-632. [PMID: 37853155 DOI: 10.1007/s43032-023-01372-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
The blastocyst nidation is the most crucial stage to a successful pregnancy, as the white cells work to promote a favorable endometrial microenvironment for this process. Intriguingly, this implantation window lasts, on average, 6 days in most regular women, and its quality is affected by many pathological conditions. Since the grounds of reproductive failure in healthy couples are still uncharted, studies have widely suggested a potential hostile role of the immune system in the equilibrium of the maternal-fetal interface. In recent years, natural killer cells have been the highlight as they represent the greatest lymphocyte in the uterus and have immune surveillance through cytotoxicity during the implantation window. This review explored the main techniques used for natural killer (NK) cell testing in the implantation window over the last 13 years on the PubMed® database. Of 2167 published articles potentially relevant for the review, only thirty-three were about cell evaluation in healthy women, met the inclusion criteria, and had their methodology critically analyzed. Here, we bring a summary from the study group and sample collection to evidence comments about their findings and correlations. Meanwhile, we also summarize the current relationship between NK cells and endometrial receptivity with reproductive failure to help enhance the possibilities for future research. In conclusion, our overview points out that restricted and unstandardized methods support the controversy between the NK population and unsuccessful embryo implantation, which is an obstacle to studying why healthy eggs do not thrive and finding a solution for one of the most controversial topics in human reproduction.
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Affiliation(s)
- Juliana Peron Gothe
- Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Av. John Boyd Dunlop S/N - Jardim Ipaussurama, Campinas, São Paulo, 13034-685, Brazil.
| | - Amílcar Castro de Mattos
- Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Av. John Boyd Dunlop S/N - Jardim Ipaussurama, Campinas, São Paulo, 13034-685, Brazil
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3
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Ughade PA, Shrivastava D. Unveiling the Role of Endometrial CD-138: A Comprehensive Review on Its Significance in Infertility and Early Pregnancy. Cureus 2024; 16:e54782. [PMID: 38529432 PMCID: PMC10961243 DOI: 10.7759/cureus.54782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/23/2024] [Indexed: 03/27/2024] Open
Abstract
This review comprehensively examines the role of endometrial CD-138 (syndecan-1) in the context of infertility and early pregnancy. The endometrium, a dynamic tissue responsive to hormonal cues, plays a central role in fertility, and understanding the molecular intricacies governing its function is crucial. CD-138, a cell surface proteoglycan, emerges as a critical player expressed by various endometrial cell types. Our exploration encompasses a brief overview of the endometrium, introducing CD-138 as a significant molecular entity. The rationale for the review underscores the importance of elucidating endometrial factors in fertility and addresses existing knowledge gaps related to CD-138. Throughout the review, we unravel the multifaceted nature of CD-138 and its involvement in infertility, highlighting its potential as a diagnostic marker. Furthermore, insights into CD-138's role during early pregnancy, including trophoblast-endothelial interactions, are discussed. In conclusion, the findings underscore the clinical implications of CD-138, suggesting its utility in diagnostics and offering prospects for targeted therapeutic interventions. The identified knowledge gaps propel future research directions, promising to deepen our understanding of this enigmatic molecule and its transformative potential in reproductive medicine.
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Affiliation(s)
- Prachi A Ughade
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Deepti Shrivastava
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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4
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Tsonis O, Gkrozou F, Dimitriou E, Barmpalia Z, Tsonis K, Vatopoulou A, Paschopoulos M. Hysteroscopic features suggestive of chronic endometritis: a systematic review. HUM FERTIL 2023; 26:1530-1543. [PMID: 37811835 DOI: 10.1080/14647273.2023.2265155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/27/2023] [Indexed: 10/10/2023]
Abstract
The purpose of this systematic review is to identify common hysteroscopic findings suggestive of endometritis, chronic or subclinical, based on current scientific evidence. Data sources were MEDLINE, Embase, PubMed and other sources of grey literature. Four (4) authors independently selected studies addressing hysteroscopic detection of CE based on specific and clearly stated hysteroscopic criteria. The diagnosis was confirmed by histologic assessment, as stated in the materials and methods of these studies included. The initial search identified 599 studies, of which 21 met the inclusion criteria. Significant heterogeneity among published studies on Chronic endometritis (CE) remains the main limitation in performing a metanalysis and further analysis of diagnostic accuracy on the subject. Hysteroscopy is an important diagnostic tool in cases of chronic endometritis when accompanied by endometrial biopsies. Clinicians relate hyperaemia and endometrial oedema with chronic endometritis while more than half include micropolyposis as a pathognomonic feature of this subclinical condition. Micropolyps, stromal oedema, haemorrhagic spots, strawberry aspect, and hyperaemia are proposed as adequate indicators of hysteroscopic evidence of CE according to the literature. The impact of CE in long-term reproductive outcomes remain unclear, thus clinicians ought to communicate this to the patients and provide treatment where clinically appropriate. In addition, we present hysteroscopic images of histologically confirmed CE cases that could play the role of a hysteroscopic atlas.
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Affiliation(s)
- Orestis Tsonis
- Assisted Conception Unit, Guy's and St Thomas' Hospital NHS, London, UK
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
| | - Fani Gkrozou
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
| | - Evangelos Dimitriou
- MSc Biostatistics, Medical School and Department of Mathematics, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Barmpalia
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
| | - Klarisa Tsonis
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
| | - Anastasia Vatopoulou
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece
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5
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Fan X, Zhao Q, Li Y, Chen Z, Liao J, Chen H, Meng F, Lu GX, Lin G, Gong F. Immune profiling and RNA-seq uncover the cause of partial unexplained recurrent implantation failure. Int Immunopharmacol 2023; 121:110513. [PMID: 37336073 DOI: 10.1016/j.intimp.2023.110513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Detailed knowledge of the changes in endometrial immune cells during the window of implantation in unexplained recurrent implantation failure (RIF) patients, the functions performed by immune cells, and the interactions between them is largely lacking. This study aimed to classify RIF patients and explore the mechanism through endometrial immune profiling and RNA-seq analysis. METHODS This study enrolled a total of 172 patients, comprising 144 women with unexplained RIF and 28 fertile women. Endometrial samples were collected using endometrial scratching at the mid-luteal phase before in vitro fertilization treatment or pregnancy. Transcriptome sequencing and immunohistochemical staining of endometrial immune cells including natural killer (NK) cells, macrophages, T cells, and B cells were performed. MAIN OUTCOME MEASURE(S) Comparison of the percentage of endometrial immune cells and the RNA-seq information between RIF patients and fertile control patients. RESULT(S) The proportions of uterine CD56+ uNK cells, CD57+ NKT cells, CD68+ macrophages, and CD19+ B cells were significantly elevated in RIF patients. In addition, the number of positive CD68 glandular lumens was significantly higher in RIF patients than in the fertile group. In addition, based on this result, we classified RIF patients into three categories. CONCLUSION(S) Hyperactivation of endometrial immune cells may be associated with reduced endometrial tolerance and recurrent implantation failure, affecting pregnancy outcomes in RIF patients.
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Affiliation(s)
- Xiangxiu Fan
- An Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University Changsha, China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Qi Zhao
- An Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University Changsha, China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Yuan Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China; Clinical Research Center For Reproduction and Genetics In Hunan Province, China
| | - Ziyi Chen
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China; Clinical Research Center For Reproduction and Genetics In Hunan Province, China
| | - Jingnan Liao
- An Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University Changsha, China
| | - Huijun Chen
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Fei Meng
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China; Clinical Research Center For Reproduction and Genetics In Hunan Province, China
| | - Guang-Xiu Lu
- An Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University Changsha, China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, Changsha, China; Clinical Research Center For Reproduction and Genetics In Hunan Province, China
| | - Ge Lin
- An Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University Changsha, China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, Changsha, China; Clinical Research Center For Reproduction and Genetics In Hunan Province, China
| | - Fei Gong
- An Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University Changsha, China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China; Clinical Research Center For Reproduction and Genetics In Hunan Province, China.
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6
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Li J, Xu D, Ma L, Li L, Yang L. Adverse impact of CD138+ cells in proliferative-phase endometrium on pregnancy outcomes in fresh IVF/ICSI cycles. Medicine (Baltimore) 2023; 102:e33106. [PMID: 36897723 PMCID: PMC9997799 DOI: 10.1097/md.0000000000033106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/07/2023] [Indexed: 03/11/2023] Open
Abstract
To evaluate the impact of Syndecan-1 (CD138) in proliferative-phase endometrium on pregnancy outcomes in fresh in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) cycles. This retrospective cohort study contained 273 patients who underwent IVF/ICSI with fresh embryo transfer following an endometrial curettage from January 2020 to May 2022. Endometrial curettage was performed on all patients within 3 to 5 days following menstruation and endometrial tissue was acquired for detection of plasma cells by immunohistochemistry. Subsequent pregnancy outcomes of all cycles were traced and analyzed. A total of 149 patients became pregnant (i.e., pregnant group) in the fresh transfer IVF/ICSI cycles and 124 did not become pregnant (i.e., nonpregnant group). The number of CD138 + cells/ high-power field (HPF) of the nonpregnant group was significantly higher than the pregnant group (2.36 ± 4.24 vs 1.31 ± 3.41, P = .008). The cut off value of CD138 + cells/HPF was 2 by receiver operating characteristic curve analysis, with an area under the receiver operating characteristic curve of 0.572. Compared with the negative group (i.e., CD138 + cells/HPF < 2, n = 204), the positive group (i.e., CD138 + cells/HPF ≥ 2, n = 69) had a significantly lower clinical pregnancy rate (71.8% vs 40.6%, P < .001). The clinical pregnancy rate revealed a gradually decreasing trend with the increase in CD138 + cells. Proliferative-phase endometrial CD138 + cells may be an adverse indicator for pregnancy outcomes in fresh IVF/ICSI cycles, with a certain value in predicting non-pregnancy. Pregnancy outcome was poor when CD138 + cells/HPF ≥ 2 in the endometrium and may worsen with the increase in CD138 + cells.
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Affiliation(s)
- Jie Li
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Dujuan Xu
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Ling Ma
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lin Li
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lijuan Yang
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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7
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Dai J, Li Q, Zhou Q, Zhang S, Chen J, Wang Y, Guo J, Gu Y, Gong F, Tan Y, Lu G, Zheng W, Lin G. IQCN disruption causes fertilization failure and male infertility due to manchette assembly defect. EMBO Mol Med 2022; 14:e16501. [PMID: 36321563 PMCID: PMC9728048 DOI: 10.15252/emmm.202216501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Total fertilization failure (TFF) is an important cause of infertility; however, the genetic basis of TFF caused by male factors remains to be clarified. In this study, whole-exome sequencing was firstly used to screen for genetic causes of TFF after intracytoplasmic sperm injection (ICSI), and homozygous variants in the novel gene IQ motif-containing N (IQCN) were identified in two affected individuals with abnormal acrosome structures. Then, Iqcn-knockout mice were generated by CRISPR-Cas9 technology and showed that the knockout male mice resembled the human phenotypes. Additionally, we found that IQCN regulates microtubule nucleation during manchette assembly via calmodulin and related calmodulin-binding proteins, which resulted in head deformity with aberrant oocyte activation factor PLCζ. Fortunately, ICSI with assisted oocyte activation can overcome IQCN-associate TFF and male infertility. Thus, our study firstly identified the function of IQCN, highlights the relationship between the manchette assembly and fertilization, and provides a genetic marker and a therapeutic option for male-source TFF.
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Affiliation(s)
- Jing Dai
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical ScienceCentral South UniversityChangShaChina,Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina
| | - Qi Li
- Reproductive Medicine Center, Xiangya HospitalCentral South UniversityChangShaChina
| | - Qinwei Zhou
- Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina
| | - Shen Zhang
- Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina
| | - Junru Chen
- Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina
| | - Yize Wang
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical ScienceCentral South UniversityChangShaChina
| | - Jing Guo
- Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina
| | - Yifan Gu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical ScienceCentral South UniversityChangShaChina,Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning CommissionChangShaChina
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical ScienceCentral South UniversityChangShaChina,Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning CommissionChangShaChina
| | - Yueqiu Tan
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical ScienceCentral South UniversityChangShaChina,Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning CommissionChangShaChina
| | - Guangxiu Lu
- Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning CommissionChangShaChina
| | - Wei Zheng
- Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical ScienceCentral South UniversityChangShaChina,Reproductive and Genetic Hospital of CITIC‐XIANGYAChangShaChina,Clinical Research Center for Reproduction and Genetics in Hunan ProvinceChangShaChina,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning CommissionChangShaChina
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8
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Cicinelli E, McQueen DB, Huepfel B, Vitagliano A, Moreno I, Simon C, Pirtea P, Scott RT, Bellavia M, de Ziegler D. Should patients be screened for chronic endometritis before assisted reproductive technology? Fertil Steril 2022; 118:639-652. [PMID: 36182261 DOI: 10.1016/j.fertnstert.2022.08.846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Ettore Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Bari, Italy
| | - Dana B McQueen
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Chicago, Chicago, Ilinois
| | - Bridget Huepfel
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Chicago, Chicago, Ilinois
| | - Amerigo Vitagliano
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | - Inmaculada Moreno
- Carlos Simon Foundation, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Carlos Simon
- Carlos Simon Foundation, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, INCLIVA, Valencia, Spain; Department of Obstetrics and Gynecology BIDMC, Harvard University, Boston, Massachusetts
| | - Paul Pirtea
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, Hospital Foch, Suresnes, France.
| | - Richard T Scott
- IVIRMA New Jersey, Basking Ridge, New Jersey; Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Marina Bellavia
- Direttore Sanitario FMH Ginecologia - Ostetricia ed Procreazione Medico Assistita
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9
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Vitagliano A, Laganà AS, De Ziegler D, Cicinelli R, Santarsiero CM, Buzzaccarini G, Chiantera V, Cicinelli E, Marinaccio M. Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome-A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12092250. [PMID: 36140651 PMCID: PMC9498271 DOI: 10.3390/diagnostics12092250] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 01/10/2023] Open
Abstract
This systematic review and meta-analysis aims to evaluate the impact of chronic endometritis (CE) and its therapy on in vitro fertilization (IVF) outcome. Additionally, we aim to investigate whether various degrees of CE severity may exert a different effect on IVF outcome. Ongoing-pregnancy rate/live-birth-rate (OPR/LBR), clinical-pregnancy rate (CPR), and miscarriage rate (MR) were calculated. A total number of 4145 patients (from ten studies) were included. Women with CE had lower OPR/LBR (OR 1.97, p = 0.02) and CPR (OR 2.28, p = 0.002) compared to those without CE. CE cure increased OPR/LBR (OR 5.33, p < 0.0001) and CPR (OR 3.64, p = 0.0001). IVF outcome was comparable between women with cured CE and those without CE (OPR/LBR, CPR and MR: p = ns). Women with severe CE had lower OPR/LBR (OR 0.43, p = 0.003) and CPR (OR 0.40, p = 0.0007) compared to those mild CE. Mild CE showed no influence on the IVF outcome as compared to women without CE (OPR/LBR, CPR and MR: p = ns). Based on this data analysis, CE significantly reduces OPR/LBR and CPR in women undergoing IVF. Importantly, CE resolution after antibiotic therapy may improves IVF outcome, leading to similar OPR/LBR and CPR as compared to unaffected patients. The negative effects of CE on IVF outcome may be restricted to severe disease, whereas mild CE may have no influence on IVF success.
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Affiliation(s)
- Amerigo Vitagliano
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
- Correspondence:
| | - Dominique De Ziegler
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital Foch, Faculté de Médecine Paris Ouest (UVSQ), 92150 Suresnes, France
| | - Rossana Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Carla Mariaflavia Santarsiero
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Giovanni Buzzaccarini
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35128 Padua, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Marco Marinaccio
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
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10
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Dai J, Chen Y, Li Q, Zhang T, Zhou Q, Gong F, Lu G, Zheng W, Lin G. Pathogenic variant in ACTL7A causes severe teratozoospermia characterized by bubble-shaped acrosomes and male infertility. Mol Hum Reprod 2022; 28:6648105. [PMID: 35863052 DOI: 10.1093/molehr/gaac028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/04/2022] [Indexed: 11/12/2022] Open
Abstract
Teratozoospermia is a common factor associated with male infertility. However, teratozoospermia characterized by bubble-shaped acrosomes (BSAs) has not yet been identified in men and the causative genes are unknown. The present study is of a patient with severe teratozoospermia characterized by BSA and carrying a variant (c.1204G>A, p. Gly402Ser) of actin-like 7A (ACTL7A). For further verification, we generated an Actl7a-mutated mouse model (p.Gly407Ser) carrying an equivalent variant to that in the patient. We found that homozygous Actl7a-mutated (Actl7aMut/Mut) male mice were sterile, and all their sperm showed acrosomal abnormalities. We detected, by transmission electron microscopy, that during acrosomal biogenesis the acrosome detaches from the nuclear membrane in Actl7aMut/Mut mice. Furthermore, mutant ACTL7A failed to attach to the acroplaxome and was discharged by cytoplasmic droplets, which led to the absence of ACTL7A in epididymal spermatozoa in mice. The mutant sperm failed to activate the oocyte, and sperm-borne oocyte activation factor PLCζ discharge accompanied by ACTL7A was observed, leading to total fertilization failure (TFF). Immunoprecipitation followed by liquid chromatography-mass spectrometry showed that several differentially expressed proteins participate in acrosome assembly and actin filament organization. Furthermore, assisted oocyte activation by calcium ionophore exposure successfully overcame TFF in the couple with an ACTL7A pathogenic variant. Our study defined a novel phenotype of an acrosomal abnormality characterized by BSA, revealed the underlying mechanism of a pathogenic variant in ACTL7A, and provided a genetic marker and potential therapeutic option for male infertility.
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Affiliation(s)
- Jing Dai
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, ChangSha, 410078, China.,Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, China.,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, ChangSha, 410078, China
| | - Yongzhe Chen
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, ChangSha, 410078, China
| | - Qi Li
- Xiangya Hospital Central South University, ChangSha, 410008, China
| | - Tianlei Zhang
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, China.,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, ChangSha, 410078, China
| | - Qinwei Zhou
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, China.,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, ChangSha, 410078, China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, ChangSha, 410078, China.,Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, China.,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, ChangSha, 410078, China
| | - Guangxiu Lu
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, China.,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, ChangSha, 410078, China
| | - Wei Zheng
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, China.,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, ChangSha, 410078, China
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, ChangSha, 410078, China.,Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, China.,Laboratory of Reproductive and Stem Cell Engineering, National Health and Family Planning Commission, ChangSha, 410078, China
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11
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The identification of endometrial immune cell densities and clustering analysis in the mid-luteal phase as predictor for pregnancy outcomes after IVF-ET treatment. J Reprod Immunol 2021; 148:103431. [PMID: 34627075 DOI: 10.1016/j.jri.2021.103431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 11/21/2022]
Abstract
Changes in endometrial immune cell density has been reported to be associated with reproductive failure. The prognostic value of endometrial immune cell density measurement remains uncertain. We aimed to investigate the prognostic value of endometrial immune cells measurement on pregnancy outcome after IVF in women. In this prospective study, one hundred twenty-eight women underwent endometrial sampling in a natural cycle preceding single frozen-thawed embryo transfer (ET). Endometrial biopsy was obtained precisely 7 days after luteinizing hormone surge (LH + 7). Multiplex immunohistochemical method was employed to simultaneously stain the endometrium samples with a panel of human antibodies against CD56 for uterine natural killer (uNK) cells, CD3 and CD8 for T cell, CD3 for pan T cells and CD68 for macrophages. The density of the various immune cells and the clustering levels between them were measured. ET was performed at the blastocyst stage. Women who did not conceive had a significantly higher density of uNK cells and higher clustering level between uNK cells-and-macrophages than women who did conceive. In accordance, the prognostic value of uNK measurement on pregnancy outcome was significantly improved when combined with uNK-to-macrophage clustering analysis simultaneously. Taken together, our results suggested that uNK cells density and clustering level between uNK cells-and macrophages may be a promising predictor for successful implantation after IVF-ET.
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12
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Tsonis O, Balogun S, Adjei JO, Mogekwu O, Iliodromiti S. Management of recurrent miscarriages: an overview of current evidence. Curr Opin Obstet Gynecol 2021; 33:370-377. [PMID: 34419993 DOI: 10.1097/gco.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Recurrent miscarriage (RM) or recurrent pregnancy loss (RPL) is defined as the consecutive loss of two or more pregnancies before the age of viability. The exact prevalence of RM is unknown, but it has been reported between 1% and 2%. The objective of this review is to provide a critical summary of the latest evidence for the investigation and management of women with RM. RECENT FINDINGS RMs are associated with multiple factors including increased female age and lifestyle habits, as well as genetic factors, hereditary and acquired thrombophilia and infections. Metabolic and endocrine factors, in addition to anatomical causes such as uterine malformations have also been suggested as a causative factors of RM. SUMMARY The management of RM would be expected to cause specific, however, in the majority of the cases no cause is identified, and the factors associated with RM may not be causally related with the condition.
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Affiliation(s)
| | | | | | | | - Stamatina Iliodromiti
- Bart's Health NHS Trust
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University
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13
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Fan X, Yang Y, Wen Q, Li Y, Meng F, Liao J, Chen H, Lu GX, Lin G, Gong F. CD19 and intraglandular CD163-positivity as prognostic indicators of pregnancy outcome in CD138-negative women with a previous fresh-embryo-transfer failure. J Reprod Immunol 2021; 147:103362. [PMID: 34482188 DOI: 10.1016/j.jri.2021.103362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/27/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
Many factors impede embryonic implantation, and excluding obvious known factors such as chronic endometritis, the immune status of the endometrium may be related to pregnancy. Although an abundantly large number of immune cells infiltrate the endometrium during the secretory phase, whether these immune cells can be used as a predictor of prognosis in ART has not yet been clarified. In the present study we therefore retrospectively analyzed 97 CD138-negative women with a previous fresh-embryo-transfer failure. We assessed the expression of CD56+ uNK cells, CD16+ NK cells, CD57+ NK cells, CD68+ pan-macrophages, CD163+ M2 macrophages, CD4+T cells, CD8+T cells, FOXP3+ regulatory T cells, and CD19+ B cells in the endometrium by IHC to evaluate mid-luteal endometrial immune cells as prognostic indicators of pregnancy outcome in the next frozen-embryo-transfer cycle. CD19-positive cells and the intraglandular CD163-positivity rate increased significantly in the clinically non-pregnant group (0.47 % vs. 0.20 %, P = 0.021; 61 % vs. 30 %, P = 0.017). The ratios of CD4/CD8 were also higher in the non-pregnant group (1.96 vs. 1.45, P = 0.005).The area under the ROC curve of CD19 cell number alone, the intraglandular CD163-positivity alone, and CD19 number combined with the intraglandular CD163-positivity were 0.692 (95 % CI, 0.55-0.834), 0.661 (95 % CI, 0.514-0.809), and 0.748 (95 % CI, 0.614-0.882), respectively. The optimal cut-off value of CD19 was 0.464 %, and the clinical pregnancy rate and live-birth rate diminished significantly when the CD19 level was above this cut-off value. Our study suggests that CD19-positive cells and intraglandular CD163-positivity can be used as prognostic indicators of pregnancy outcome in CD138-negative patients who experienced first-fresh-embryo transfer failure.
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Affiliation(s)
- Xiangxiu Fan
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, People's Republic of China; Clinical Research Center for Reproduction and Genetics In Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, People's Republic of China
| | - Yuanyuan Yang
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, People's Republic of China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, People's Republic of China
| | - Quan Wen
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, People's Republic of China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, People's Republic of China
| | - Yuan Li
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, People's Republic of China; Clinical Research Center for Reproduction and Genetics In Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, People's Republic of China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, People's Republic of China
| | - Fei Meng
- Clinical Research Center for Reproduction and Genetics In Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, People's Republic of China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, People's Republic of China
| | - Jingnan Liao
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, People's Republic of China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, People's Republic of China
| | - Huijun Chen
- Clinical Research Center for Reproduction and Genetics In Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, People's Republic of China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, People's Republic of China
| | - Guang-Xiu Lu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, People's Republic of China; Clinical Research Center for Reproduction and Genetics In Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, People's Republic of China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, People's Republic of China
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, People's Republic of China; Clinical Research Center for Reproduction and Genetics In Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, People's Republic of China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, People's Republic of China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, People's Republic of China; Clinical Research Center for Reproduction and Genetics In Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, People's Republic of China; NHC Key Laboratory of Human Reproductive and Stem Cell Engineering, People's Republic of China.
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14
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Lozano FM, Bernabeu A, Lledo B, Morales R, Diaz M, Aranda FI, Llacer J, Bernabeu R. Characterization of the vaginal and endometrial microbiome in patients with chronic endometritis. Eur J Obstet Gynecol Reprod Biol 2021; 263:25-32. [PMID: 34144490 DOI: 10.1016/j.ejogrb.2021.05.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/24/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the endometrial and vaginal microbiome of women with and without chronic endometritis. STUDY DESIGN A cohort study with 60 patients undergoing assisted reproductive treatment with their own or donated gametes was undertaken. Vaginal and endometrial samples were taken in the cycle prior to embryo transfer. The endometrial and vaginal microbiome was analysed by mass sequencing of the V3V4 region of 16S rRNA gene. Bioinformatics analysis was performed using QIIME2 and MicrobiomeAnalyst packages. Alpha diversity, beta diversity and taxonomic characterization were compared between samples that tested positive and negative for chronic endometritis on CD138 immunohistochemistry. RESULTS Different bacterial communities were detected when vaginal and endometrial samples were analysed in patients with and without endometritis diagnosed using CD138 immunohistochemistry. In patients with endometritis, a higher alpha-diversity index was found in vaginal samples (p = 0.15 for the Shannon index) and significant differences were found in endometrial samples (p = 0.01 for the Shannon index). In the beta-diversity analysis, no significant differences were observed between the groups with and without endometritis. Vaginal and endometrial samples from women with endometritis showed a microbiome pattern that was not dominated by Lactobacillus spp. Relative abundance analysis identified Ralstonia and Gardnerella spp. in endometrial samples, and Streptoccoccus and Ureaplasma spp. in vaginal samples of patients diagnosed with chronic endometritis on CD138 immunohistochemistry. When comparing endometrial and vaginal samples diagnosed with endometritis on CD138 immunohistochemistry, both alpha diversity (p = 0.06 for the Shannon index and p = 0.08 for the Simpson index) and beta diversity (p < 0.001) showed significant differences. Lactobacillus spp. (p = 3.76E-4), Ralstonia spp. (p = 8.19E-4), Delftia spp. (p = 0.004) and Anaerobacillus spp. (p = 0.004) were identified in these sample groups. CONCLUSION These results demonstrate the existence of a characteristic vaginal and endometrial microbiota in patients with chronic endometritis. Different genera and species were identified in patients with and without chronic endometritis depending on whether the sample was endometrial or vaginal. There is a clear relationship between changes in the vaginal microbiome and chronic endometritis. The microbiota is a continuum throughout the female reproductive tract, so study of the vaginal microbiota could be useful for the diagnosis of diseases of the upper reproductive tract, such as chronic endometritis.
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Affiliation(s)
- F M Lozano
- Instituto Bernabeu Biotech, Alicante, Spain.
| | - A Bernabeu
- Instituto Bernabeu of Fertility and Gynaecology, Alicante, Spain
| | - B Lledo
- Instituto Bernabeu Biotech, Alicante, Spain
| | - R Morales
- Instituto Bernabeu Biotech, Alicante, Spain
| | - M Diaz
- Instituto Bernabeu of Fertility and Gynaecology, Alicante, Spain
| | - F I Aranda
- Servicio Anatomía Patológica, HGUA, Alicante, Spain
| | - J Llacer
- Instituto Bernabeu of Fertility and Gynaecology, Alicante, Spain
| | - R Bernabeu
- Instituto Bernabeu of Fertility and Gynaecology, Alicante, Spain
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15
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Makrigiannakis A, Makrygiannakis F, Vrekoussis T. Approaches to Improve Endometrial Receptivity in Case of Repeated Implantation Failures. Front Cell Dev Biol 2021; 9:613277. [PMID: 33796523 PMCID: PMC8007915 DOI: 10.3389/fcell.2021.613277] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/28/2021] [Indexed: 12/11/2022] Open
Abstract
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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Affiliation(s)
- Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
| | | | - Thomas Vrekoussis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
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16
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Hirata K, Kimura F, Nakamura A, Kitazawa J, Morimune A, Hanada T, Takebayashi A, Takashima A, Amano T, Tsuji S, Kaku S, Kushima R, Murakami T. Histological diagnostic criterion for chronic endometritis based on the clinical outcome. BMC WOMENS HEALTH 2021; 21:94. [PMID: 33663485 PMCID: PMC7934457 DOI: 10.1186/s12905-021-01239-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 02/23/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The diagnostic criteria of chronic endometritis remain controversial in the treatment for infertile patients. METHODS A prospective observational study was conducted in a single university from June 2014 to September 2017. Patients who underwent single frozen-thawed blastocyst transfer with a hormone replacement cycle after histological examination for the presence of chronic endometritis were enrolled. Four criteria were used to define chronic endometritis according to the number of plasma cells in the same group of patients: 1 or more (≥ 1) plasma cells, 2 or more (≥ 2), 3 or more (≥ 3), or 5 or more (≥ 5) in 10 high-power fields. Pregnancy rates, live birth rates, and miscarriage rates of the non-chronic endometritis and the chronic endometritis groups defined with each criterion were calculated. A logistic regression analysis was performed for live births using eight explanatory variables (seven infertility factors and chronic endometritis). A receiver operating characteristic curve was drawn and the optimal cut-off value was calculated. RESULTS A total of 69 patients were registered and 53 patients were finally analyzed after exclusion. When the diagnostic criterion was designated as the presence of ≥ 1 plasma cell in the endometrial stroma per 10 high-power fields, the pregnancy rate, live birth rate, and miscarriage rate were 63.0% vs. 30.8%, 51.9% vs. 7.7%, and 17.7% vs. 75% in the non-chronic and chronic endometritis groups, respectively. This criterion resulted in the highest pregnancy and live birth rates among the non-chronic endometritis and the smallest P values for the pregnancy rates, live birth rates, and miscarriage rates between the non-chronic and chronic endometritis groups. In the logistic regression analysis, chronic endometritis was an explanatory variable negatively affecting the objective variable of live birth only when chronic endometritis was diagnosed with ≥ 1 or ≥ 2 plasma cells per 10 high-power fields. The optimal cut-off value was obtained when one or more plasma cells were found in 10 high-power fields (sensitivity 87.5%, specificity 64.9%). CONCLUSIONS Chronic endometritis should be diagnosed as the presence of ≥ 1 plasma cells in 10 high-power fields. According to this diagnostic criterion, chronic endometritis adversely affected the pregnancy rate and the live birth rate.
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Affiliation(s)
- Kimiko Hirata
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan.,Goto Ladies Clinic, 4-13 Hakubaicho, Takatsuki, Osaka, 569-1116, Japan
| | - Fuminori Kimura
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan.
| | - Akiko Nakamura
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Jun Kitazawa
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Aina Morimune
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Tetsuro Hanada
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Akie Takebayashi
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan.,Department of Obstetrics and Gynaecology, National Hospital Organization Shiga Hospital, 255 Gochi-cho, Higashioumi, Shiga, 527-8505, Japan
| | - Akiko Takashima
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Tsukuru Amano
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Shoji Kaku
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
| | - Ryoji Kushima
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynaecology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shifga, 520-2192, Japan
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Song D, He Y, Wang Y, Liu Z, Xia E, Huang X, Xiao Y, Li TC. Impact of antibiotic therapy on the rate of negative test results for chronic endometritis: a prospective randomized control trial. Fertil Steril 2021; 115:1549-1556. [PMID: 33549312 DOI: 10.1016/j.fertnstert.2020.12.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the rates of negative test results for chronic endometritis (CE) between subjects who did and did not receive antibiotic treatment. DESIGN Prospective, single-blind randomized controlled trial. SETTING Tertiary hysteroscopic center in a university teaching hospital. PATIENT(S) A total of 132 women with CE confirmed with immunohistochemical study with CD138 epitope. INTERVENTION(S) Women randomized to antibiotic therapy received oral levofloxacin 500 mg and tinidazole 1,000 mg daily for 14 days. Women randomized to the control group did not receive any treatment. A repeated endometrial biopsy was performed 4 to 8 weeks after the initial biopsy to determine whether CE was still present. MAIN OUTCOME MEASURE(S) The rate of negative test results for CE (from positive to negative). RESULT(S) The CE rate of negative test results in the treatment group (89.3%) after one course of antibiotic treatment was significantly higher than that in the control group (12.7%). Among subjects who attempted pregnancy, there was no significant difference in ongoing pregnancy rates and miscarriage rates between the treatment arm (43.2%, 5.4%) and the control arm (25.7%, 14.3%). Among subjects randomized, there was also no significant difference in ongoing pregnancy rates and miscarriage rates between the treatment arm (27.1%, 3.4%) and the control arm (16.4%, 9.1%). CONCLUSION A course of broad-spectrum oral antibiotic therapy for 14 days is effective in the treatment of CE in >89.8% of cases. However, it is not yet clear whether treatment improved pregnancy outcomes. CLINICAL TRIAL IDENTIFICATION NUMBER NCT02648698.
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Affiliation(s)
- Dongmei Song
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Yanfei He
- Reproductive Health Department, Dezhou Decheng Maternal and Child Health Hospital, Shandong, People's Republic of China
| | - Yixuan Wang
- University of Science and Technology, Beijing, People's Republic of China
| | - Ziyu Liu
- Department of Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Enlan Xia
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Xiaowu Huang
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Yu Xiao
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Tin-Chiu Li
- Department of Hysteroscopic Centre, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China; Assisted Conception Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China.
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18
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Tian X, Song JY, Sun ZG. Effects of waiting time between failed fresh cycle embryo transfer and the next frozen embryo transfer on pregnancy outcomes in assisted reproductive technology. Int J Gynaecol Obstet 2020; 153:248-253. [PMID: 33124045 DOI: 10.1002/ijgo.13453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/03/2020] [Accepted: 10/28/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore how waiting time after failed fresh cycle embryo transfer affects the pregnancy outcomes of the next frozen embryo transfer (FET). METHODS A retrospective analysis was carried out on the data of women who had received at least one FET after a failed fresh embryo transfer between January 2013 to December 2019. The women were grouped based on the "time" of the first FET, referring to the period between a failed fresh embryo transfer and the beginning of the next cycle of FET. This time is divided into two classes: immediate (<90 days after the failed fresh embryo transfer) and delayed (≥90 days after failed fresh embryo transfer). The following parameters were investigated: clinical pregnancy rate; biochemical pregnancy rate; ectopic pregnancy rate; and non-pregnancy rate. RESULTS A total of 293 cases of fresh embryo transfer cycles were included. No significant differences in the number of obtained oocytes, total number of FET, and the total amount of gonadotropin were seen between the immediate and delayed fresh embryo transfer groups. The pregnancy outcomes of the two groups were similar. CONCLUSION The duration of waiting time between failed fresh embryo transfer and the next FET does not affect pregnancy outcomes.
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Affiliation(s)
- Xiao Tian
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhen-Gao Sun
- Reproduction and Genetics Center of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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19
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Xu Y, Mei J, Diao L, Li Y, Ding L. Chronic endometritis and reproductive failure: Role of syndecan-1. Am J Reprod Immunol 2020; 84:e13255. [PMID: 32329146 DOI: 10.1111/aji.13255] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022] Open
Abstract
Chronic endometritis (CE) is an unusual inflammatory condition characterized by endometrial plasmacyte infiltration. It has a high prevalence in women with reproductive failure. Because of its characteristic localization patterns and molecular functions, syndecan-1 has been identified as a biomarker of plasmacyte, and syndecan-1 immunohistochemistry (IHC) becomes the most dependable diagnostic method for CE. In this review, we discuss the association between CE and reproductive failure, the clinicopathological characterization of CE, the function and expression of syndecan-1, the progress of syndecan-1 IHC in the diagnosis of CE, and the prediction of reproductive outcome.
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Affiliation(s)
- Yanhong Xu
- Center for Reproductive Medicine, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China.,Department of Obstetrics and Gynecology, Center for Reproductive Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Mei
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Lianghui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yuye Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Lijun Ding
- Center for Reproductive Medicine, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China.,Department of Obstetrics and Gynecology, Center for Reproductive Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Clinical Center for Stem Cell Research, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Testing the endometrium: is there enough evidence to justify clinical use? Curr Opin Obstet Gynecol 2020; 32:185-190. [DOI: 10.1097/gco.0000000000000627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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