Endometrial reaction to intrauterine device in pregnancy

The effectiveness of using a molded sorbent: Modified polyvinylpyrrolidone for the combined treatment of chronic endometritis

OBJECTIVE

To improve the management of patients with chronic endometritis (CE) by using a molded sorbent-modified by polyvinylpyrrolidone (FSMP).

METHODS

This prospective study included 70 patients with CE divided into two groups: group 1 (n = 23) received traditional antibiotic therapy (from days 3 to 10 of the menstrual cycle); group 2 (n = 47), received antibiotics and FSMP was inserted from days 5 to 10.

RESULTS

At the end of therapy, group 1 had massive growth of pathogenic microflora in 21.7%, moderate growth in 69.6%, and no growth in 8.7% of cases. In group 2, after combined therapy, massive growth was observed in 4.3%, moderate growth in 44.7%, and no growth in 51.0%. In group 2 after 5 days, serum levels of interleukin-1β (IL-1β) were 1.9 times, of IL-6 were 7.0 times, and of IL-8 and IL-1 receptor antagonist were 1.3 times lower than in group 1. In uterine cavity aspirates, IL-1β decreased around 4.8 times, IL-6 by 11.8 times, IL-8 by 3.2 times, tumor necrosis factor-α by 3.9 times, and IL-1 receptor antagonist by 2.1 times in comparison to group 1.

CONCLUSION

Combined therapy of FSMP with antibiotics is more effective in treating CE, because it contributes to the almost complete elimination of pathogens and toxins from the uterine cavity, blocking the local pro-inflammatory cascade.

Evaluation of endometrial inflammation by quantification of macrophages, T lymphocytes, and interleukin-1 and -6 in human endometrium

PURPOSE

Our purpose was to determine the impact of endometrial inflammation on fertility.

METHODS

The study population included 49 women: 5 women bearing an intrauterine device, 33 sterile patients, and 11 fertile women. Endometrial biopsies were performed between day 17 and day 21 of the cycle. Immunostaining was performed with an ABC kit. Monoclonal antibodies were CD68 for macrophages, CD3 for T lymphocytes, and B-E8 for interleukin (IL)-6; IL-1 alpha and IL-1 beta were stained with polyclonal antibodies. A double immunofluorescence staining was performed to identify endometrial cells. Macrophage and lymphocyte rates were defined as the percentage of stained cells by field. Double staining was compared among macrophages, T lymphocytes, and anti-IL antibodies in each group.

RESULTS

The macrophage rate was high for women bearing an intrauterine device, intermediate for sterile patients, and low for fertile women (P = 0.03). There was a lack of double staining between activated T lymphocytes and anti-IL-6 antibody in tubal sterility and endometriosis. Endometrial macrophages were stained with anti-IL antibodies for all groups.

CONCLUSIONS

Endometrial macrophages seem to be an interesting parameter for evaluating endometrial inflammation. In tubal infertility and endometriosis, the lack of expression of IL-6 in T lymphocytes could participate in impaired embryo implantation.