Prevalence of chronic endometritis in patients with infertility due to hydrosalpinx or pelvic peritubal adhesions and effect of laparoscopic surgical correction on pregnancy rates post in vitro fertilization. (May 2023)

• Record Type: Journal Article
• Authors: Osada, Hisao; Seto, Michiharu; Nakase, Kaori; Ezoe, Kenji; Miyauchi, Osamu; Fujita, Hiroshi; Miyakawa, Yasuji; Nagaishi, Masaji; Kato, Keiichi; Teramoto, Shokichi; Shozu, Makio
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 284(2023)
• Page Start: 143
• Page End: 149
• Publication Date: 2023-05
• Subjects: CE chronic endometritis -- CPR clinical pregnancy rate -- LBR live birth rate -- IVF–ET in vitro fertilization and embryo transfer -- HSG hysterosalpingography -- LSC laparoscopic surgical correction -- MRI magnetic resonance imaging -- TUS transvaginal ultrasonography -- HPF high-power fields -- PC plasma cells; Tubal factor infertility -- Tuboplasty -- Endometriosis -- Endometrial implant ablation -- Proximal tubal occlusion; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2023.03.021
• Languages: English
• ISSNs: 0301-2115

Abstract

Highlights: Chronic endometritis causes recurrent implantation failure and pregnancy loss. Conventional chronic endometritis treatment involves the use of strong antibiotics. Pathological fluid via fallopian tube maybe the cause of chronic endometritis. Laparoscopically correcting the tube and adhesion improves chronic endometritis. Abstract: Objective(s): To assess the prevalence of chronic endometritis (CE) in patients with infertility and hydrosalpinx or peritubal adhesions and to examine the effects of laparoscopic surgical correction (LSC) on CE and pregnancy rates post in vitro fertilization and embryo transfer (IVF-ET). Study design: This is a retrospective cohort study at private IVF-ET centers. A total of 438 patients, known to have hydrosalpinx (n = 194) or peritubal adhesions (n = 244), and undergoing IVF treatment between April 1, 2018 and September 30, 2020 were included in the study. Hysterosalpingography, magnetic resonance imaging, and transvaginal ultrasonography were used to diagnose the hydrosalpinx or peritubal adhesions. Laparoscopic examination and surgical correction were performed on patients with CE. IVF-ET was performed after recovery from LSC. Results: CE was present in 45.9% of patients (89/194) with hydrosalpinx and 14.3% with peritubal adhesions (35/244). All the 89 patients with CE and hydrosalpinx underwent laparoscopic salpingostomy and/or fimbrioplasty, and 64 (71.9%) further underwent proximal tubal occlusion. All the 35 patients with CE and peritubal adhesions underwent laparoscopic adhesiolysis and/or fimbrioplasty, and 19 (54.3%) further underwent proximal tubal occlusion. CD138 PC levels after LSC decreased to < 5 in 70 of 124 patients (56.5%) in one menstrual cycle and decreased to < 5 in all cases within 6 months. Of the 66 patients who underwent a single blastocyst transfer, 57 delivered (cumulative live birth rate (LBR): 86.3%). The cumulative LBR of patients treated for CE with LSC (86.3%) was significantly different from those given antibiotic therapy (320 patients; 38.4%; p <.0001) and the CD138-negative groups (811; 31.8%; p <.0001). Conclusion: CE is prevalent in patients with hydrosalpinx and/or peritubal adhesions who present with infertility. LSC improved CE without antibiotic therapy, improving the CP and LBR after IVF-ET.