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. 2022 Dec 17;22(1):529.
doi: 10.1186/s12905-022-02128-8.

The effectiveness of intrauterine antibiotic infusion versus oral antibiotic therapy in the treatment of chronic endometritis in patients during IVF (in vitro fertilization) procedures

Mihai Luncan  1   2 , Anca Huniadi  3   4   5 , Erika Bimbo-Szuhai  1   2 , Mihai Botea  1   2 , Ioana Zaha  1   6 , Liana Stefan  1   2   6 , Corina Beiusanu  1 , Dana Romanescu  1 , Annamaria Pallag  7 , Alin Bodog  1 , Laurean Ovidiu Pop  1 , Mircea Ioan Șandor  1
Affiliations

The effectiveness of intrauterine antibiotic infusion versus oral antibiotic therapy in the treatment of chronic endometritis in patients during IVF (in vitro fertilization) procedures

Mihai Luncan et al. BMC Womens Health. .

Abstract

Background: Chronic Endometritis (CE) is a subtle pathology, likely infectious in most cases, with a negative impact on the female fertility, but often overlooked even among fertility specialists. The purpose of the study is to demonstrate the predominant infectious nature of CE and to find the best therapeutic option by comparing the results of oral antibiotic therapy versus intrauterine antibiotic infusion in patients with CE undergoing IVF procedures. The objective was to compare the cure rate of CE-defined as the percentage of patients without CE at the test of cure, between the two groups and, the hysteroscopic aspect with the positive CD 138 staining.

Methods: This was a prospective, case-control study that took place in a single university fertility clinic, in Oradea, Romania and included 57 patients with CE divided into 2 groups: orally administered antibiotics group who received a combination of antibiotics compared to intrauterine infusion group who received intrauterine infusion of antibiotic. Chronic Endometritis was diagnosed through hysteroscopy and immunohistochemistry for CD 138. Patients in both groups were tested for CE twice to evaluate the cure rate after oral combination antibiotic therapy versus intrauterine infusion of antibiotic.

Results: Out of 115 patients with endometrial biopsies 57 tested positive for CE, with a 49.6% chronic endometritis prevalence. Among the group that was administered oral antibiotics, 11 patients (45.83%) experienced CE resolution after triple antibiotic therapy. Of the intrauterine infusion group, 25 patients (89.29%) presented negative results (p 0.0020). The normal hysteroscopic aspect had a similar prevalence in the patients with immunohistochemical positive and negative CD 138.

Conclusions: Our study demonstrated the effectiveness and superiority of intrauterine antibiotic infusion over the use of oral combination antibiotic therapy for CE cure.

Trial registration: ISRCTN17542620/14.09.2022.

Keywords: Chronic endometritis; Hysteroscopy; Immunohistochemistry for CD 138; Intrauterine antibiotic infusion; Oral antibiotic therapy.

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Conflict of interest statement

Not applicable.

Figures

Fig. 1
Fig. 1
Algorithm of patient selection in the study groups
Fig. 2
Fig. 2
Hysteroscopy findings in chronic endometritis. A. Generalized hyperemia. B. Pale mucosa with polyp. C. Pale mucosa with hemorrhagic spots. D. Strawberry aspect. E. Focal hyperemia. F. Micro-polyps
Fig. 3
Fig. 3
a. Fragment of the endometrial mucosa showing proliferative endometrial glands with an edematous stroma. It is difficult to identify plasma cells in HE staining. Most inflammatory cells are lymphocytes (HE 100X). b. Fragment of the endometrial mucosa that shows a positive reaction to CD138 by the IHC (immunohistochemical) technique. Positive control is represented by glandular epithelial cells. In the stroma there are cells with a positive expression (100x). c. The image shows the expression of the positive control (glands) for the CD138 reaction and in the stroma there are several cells with surface marker expression, with equal epithelial intensity of CD138 (plasma cells). Most stromal cells are negative. 200X
See this image and copyright information in PMC

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