Fertility, Infertilty and Perinatology Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Drs. Zargar, Ghafourian, Nikbakht, and Hosseini); Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Dr. Zargar).
Fertility, Infertilty and Perinatology Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Drs. Zargar, Ghafourian, Nikbakht, and Hosseini).
J Minim Invasive Gynecol. 2020 Jan;27(1):116-121. doi: 10.1016/j.jmig.2019.02.016. Epub 2019 Mar 6.
The identification of less invasive methods with acceptable diagnostic value for evaluating intrauterine abnormalities can improve the satisfaction of patients and physicians. Although hysteroscopy plus biopsy has favorable predictive and diagnostic values, limited studies have evaluated its value, and the exact value of this method is not completely understood. The aim of this study was to evaluate the prevalence of chronic endometritis in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) by hysteroscopy and immunohistochemistry.
A cross-sectional study.
An infertility clinic at Jundishapur University Hospital, Ahvaz, Iran.
Women with RIF after IVF and RPL.
Hysteroscopy on the third to fifth day after finishing the menstruation cycle and then a biopsy for immunohistochemistry by a specific monoclonal antibody against the CD138 marker.
In total, 85 patients with a mean age of 36.08 ± 5.76 years underwent hysteroscopy on the third to fifth day after finishing the menstruation cycle. At the end of hysteroscopy, a biopsy was taken and assessed using immunohistochemistry by a specific monoclonal antibody against the CD138 marker. Immunohistochemical staining findings of >5 plasma cells per 20 high-power fields were considered the gold standard. The prevalence of chronic endometritis (CE) in both groups and the diagnostic value of hysteroscopy were evaluated. All data were analyzed using the Fisher exact test and analysis of variance. The prevalence of RIF-related CE was 23.4% (11); 21.3% (10) of the cases were diagnosed by hysteroscopy. The prevalence of RPL-related CE was 36.8% (14) and 31.6% (12) based on hysteroscopy and immunohistochemistry staining, respectively. Subsequently, 10 patients (RIF/RPL-related CE with a positive hysteroscopic outcome) were selected randomly for in vitro fertilization therapy, and 3 (30%) of them eventually became pregnant. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy in diagnosing CE were 86.36%, 87.30%, 70.37%, and 94.82%, respectively.
Hysteroscopy is a reliable diagnostic technique in patients with RIF after in vitro fertilization and RPL that can reliably diagnose chronic endometritis.
寻找具有可接受诊断价值的微创方法来评估子宫内异常，这可以提高患者和医生的满意度。虽然宫腔镜加活检具有良好的预测和诊断价值，但有限的研究评估了其价值，并且这种方法的确切价值尚不完全清楚。本研究旨在通过宫腔镜和免疫组织化学评估反复种植失败（RIF）和复发性妊娠丢失（RPL）患者慢性子宫内膜炎的患病率。
横断面研究。
伊朗阿瓦士 Jundishapur 大学医院不孕不育科。
接受体外受精后 RIF 和 RPL 的患者。
在月经周期结束后的第 3 至第 5 天进行宫腔镜检查，然后通过针对 CD138 标志物的特异性单克隆抗体进行免疫组织化学活检。
共有 85 名平均年龄为 36.08 ± 5.76 岁的患者在月经周期结束后的第 3 至第 5 天接受了宫腔镜检查。宫腔镜检查结束时，进行活检，并使用针对 CD138 标志物的特异性单克隆抗体进行免疫组织化学评估。每个 20 高倍视野中 >5 个浆细胞的免疫组织化学染色结果被认为是金标准。评估了两组慢性子宫内膜炎（CE）的患病率和宫腔镜的诊断价值。使用 Fisher 确切检验和方差分析对所有数据进行分析。RIF 相关 CE 的患病率为 23.4%（11 例）；21.3%（10 例）通过宫腔镜诊断。RPL 相关 CE 的患病率为 36.8%（14 例）和 31.6%（12 例），分别基于宫腔镜和免疫组化染色。随后，随机选择 10 名（RIF/RPL 相关 CE 宫腔镜检查结果阳性）患者进行体外受精治疗，其中 3 名（30%）最终怀孕。宫腔镜诊断 CE 的灵敏度、特异性、阳性和阴性预测值分别为 86.36%、87.30%、70.37%和 94.82%。
在体外受精后 RIF 和 RPL 患者中，宫腔镜是一种可靠的诊断技术，可可靠地诊断慢性子宫内膜炎。
