Buzzaccarini Giovanni, Vitagliano Amerigo, Andrisani Alessandra, Santarsiero Carla Mariaflavia, Cicinelli Rossana, Nardelli Claudia, Ambrosini Guido, Cicinelli Ettore
Gynecological Clinic, UOS Medically Assisted Procreation, University of Padova, via Nicolò Giustiniani 3, Padova, Italy.
Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Piazza G. Cesare 11, Bari, Italy.
J Assist Reprod Genet. 2020 Dec;37(12):2897-2911. doi: 10.1007/s10815-020-01955-8. Epub 2020 Oct 6.
Chronic endometritis (CE) is a frequent hysteroscopic and histological finding which affects embryo transfer implantation during IVF-ICSI cycles. In particular, CE impairs proper decidualization and, subsequently, implantation. Although this correlation has been clearly clarified, a pathophysiological explanation assembling all the studies performed has not been elucidated yet. For this reason, we have structured a systematic review considering all the original articles that evaluated a pathological element involved in CE and implantation impairment.
The authors searched electronic databases and, after screening, collected 15 original articles. These were fully scanned and used to create a summary pathway.
CE is primarily caused by infections, which lead to a specific cytokine and leukocyte pattern in order to prepare the uterus to fight the noxa. In particular, the immunosuppression requested for a proper semi-allogenic embryo transfer implantation is converted into an immunoreaction, which hampers correct embryo implantation. Moreover, endometrial vascularization is affected and both irregular vessel density and luminal thickening and thrombosis reduce what we have first identified as endometrial flow reserve. Finally, incorrect uterine wave propagation could affect embryo contact with decidua.
This is the first summary of evidence on CE pathophysiology and its relationship with infertility. Understanding the CE pathophysiology could improve our knowledge in embryo transfer success.
慢性子宫内膜炎（CE）是一种常见的宫腔镜和组织学表现，在体外受精-卵胞浆内单精子注射（IVF-ICSI）周期中会影响胚胎移植着床。特别是，CE会损害正常的蜕膜化，进而影响着床。尽管这种相关性已得到明确阐明，但尚未阐明综合所有已开展研究的病理生理学解释。因此，我们构建了一项系统评价，纳入了所有评估与CE及着床受损相关病理因素的原始文章。
作者检索了电子数据库，经筛选后收集了15篇原始文章。对这些文章进行了全面研读，并用于构建一条总结路径。
CE主要由感染引起，感染会导致特定的细胞因子和白细胞模式，从而使子宫做好抵抗有害物质的准备。特别是，为实现合适的半同种异体胚胎移植着床所需要的免疫抑制转变为一种免疫反应，阻碍了胚胎的正确着床。此外，子宫内膜血管生成受到影响，血管密度不规则以及管腔增厚和血栓形成都会降低我们最初确定的子宫内膜血流储备。最后，子宫波传播异常可能会影响胚胎与蜕膜的接触。
这是关于CE病理生理学及其与不孕症关系的证据的首次总结。了解CE病理生理学有助于提高我们对胚胎移植成功率的认识。
