慢性子宫内膜炎对不孕的影响：患病率、生殖结局，以及宫腔镜作为筛查工具的作用。

The Impact of Chronic Endometritis on Infertility: Prevalence, Reproductive Outcomes, and the Role of Hysteroscopy as a Screening Tool.

机构信息

Department of Gynaecology, UZ Leuven, Leuven, Belgium.

Department of Gynaecology, GZA Hospitals, Antwerp, Belgium.

出版信息

Gynecol Obstet Invest. 2023;88(2):108-115. doi: 10.1159/000529304. Epub 2023 Feb 3.

DOI:10.1159/000529304

PMID:36739858

Abstract

OBJECTIVES

The objective of this study was to examine the prevalence of chronic endometritis (CE) in infertile women, its impact on reproductive outcomes, and the accuracy of hysteroscopy as a screening tool for CE.

DESIGN

This was a prospective observational study.

PARTICIPANTS

Participants involved in this study were 514 asymptomatic patients with infertility.

SETTING

The review was conducted in a tertiary care center.

METHODS

The participants underwent a hysteroscopy and endometrial biopsy (EMB). Antibiotics were given for cases of CE. We investigated the prevalence of CE in patients starting assisted reproductive technologies (ART) as a primary outcome. Secondary outcomes were the clinical pregnancy rate (CPR) in the ART cycle after hysteroscopy, EMB, and antibiotic treatment in cases of CE; the cumulative CPR in the subsequent 2 years after hysteroscopy and EMB; the sensitivity and specificity of hysteroscopy as a screening tool compared to EMB as the "gold standard" for diagnosing CE.

RESULTS

CE was identified in 2.8% of patients starting ART (11/393). CPRs did not differ significantly between patients with CE and the entire cohort of patients without CE in the subsequent ART cycle (OR: 0.43; 95% CI: 0.09-2.02) or in the 2 years after EMB (OR: 0.56; 95% CI: 0.16-1.97). In a matched control comparison (with matching for age, basal FSH, and cause of infertility), CPR in patients with CE did not differ in the subsequent ART cycle (OR: 0.39; 95% CI: 0.09-1.61); however, their CPR in the 2 years after EMB was significantly lower (OR: 0.22; 95% CI: 0.13-0.38). The sensitivity and specificity of hysteroscopy as a screening tool for diagnosing CE were 8.3% and 90.1%, respectively.

LIMITATIONS

Due to our cohort's low CE prevalence, we could not detect significant differences in CPRs.

CONCLUSION

CE is rare in our studied population of asymptomatic patients starting ART. Hysteroscopy cannot replace EMB for diagnosing CE.

摘要

目的

本研究旨在探讨不孕女性慢性子宫内膜炎（CE）的患病率、对生殖结局的影响，以及宫腔镜作为 CE 筛查工具的准确性。

设计

这是一项前瞻性观察性研究。

参与者

本研究纳入了 514 例无症状不孕患者。

地点

本研究在一家三级保健中心进行。

方法

所有参与者均接受宫腔镜检查和子宫内膜活检（EMB）。对于 CE 患者，给予抗生素治疗。我们将作为主要结局的开始辅助生殖技术（ART）的患者中 CE 的患病率作为研究终点。次要结局包括宫腔镜、EMB 及 CE 治疗后 ART 周期的临床妊娠率（CPR）；宫腔镜、EMB 后 2 年内的累积 CPR；与 EMB 作为诊断 CE 的“金标准”相比，宫腔镜作为筛查工具的敏感性和特异性。

结果

在开始 ART 的患者中（393 例），有 2.8%（11/393）诊断为 CE。CE 患者与无 CE 的整个患者队列在随后的 ART 周期（OR：0.43；95%CI：0.09-2.02）或 EMB 后 2 年内（OR：0.56；95%CI：0.16-1.97）的 CPR 无显著差异。在匹配对照比较（匹配年龄、基础 FSH 和不孕原因）中，CE 患者在随后的 ART 周期中的 CPR 无差异（OR：0.39；95%CI：0.09-1.61）；然而，他们在 EMB 后 2 年内的 CPR 显著降低（OR：0.22；95%CI：0.13-0.38）。宫腔镜作为 CE 诊断筛查工具的敏感性和特异性分别为 8.3%和 90.1%。