Natural ART Clinic Nihombashi, Tokyo Nihombashi Tower (8F), 2-7-1 Nihombashi, Chuo-ku, Tokyo 103-6028, Japan.
Seto Hospital, 8-6 Kanayama-cho, Tokorozawa-shi, Saitama 359-1128, Japan.
Eur J Obstet Gynecol Reprod Biol. 2023 May;284:143-149. doi: 10.1016/j.ejogrb.2023.03.021. Epub 2023 Mar 21.
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).
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.
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).
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.
评估不孕患者合并输卵管积水或周围粘连时慢性子宫内膜炎（CE）的患病率，并研究腹腔镜手术矫正（LSC）对体外受精-胚胎移植（IVF-ET）后 CE 和妊娠率的影响。
这是在私立 IVF-ET 中心进行的回顾性队列研究。共有 438 名已知患有输卵管积水（n=194）或周围粘连（n=244）并于 2018 年 4 月 1 日至 2020 年 9 月 30 日接受 IVF 治疗的患者纳入本研究。子宫输卵管造影、磁共振成像和经阴道超声用于诊断输卵管积水或周围粘连。对 CE 患者进行腹腔镜检查和手术矫正。LSC 恢复后进行 IVF-ET。
输卵管积水患者中 CE 发生率为 45.9%（89/194），周围粘连患者中 CE 发生率为 14.3%（35/244）。所有 89 例输卵管积水合并 CE 患者均行腹腔镜输卵管造口术和/或输卵管造口术，其中 64 例（71.9%）进一步行近端输卵管阻塞术。所有 35 例周围粘连合并 CE 患者均行腹腔镜粘连松解术和/或输卵管造口术，其中 19 例（54.3%）进一步行近端输卵管阻塞术。124 例患者中有 70 例（56.5%）在一个月经周期内 LSC 后 CD138 PC 水平降至<5，所有患者在 6 个月内降至<5。66 例接受单个囊胚移植的患者中，57 例分娩（累积活产率（LBR）：86.3%）。接受 LSC 治疗的 CE 患者的累积 LBR（86.3%）与接受抗生素治疗的患者（320 例；38.4%；p<.0001）和 CD138 阴性组（811 例；31.8%；p<.0001）显著不同。
不孕合并输卵管积水或周围粘连的患者中 CE 较为常见。LSC 可改善 CE 而无需抗生素治疗，提高 IVF-ET 后的 CP 和 LBR。
