Gawron Iwona, Derbisz Kamil, Jach Robert, Trojnarska Dominika, Milian-Ciesielska Katarzyna, Pietrus Milosz
Jagiellonian University Medical College, Faculty of Medicine, Chair of Gynecology and Obstetrics, Kopernika 23, 31-501, Krakow, Poland.
Clinical Department of Gynecological Endocrinology and Gynecology, University Hospital in Krakow, Kopernika 23, 31-501, Krakow, Poland.
BMC Womens Health. 2025 Mar 3;25(1):94. doi: 10.1186/s12905-025-03632-3.
Pelvic endometriosis is an estrogen-driven inflammatory syndrome of unknown origin that alters the peritoneal microenvironment and likely impairs endometrial receptivity, adversely affecting fertility. Chronic endometritis (CE) may be a potential contributing factor to reduced endometrial receptivity in endometriosis. The aim of the study was to analyze the correlation between pelvic endometriosis and CE.
The study included women undergoing laparoscopy for suspected pelvic endometriosis, and each underwent endometrial aspiration biopsy for CE. The stage of endometriosis was assessed intraoperatively, and CE activity was evaluated histopathologically and immunohistochemically. The associations between selected clinical characteristics of the disease and the density of endometrial plasma cells, immunohistochemical status, and histopathological profile of the endometrium were analyzed.
Stage III endometriosis reduced the risk of the inflammatory immunohistochemical profile by 80% (OR = 0.18, p = 0.037) when compared to Stage I. Peritoneal endometriosis was associated with a 3.429-fold increase in the risk of the immunohistochemical endometrial inflammatory profile (OR = 3.429, p = 0.038). No significant associations were found between the clinical features of the disease and plasma cell density or the histopathological profile of the endometrium (all p values > 0.05). No significant differences were observed in IVF use (p = 0.67), pregnancy rates (p = 1), or live birth rates (p = 0.41) between infertile women with and without CE.
Should peritoneal endometriosis be diagnosed during a laparoscopy conducted for the treatment of infertility, it is advisable to obtain an endometrial biopsy for CE evaluation, as this may enhance the efficacy of the therapeutic approach. The hypothetical link between pelvic endometriosis-related inflammation, its clinical manifestations, and CE requires further investigation. The lack of a noninvasive marker for endometriosis and its grade limits the study results due to reliance on surgical cases, highlighting the need for advanced research in the field of noninvasive diagnostic tools.
NCT05824507 (registered April 20, 2023).
盆腔子宫内膜异位症是一种由雌激素驱动的、病因不明的炎症综合征，它会改变腹膜微环境，并可能损害子宫内膜容受性，对生育能力产生不利影响。慢性子宫内膜炎（CE）可能是导致子宫内膜异位症中子宫内膜容受性降低的一个潜在因素。本研究的目的是分析盆腔子宫内膜异位症与CE之间的相关性。
该研究纳入了因疑似盆腔子宫内膜异位症而接受腹腔镜检查的女性，且每位女性均接受了用于诊断CE的子宫内膜抽吸活检。术中评估子宫内膜异位症的分期，并通过组织病理学和免疫组织化学方法评估CE的活性。分析了该疾病的选定临床特征与子宫内膜浆细胞密度、免疫组织化学状态以及子宫内膜组织病理学特征之间的关联。
与I期相比，III期子宫内膜异位症使炎症免疫组织化学特征的风险降低了80%（OR = 0.18，p = 0.037）。腹膜子宫内膜异位症与免疫组织化学子宫内膜炎症特征的风险增加3.429倍相关（OR = 3.429，p = 0.038）。未发现该疾病的临床特征与浆细胞密度或子宫内膜组织病理学特征之间存在显著关联（所有p值>0.05）。在患有和未患有CE的不孕女性之间，体外受精的使用情况（p = 0.67）、妊娠率（p = 1）或活产率（p = 0.41）均未观察到显著差异。
如果在因不孕症进行的腹腔镜检查中诊断出腹膜子宫内膜异位症，建议获取子宫内膜活检以评估CE，因为这可能会提高治疗方法的疗效。盆腔子宫内膜异位症相关炎症、其临床表现与CE之间的假设联系需要进一步研究。由于依赖手术病例，缺乏子宫内膜异位症及其分级的非侵入性标志物限制了研究结果，凸显了在非侵入性诊断工具领域进行深入研究的必要性。
NCT05824507（2023年4月20日注册）
