Michael R. Strug D.O., Ph.D. , Lindsay A. Hartup M.D. , Emily Ryan M.D. , Ruth B. Lathi M.D.
{"title":"Unveiling the silver lining: a narrative review of clinical evaluation and management of chronic endometritis and its impact on fertility","authors":"Michael R. Strug D.O., Ph.D. , Lindsay A. Hartup M.D. , Emily Ryan M.D. , Ruth B. Lathi M.D.","doi":"10.1016/j.xfnr.2024.100073","DOIUrl":null,"url":null,"abstract":"<div><p>Chronic endometritis (CE) is a challenging clinical diagnosis that is often encountered in patients with conditions impacting fertility. Evaluation for CE is somewhat controversial, largely because of a lack of consensus regarding appropriate screening methods and benefits of treatment. Testing is relatively invasive, requiring direct endometrial sampling with histologic evaluation for the presence of plasma cells, a key feature of CE. However, other testing methods have been proposed, including, more recently, microbiome testing. Moreover, defined histologic criteria are currently lacking with significant variability in practice patterns regarding diagnosis. We seek to comprehensively review the literature and examine what is known regarding the pathophysiology, histologic findings, clinical presentation, and treatment of CE. We further examine the association of CE and its implications for patients with conditions impacting fertility, including infertility, recurrent pregnancy loss, recurrent implantation failure, and endometriosis. On the basis of the evidence, we aim to better define when to initiate evaluation for CE and to determine indications for treatment. We also provide a clinical algorithm for CE screening and management.</p></div>","PeriodicalId":73011,"journal":{"name":"F&S reviews","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"F&S reviews","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666571924000069","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Chronic endometritis (CE) is a challenging clinical diagnosis that is often encountered in patients with conditions impacting fertility. Evaluation for CE is somewhat controversial, largely because of a lack of consensus regarding appropriate screening methods and benefits of treatment. Testing is relatively invasive, requiring direct endometrial sampling with histologic evaluation for the presence of plasma cells, a key feature of CE. However, other testing methods have been proposed, including, more recently, microbiome testing. Moreover, defined histologic criteria are currently lacking with significant variability in practice patterns regarding diagnosis. We seek to comprehensively review the literature and examine what is known regarding the pathophysiology, histologic findings, clinical presentation, and treatment of CE. We further examine the association of CE and its implications for patients with conditions impacting fertility, including infertility, recurrent pregnancy loss, recurrent implantation failure, and endometriosis. On the basis of the evidence, we aim to better define when to initiate evaluation for CE and to determine indications for treatment. We also provide a clinical algorithm for CE screening and management.
慢性子宫内膜炎(CE)是一种具有挑战性的临床诊断,经常在患有影响生育的疾病的患者中出现。对慢性子宫内膜炎的评估存在一定争议,这主要是因为对适当的筛查方法和治疗的益处缺乏共识。检测具有相对的侵入性,需要直接对子宫内膜取样,并对浆细胞的存在进行组织学评估,而浆细胞是 CE 的主要特征。不过,也有人提出了其他检测方法,包括最近提出的微生物组检测。此外,目前还缺乏明确的组织学标准,在诊断方面的实践模式也存在很大差异。我们试图全面回顾相关文献,研究有关 CE 的病理生理学、组织学发现、临床表现和治疗的已知信息。我们还进一步研究了 CE 与影响生育的疾病(包括不孕症、复发性妊娠失败、复发性植入失败和子宫内膜异位症)之间的关联及其对患者的影响。在证据的基础上,我们旨在更好地界定何时启动 CE 评估,并确定治疗的适应症。我们还提供了 CE 筛查和管理的临床算法。