A group of 65 IUD users was studied during a period of 165 years of use, with a mean of 2.6 +/- 1.7 years per woman. The main complaint which differed significantly from the 120 controls was the occurrence of spotting in 33.8% of IUD users. Normal endometrial mucosae were found in 36.9% of IUD users and 38.7% of controls. Chronic endometritis was evidenced in 35.4% of IUD users versus 12.5% of controls; the former were asymptomatic in 25.0% of the cases. 39.1% of them had normal endometrial synchrony. Chronic endometritis occurred 2.2 +/- 1.3 years after insertion of the device. Endometritis was always symptomatic in controls; only 13.3% of them exhibited endometrial synchrony. The fundamental mechanism(s) responsible for the contraceptive efficiency of intrauterine contraceptive devices (IUD) remains a subject of controversy and a field of investigation. The most recent studies are essentially directed towards the biochemical analysis of uterine fluid [1]. Nevertheless, the presence of an inflammatory process, either morphologically or biochemically detectable, seems to be one of the fundamental modifications induced by the IUD. Since a certain reluctance to use IUDs has been observed in some countries, which has been ascribed mainly to contradictory reports on the risk of pelvic inflammatory disease (PID) in women wearing such devices [2], we found it interesting to intend to objectivate and reevaluate the influence of IUD on chronic aspecific endometritis, a possible precursor state of salpingitis and PID.

To evaluate the association between endometriosis end chronic endometritis (CE) diagnosed by hysteroscopy, conventional histology, and immunohistochemistry.Case-control study.University hospital.Women with and without endometriosis who have undergone hysterectomy.Retrospective evaluation of 78 women who have undergone hysterectomy and were affected by endometriosis and 78 women without endometriosis.CE diagnosed based on conventional histology and immunohistochemistry with anti-syndecan-1 antibodies to identify CD138 cells.The prevalence of CE was statistically significantly higher in the women with endometriosis as compared with the women who did not have endometriosis (33 of 78, 42.3% vs. 12 of 78, 15.4% according to hysteroscopy; and 30 of 78, 38.5% vs. 11 of 78, 14.1% according to histology). The women were divided into two groups, 115 patients without CE and 41 patients with CE. With univariate analysis, parity was associated with a lower risk for CE, and endometriosis was associated with a statistically significantly elevated risk of CE. Using multivariate analysis, parity continued to be associated with a lower incidence of CE, whereas endometriosis was associated with a 2.7 fold higher risk.The diagnosis of CE is more frequent in women with endometriosis. Although no etiologic relationships between CE and endometriosis can be established, this study suggests that CE should be considered and if necessary ruled out in women with endometriosis, particularly if they have abnormal uterine bleeding. Identification and appropriate treatment of CE may avoid unnecessary surgery.Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

To identify maternal clinical risk factors for postcesarean maternal infection in a randomized clinical trial of preincision extended-spectrum antibiotic prophylaxis.We conducted a planned secondary analysis of a randomized clinical trial. Patients were 24 weeks of gestation or greater and delivered by cesarean after a minimum of 4 hours of ruptured membranes or labor. All participants received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model for maternal infection.Of 2,013 patients, 1,019 were randomized to azithromycin. Overall, 177 (8.8%) had postcesarean maternal infection. In the final adjusted model, compared with the reference groups, women of black race-ethnicity, with a nontransverse uterine incision, with duration of membrane rupture greater than 6 hours, and surgery duration greater than 49 minutes, were associated higher odds of maternal infection (all with adjusted odds ratios [ORs] of approximately 2); azithromycin was associated with lower odds of maternal infection (adjusted OR 0.4, 95% confidence interval 0.3-0.6).Despite preincision azithromycin-based extended-spectrum antibiotic prophylaxis, postcesarean maternal infection remains a significant source of morbidity. Recognition of risk factors may help guide innovative prevention strategies.ClinicalTrials.gov, https://clinicaltrials.gov, NCT012235546.

The histologic and clinical manifestations of chronic endometritis were reviewed in 99 women. The morphologic features found to be of value in diagnosing this condition were superficial stromal edema, increased stromal density, and pleomorphic stromal inflammatory infiltrate dominated by lymphocytes in the absence of premenstrual changes or any other significant pathologic endometrial lesions. When these changes were present, a plasma cell infiltrate was invariably found. Clinically, the major presenting complaint was vaginal bleeding in 94% of the patients. No correlation was found between the presenting clinical complaint and either the extent of the lesion or the number of plasma cells in the leukocyte infiltrate. On follow-up, the lesion appeared to be eradicated by biopsy or curettage in approximately 80% of the patients. The major predisposing conditions were found to be intrauterine leiomyomas and a recent endometrial biopsy or curettage. The limitations of the plasma cells criterion for recognition of the lesion are discussed.

To determine in women with recurrent pregnancy loss (RPL) and/or implantation failure (RIF) the prevalence of chronic endometritis (CE), systemic inflammation and autoimmunity, and whether they relate.

Endometritis is defined as an infection or inflammation of the endometrium. Endometritis is of two types: acute and chronic. Acute endometritis is the symptomatic acute inflammation of the endometrium, which upon examination with a microscope shows micro-abscess and neutrophil invasion in the superficial endometrium. One of its most common manifestations is postpartum endometritis. Chronic endometritis is a silent disease usually diagnosed on the workup of secondary amenorrhoea and infertility. An important cause of chronic endometritis is tuberculosis, especially in developing nations. Chronic and acute endometritis have been associated with poor reproductive outcomes. Worse outcomes have been reported for individuals with chronic endometritis. This is a scoping review of endometritis and its impact on fertility.

Endometritis is subdivided into two categories. Acute endometritis is symptomatic and characterized by microabscess formation and neutrophil invasion in the endometrial superficial epithelium, gland lumina, and uterine cavity. Chronic endometritis is rather silent and recognized as unusual plasmacyte infiltration in the endometrial stromal areas. Over the last decade, studies have disclosed the potential association between poor reproductive outcomes and endometritis, particularly chronic endometritis. The aim of this review is to address the current literature surrounding chronic endometritis and highlight recent advances in the research of this long-neglected gynecologic disease.Copyright © 2018 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Chronic endometritis was identified immunohistochemically in 9.3% of patients with recurrent miscarriages (in 12.9% of patients with miscarriages of unknown etiology). Chronic endometritis is not negligible in patients with recurrent miscarriages.Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

\n Background.\n It is widely assumed that the uterine cavity in non-pregnant women is physiologically sterile, also as a premise to the long-held view that human infants develop in a sterile uterine environment, though likely reflecting under-appraisal of the extent of the human bacterial metacommunity. In an exploratory study, we aimed to investigate the putative presence of a uterine microbiome in a selected series of non-pregnant women through deep sequencing of the V1-2 hypervariable region of the 16S ribosomal RNA (rRNA) gene.\n

In a prospective open study the sterility of the uterine cavity was evaluated in 99 women admitted for hysterectomy. The indications for hysterectomy were in most cases persistent irregular vaginal bleeding and fibromyomas of the uterus. Samples for both aerobic and anaerobic bacteria, Chlamydia trachomatis, yeasts and viruses were taken preoperatively from the apex of the vagina and cervical of. Immediately after hysterectomy the uterus was opened under sterile conditions and samples obtained from the isthmus and fundus of the uterine cavity for microbiological examination. Wet smears were taken from the same sites.

While endometrial neutrophils and plasma cells are criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease (PID) research, plasma cell misidentification and nonspecificity may limit the accuracy of these criteria. Herein, we examined: (1) the identification of endometrial plasma cells with conventional methyl green pyronin-based methodology versus plasma cell-specific (CD138) immunostaining, (2) the prevalence of endometrial plasma cells among women at low risk for PID, and (3) endometrial leukocyte subpopulations among women diagnosed with acute or chronic histologic endometritis by conventional criteria. We observed an absence of CD138+ cells in 25% of endometrial biopsies in which plasma cells had been identified by conventional methodology, while additional immunohistochemical analyses revealed indistinguishable inflammatory infiltrates among women diagnosed with acute or chronic endometritis by conventional criteria. Among women considered at lower risk for PID development, flow cytometric analyses detected plasma cells in 30% of endometrial biopsy specimens, suggesting that these cells, even when accurately identified, only nonspecifically identify upper genital tract inflammatory processes. Combined, our findings underscore the limitations of the criteria used to diagnose histologic endometritis in PID-related research and suggest that satisfactory understanding of PID pathogenesis, treatment, and prevention is hindered by continued use of these criteria.Copyright © 2011 Elsevier GmbH. All rights reserved.

This report describes the case of a 32-year-old female with chronic pelvic pain who was otherwise in good health. Endocervical curettings contained rare cells with intranuclear and cytoplasmic inclusions characteristic of cytomegalovirus (CMV) infection. Endometrial curettings demonstrated a stromal lymphocytic and plasmacytic infiltrate as well as numerous small, non-necrotizing granulomas, but no CMV by microscopic examination. However, CMV was identified by the polymerase chain reaction in DNA extracted from a paraffin section of the endometrial tissue. In conjunction with previous reports, the clinical and pathologic features of this case suggest that CMV can cause chronic endometritis in nonimmunocompromised patients. Furthermore, CMV infection should be considered in the differential diagnosis of granulomatous endometritis. This case demonstrates the usefulness of using the polymerase chain reaction to detect CMV in paraffin-embedded material.

To determine whether lymphocytic infiltration of the endometrium accompanies human immunodeficiency virus (HIV) infection.Endometrial samples from 12 HIV-infected women and from rigorously matched controls were examined. The following markers were used: common leukocyte antigen (CD45), T lymphocytes (CD3), monocytes-macrophages (CD68), and CD4 and CD8 lymphocytes. Cell counts were performed without knowledge of HIV status. Factors considered in relation to these markers were menstrual symptoms, pelvic pain, peripheral blood CD4+ count, and time since seroconversion.Histology showed conventional features of chronic endometritis in only one case. In the remainder, the endometrium of HIV-infected women, compared with controls, showed an increase in CD45 cells (P <.02) and an increase in CD3 staining cells (P <.05). This appeared to be restricted to those with menstrual symptoms, and this group also had lower peripheral blood CD4 counts. There was no difference in cells of the monocyte-macrophage series (CD68). In contrast to control samples, CD4 lymphocytes were infrequent or absent in the endometrium of HIV-infected women, regardless of peripheral blood CD4 count or presence of menstrual symptoms; however, this was not universal, as one sample showed an area of dense CD4 cell infiltration. The ratio of CD4 to CD8 was reduced in HIV-seropositive samples compared with controls (P <.02).We hypothesize that chronic endometritis of a nonclassical form may be common in advancing HIV disease, possibly directed against HIV-infected cells or self-determined antigens. This could be associated with morbidity and may represent a reservoir of infection. Endometrial depletion of CD4 cells is a common, but not universal, feature and may be independent of immune compromise.

Chronic endometritis (CE) is a local inflammatory disease characterized by unusual plasmacyte infiltration in the endometrial stromal areas. CE has been neglected in gynecologic practice, as it is a less symptomatic benign disease that requires demanding and time‐consuming histopathologic examinations for the definite diagnosis. Recent studies, however, suggest the association of CE with infertility and obstetric and neonatal complications. In this review article, we aimed to update the knowledge on epidemiology, etiology, and pathogenesis of CE as well as discuss its clinical management from diagnosis to treatment.

A failure to achieve pregnancy after three or more embryo transfer cycles with high‐quality blastocysts is referred to as recurrent implantation failure (RIF). RIF can be due to altered uterine factors or male factors or embryo factors. Disrupted endometrial receptivity, altered expression of genes in several pathways, immunologic disturbances in the peripheral blood and/or the endometrium, and epigenetic alterations are associated with RIF. Amongst the immunologic disturbances, altered Th1/Th2 ratio, altered NK cell and macrophage numbers are observed in women with RIF. However, not all women with RIF have the same kind of immune dysfunction suggesting that RIF is a heterogeneous condition associated with varied immune responses and one size may not fit all. Thus, personalized therapies based on the immune status of the patient are being tested in women with RIF. In general, women with a high Th1/Th2 ratio are offered Tacrolimus, while intravenous IgG is recommended in women with high NK cell numbers/HLA mismatch. Women with hyperactivated immune status in the uterus are offered progesterone support, prednisolone, vitamin E, and intralipid treatment to suppress inflammation and oxidative stress, while endometrial scratching and intrauterine hCG administration are offered to women with hypo‐active immune status. There is a need for standardized tests for evaluation of immune status in patients and sufficiently powered randomized controlled trials for personalized therapies to determine which of these will be beneficial in women with RIF. Till then, the ART community should limit the use of such add‐on interventions in women with RIF.

Endometriosis is a chronic inflammatory condition affecting up to 10% of women of reproductive age and this, depending on its severity, very often leads to infertility. New research has shed light on the role of underlying endometritis due to the presence of inflammatory, non-oestrogen metabolising microbiome at the mucosal interface and this in turn leads to the activation of aggressive, non-tolerant immune cells in the endometrium. These immune cells require the presence of tolerance-inducing commensals such as Lactobacilli so as to allow the implantation of the fertilised egg. New therapies should be holistic and address both the dysbiosis as well as immune abnormalities. Routine immune monitoring of the immune cells derived from the endometrium and/or microbial profiling should recommended to better predict assisted reproduction outcomes in these couples.

Chronic endometritis (CE) is a poorly investigated pathology which has been related to adverse reproductive outcomes, such as implantation failure and recurrent miscarriage. In this paper, we aim to provide an overview of diagnosis, etiology, pathophysiology and treatment of CE, its impact on endometrial microenvironment and its association with infertility. We present a narrative review of the current literatures, synthesizing the findings retrieved from searches of computerized databases. CE is more prevalent in infertile patients. Effective antibiotic treatment of CE seems to improve the pregnancy and live birth rate in patients with unexplained recurrent pregnancy loss (RPL), and increase ongoing pregnancy rate in patients with recurrent implantation failure. In order to increase the diagnostic accuracy, immunohistochemistry is recommended besides the conventional histology. In addition, hysteroscopy could be considered as gold standard tool for diagnosis, considering its high correlation with histological findings. CE, as the chronic inflammation of endometrium, is usually asymptomatic and probably underestimated. Interaction of bacteria with endometrial microenvironment promotes changes in leukocyte population, cytokine production and growth factors which support its negative impact on endometrial receptivity. Nevertheless, standardization of the criteria for histopathological diagnosis and immunohistochemistry technique needs to be defined.Copyright© by Royan Institute. All rights reserved.

Human cycling endometrium displays a series of periodic transitions unique to this mucosal tissue, which includes rapid proliferation, secretory transformation, physiological angiogenesis, interstitial edema, and menstrual shedding. Among these properties of the endometrium are the inflammatory changes that occur dynamically across the menstrual cycle. Immunocompetent cell composition and inflammatory gene expression pattern in the human endometrium drastically fluctuate from the proliferative phase to the secretory phase, particularly at the time of ovulation. These local immune responses are fine-tuned by the direct or indirect action of two representative ovarian steroids, estradiol and progesterone, and are essential for successful blastocyst implantation. Meanwhile, studies have been accumulating the evidence that such physiological endometrial inflammatory status is altered in the presence of certain gynecologic pathologies. Given that blastocysts are semi-allografts for maternal tissue, even subtle alterations in endometrial immunity potentially have a negative impact on implantation process. In this article, we aimed to review and discuss the physiological and pathological mucosal inflammatory conditions that can affect endometrial receptivity.

The aim is to identify the chronic endometritis (CE) incidence in recurrent implantation failure (RIF) patients undergoing in vitro fertilization (IVF) treatment and compare the IVF outcomes of RIF patients with CE following antibiotic therapy with RIF patients without CE. Another purpose is to compare the IVF outcomes of described RIF patients with patients undergoing the first cycle of IVF.

To study the effect of chronic endometritis (CE) diagnosed by CD138 immunohistochemical (IHC) staining on endometrial fibrosis and reproductive prognosis in patients with moderate or severe intrauterine adhesions (IUAs).Prospective cohort study (Canadian Task Force classification II-2).University-affiliated hospital.One hundred sixty-seven women with moderate to severe IUAs.Transcervical resection of adhesions (TCRA) and endometrial biopsy were performed in all patients. According to results of IHC staining with anti-syndecan-1 antibodies to identify CD138 cells, participants were classified into two groups: 78 patients with CE (CE group) and 89 women without CE (NCE group). IHC staining for fibrosis markers transforming growth factor beta 1, anti-fibrosis markers matrix metalloproteinase 9, and endometrial receptivity marker integrin alpha v beta 3 was later applied to all tissue samples.Endometrial fibrosis, endometrial receptivity, and reproductive prognosis.CE diagnosed by CD138 IHC staining has a high incidence, 46%, in moderate and severe IUAs. In the CE group, the expression of transforming growth factor beta 1 was higher than that in the NCE group, and the expression of matrix metalloproteinase 9 and alpha v beta 3 was lower than that in the NCE group. The pregnancy rate and live birth rate in the NCE group were higher than those in the CE group (42.7% vs. 31.5%, 26.9% vs. 17.9%).CE may affect the endometrial fibrosis homeostasis in IUAs. Women with CE were more likely to experience recurrence of adhesions and had poorer reproductive outcomes.NCT02744807.Copyright © 2019. Published by Elsevier Inc.

To evaluate the alterations in endometrial waves (EW) originating from the contraction of the subendometrial myometrial layer in the periovulatory and midluteal phases in women diagnosed with chronic endometritis (CE).Case-control study.University hospital.Forty-five women referred for hysteroscopy and diagnosed with CE.Three-minute recording of transvaginal ultrasound scanning on sagittal uterine plane at periovulatory (cycle days 11-14) and midluteal phase (cycle days 19-22).Direction and frequency of EW measured by transvaginal ultrasound scan.The direction and frequency of EW were analyzed offline as accelerated (four to eight times normal speed) image sequences using video editing software, and the results were compared with 45 cycling women without CE. The EW pattern was significantly different when comparing the women with CE and controls at both the periovulatory and midluteal phases. During the periovulatory phase, we observed retrograde contractions in 26.7% versus 88%, anterograde in 24% versus 0, opposing in 22.7% versus 12%, not propagated in 13.3% versus 0, and absent in 13.3% versus 0, respectively, in the CE cases versus the control group. During the midluteal phase, we observed not propagated (41.3% vs. 61.3%), opposing (24% vs. 25.4%), absent (16.1% vs. 13.3%), anterograde (13.3% vs. 0), and retrograde (5.3% vs. 0), respectively, in the CE cases versus the control group.Women with CE show altered EW patterns in both the periovulatory and midluteal phases. Altered uterine contractility may aid in explaining the symptoms related to CE such as pain, abnormal uterine bleeding, infertility, and possibly endometriosis.Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Functional polyps and chronic endometritis are among the most common abnormalities seen in the endometrium of patients with implantation failures and recurrent miscarriages. In this study we describe morphological vascular changes in endometrial samples from asymptomatic infertile patients and their association with chronic endometritis and polyp.We selected 435 asymptomatic infertility patients submitted to office-based diagnostic hysteroscopy and endometrial biopsy. We described vascular changes and searched for histologic signs of endometritis and functional polyps in the endometrial samples. We explored the associations between these conditions.Signs of endometritis, vascular changes and polyps were identified in 176 (40.5%), 168 (38.6%) and 102 (23.4%) cases, respectively. There was a significant association between endometritis and vascular changes. The more frequent vascular alteration (70%) was the hyaline thickening of vessels, a morphological pattern very similar to the thick-walled vessels of polyps. Polyps were associated with endometritis in 28 (27.4%) cases and with other vascular changes besides the vascular stalk in 14 (13.7%). All the polyps with vascular changes had histologic evidence of endometritis. There was a significant association between inflammatory phenomena and vascular changes, even among cases of polyps.Endometrial samples from infertile patients present a broad spectrum of vascular changes, most of them associated with endometritis. This association is also identified in functional polyps. Our results suggest that these alterations may be etiologically related. It is possible that the vessel axis of functional polyps actually may originate from the evolution of the vascular changes associated with endometritis. This would place functional polyps among the spectrum of inflammatory endometrial diseases.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The aim of this study was to evaluate the effects of tumour necrosis factor-alpha (TNF-alpha) on sperm motility, mitochondrial membrane potential (DeltaPsi), phosphatidylserine (PS) externalization, sperm chromatin packaging quality, and DNA fragmentation. Motile spermatozoa, obtained from 10 normozoospermic men, were incubated with increasing concentrations of TNF-alpha and analyzed 1, 3, 6, and 24 h after incubation by flow cytometry. TNF-alpha decreased total motility 24 h after incubation at 10 ng/mL and progressive motility 3 h after incubation. Accordingly, TNF-alpha reduced sperm DeltaPsi in a concentration- and time-dependent manner. TNF-alpha increased the percentage of spermatozoa with PS externalization from the concentration of 1 ng/mL 1 h after incubation. TNF-alpha produced sperm chromatin and DNA damage in a concentration- and time-dependent manner. In conclusion, these findings may explain the reduction of fertility, secondary to upregulated production of TNF-alpha, in men with urogenital infections.

The protein kinase C (PKC) family of isoenzymes may be a crucial player in transducing H2O2-induced signaling in a wide variety of physiological and pathophysiological processes. PKCs contain unique structural features that make them highly susceptible to oxidative modification. Depending on the site of oxidation and the extent to which it is modified, PKC can be either activated or inactivated by H2O2. The N-terminal regulatory domain contains zinc-binding, cysteine-rich motifs that are readily oxidized by H2O2. When oxidized, the autoinhibitory function of the regulatory domain is compromised, and as a result, PKC is activated in a lipid cofactor-independent manner. The C-terminal catalytic domain contains several reactive cysteine residues, which when oxidized with a higher concentration of H2O2 leads to an inactivation of PKC. Here, we describe the methods used to induce oxidative modification of purified PKC isoenzymes by H2O2 and the methods to assess the extent of this modification. Protocols are given for isolating oxidatively activated PKC isoenzymes from cells treated with H2O2. Furthermore, we describe the methods used to assess indirect regulation of PKC isoenzymes by determining their cytosol to membrane or mitochondrial translocation and tyrosine phosphorylation of PKCδ in response to sublethal levels of H2O2. Finally, as an example, we describe the methods used to demonstrate the role of H2O2-mediated cell signaling of PKCɛ in green tea polyphenol-induced preconditioning against neuronal cell death caused by oxygen-glucose deprivation and reoxygenation, an in vitro model for cerebral ischemic/reperfusion injury. Copyright © 2013 Elsevier Inc. All rights reserved.

Infertility is a world-wide problem, defined as failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse. There are multiple causes for infertility involving both male and female factors. Fallopian tube occlusion is a common reason for female infertility. The initial attempts to treat proximal obstruction involved the use of a whalebone bougie positioned in the uterine cornua to dilate the proximal tube by Smith as early as 1849. Fluoroscopic fallopian tube recanalization for the treatment of infertility was first described in 1985. Since that time, there have been over 100 papers describing various methods for recanalization of occluded fallopian tubes. Fallopian tube recanalization is a minimally invasive procedure which is performed on an outpatient basis. It should be a first line therapy for patients with proximal occlusion of fallopian tubes.© 2023. The Author(s).

慢性子宫内膜炎（chronic endometritis，CE）是子宫内膜受感染所致的慢性内膜炎症性疾病，临床症状轻微，但与不孕症及不良妊娠结局有密切关系。诊断CE的金标准为组织学观察到子宫内膜间质细胞间隙有浆细胞浸润。抗生素是目前治疗CE的首选方法，可能改善不孕患者的妊娠结局，但部分持续性CE患者对抗生素治疗不敏感。

To assess the prevalence of chronic endometritis in women with a history of recurrent early pregnancy loss (REPL) and/or fetal demise (FD).Observational cohort study using prospectively collected data.Recurrent pregnancy loss program in an academic medical center.Three hundred ninety-five women with a history of two or more pregnancy losses of less than 10 weeks' size or a fetal demise of 10 or more weeks' size.All women had an endometrial biopsy. Chronic endometritis was treated with antibiotics, and a second endometrial biopsy was recommended as a "test of cure."Subsequent live-birth rate (LBR).The overall prevalence of chronic endometritis was 9% (35/395) in this cohort; 7% (21/285) in the REPL group, 14% (8/57) in the FD group, and 11% (6/53) in the combined REPL/FD group. The cure rate was 100% after a course(s) of antibiotics. The subsequent cumulative LBR was 88% (21/24) for the treated chronic endometritis group versus 74% (180/244) for the group without chronic endometritis. The per-pregnancy LBR for the treated chronic endometritis group was 7% (7/98) before treatment versus 56% (28/50) after treatment.There was a high prevalence of chronic endometritis in this cohort. The test of cure was 100% with antibiotics. Subsequent LBRs after treatment were encouraging.Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Evaluation of anti-tubercular therapy on endometrium in Female Genital Tuberculosis.Total of 50 women having FGTB on endometrial aspirate (positive AFB, epithelioid granuloma, positive PCR, laparoscopy or hysteroscopy findings) were enrolled. Ultrasound was performed for endometrial thickness, mean resistive index and pulsatility index before and after anti-tubercular therapy (ATT). Diagnostic hysteroscopy was performed for intra-uterine adhesions and to visualise cavity before and after ATT.Menstrual cycle improved after anti-tubercular therapy (ATT). Endometrial aspirate findings improved with disappearance of AFB, epithelioid granuloma and decrease in PCR (94%vs 33%). After ATT, ultrasound examination of endometrial thickness improved from 7.01±1.48 mm to 7.51±1.48 mm while mean resistive index and pulsatility index decreased from 0.729±0.304 to 0.692±0.399 and 1.180 to 1.138. With ATT, improvement was seen in hysteroscopic findings with normal looking cavity increasing from 18(36%) to 34(72.1%) and pale looking cavity decreasing from 20(42.5%) to 8(16.8%). Before ATT, prevalence of intrauterine adhesions was 62% which decreased to 28.7% after ATT. Improvement was significant only in grade I adhesions from 34% to 2.1%, (p<0.001). There was no improvement in higher grade of intrauterine adhesions with ATT with grade II (6% vs 4.2%) and grade 2a (4% vs 2.1%), grade III being (2% vs 2.1%), grade II a (4% vs 4.2%), grade Va (4% vs 4.2%) and grade Vb (8% vs 10.6%) before and after ATT respectively.Early ATT improved menstrual cycle, endometrial thickness and reduced incidence of grade I adhesions. Advanced stages did not show any improvement.

Endometriosis causes severe chronic pelvic pain and infertility. We have recently reported that niclosamide treatment reduces growth and progression of endometriosis-like lesions and inflammatory signaling (NF${\rm \small K}$B and STAT3) in a mouse model. In the present study, we examined further inhibitory mechanisms by which niclosamide affects endometriotic lesions using an endometriotic epithelial cell line, 12Z, and macrophages differentiated from a monocytic THP-1 cell line. Niclosamide dose dependently reduced 12Z viability, reduced STAT3 and NF${\rm \small K}$B activity, and increased both cleaved caspase-3 and cleaved PARP. To model the inflammatory microenvironment in endometriotic lesions, we exposed 12Z cells to macrophage conditioned media (CM). Macrophages were differentiated from THP-1 cells using 12-O-tetradecanoylphorbol-13-acetate as M0, and then M0 macrophages were polarized into M1 or M2 using LPS/IFNγ or IL4/IL13, respectively. Conditioned media from M0, M1, or M2 cultures increased 12Z viability. This effect was blocked by niclosamide, and cell viability returned to that of CM from cells treated with niclosamide alone. To assess proteins targeted by niclosamide in 12Z cells, CM from 12Z cells cultured with M0, M1, or M2 with/without niclosamide were analyzed by cytokine/chemokine protein array kits. Conditioned media from M0, M1, and/or M2 stimulated the secretion of cytokines/chemokines from 12Z cells. Production of most of these secreted cytokines/chemokines in 12Z cells was inhibited by niclosamide. Knockdown of each gene in 12Z cells using siRNA resulted in reduced cell viability. These results indicate that niclosamide can inhibit the inflammatory factors in endometriotic epithelial cells stimulated by macrophages by targeting STAT3 and/or NF${\rm \small K}$B signaling.© The Author(s) 2018. Published by Oxford University Press on behalf of Society for the Study of Reproduction.

Based on the role of bone marrow (BM) stem cells in regeneration of endometrium, refractory cases of Asherman's syndrome (AS) and endometrial atrophy (EA) may benefit with BM-derived intrauterine stem cell instillation. Aims and Objectives: To evaluate the role of BM-derived autologous stem cell therapy in endometrial regeneration and restoration of menstruation and fertility in refractory cases of AS and EA.This study was conducted at a tertiary care center.This was a prospective, single-arm longitudinal study.Twenty-five cases with refractory AS or EA were included. BM-derived mononuclear stem cells were instilled into the subendometrial zone followed by oral estrogen therapy for 3 months. Menstrual flow and endometrial thickness (ET) were assessed at 3, 6, and 9 months and 5 years.Statistical analysis was carried out using statistical software STATA version 12.0. Mean prestem cell transfer ET (mm) was 3.3 ± 1.0. At the end of 3 months, there was a significant increase in ET (mm) to 5.1 ± 1.9 ( = 0.001), but there was no significant change at 6 months (5.6 ± 1.5; = 0.164), at 9 months (6.1 ± 1.7; = 0.135), or at the end of 5 years. Six of the seven amenorrheic patients resumed menses. Three patients had a successful pregnancy outcome.Intrauterine stem cell treatment is a promising novel approach for refractory cases of AS and EA.Copyright: © 2020 Journal of Human Reproductive Sciences.