PATHOGENETIC RATIONALE FOR THE THERAPY OF CHRONIC ENDOMETRITIS

Objective. To comparatively evaluate the efficiency of different treatment regimens for chronic endometritis (CE) in view of pathogen eradication, normalization of the endometrial morphological structure, and restoration of the reproductive potential. Subjects and method. The investigation enrolled 101 patients with CE and 31 apparently healthy women. According to the treatment received, the patients with CE were randomized into two groups: 1) empiric antibiotic (AB) therapy using antibiotic combinations in conjunction with antiaggregants and antihypoxants regardless of the presence of the pathogen (n = 54); 2) personified complex treatment including AB and/or nonsteroidal antiinflammatory drugs (NSAIDs) in combination with antiaggregants and antihypoxants was prescribed on the basis of a detailed assessment of the microbial landscape (n = 47). Before and after treatment, the patients included in the study underwent ultrasonography of the small pelvic organs, hysteroscopy, and diagnostic curettage or pipelle endometrial biopsy with further morphological examination, as well as real-time polymerase chain reaction study of the microflora in endometrial biopsy specimens. Statistical processing used Student’s t-testand Mann- Whilney U-test, X 2 test to compare discrete quantities, and McNemar’s test. P-values < 0.05 were considered statistically significant for all types of analysis. Results. Following empiric AB treatment (Group 1), abnormal uterine bleeding was noted in 30.3% of the cases; the infectious agents in the endometrium were detected in 21.2%; the endometrial morphological pattern became normalized in 60.6%; the conception rate was 30.3%; after selective therapy with regards to the presence or absence of a microbial agent (Group 2), these indicators were 6.1% (p = 0.009), 3% (p = 0.024), 90.9% (p = 0.003), and 63.6% (p = 0.007), respectively. Conclusion. It is necessary to study the endometrial microbial landscape compulsorily to choose adequate therapy for CE in each specific clinical case. If the infectious agents are present in the uterine cavity in CE, combination therapy should be used in conjunction with AB agents in view of the detected pathogen; the morphological efficiency is 68.4%; reproductive function is realized in 42.1%. If the infectious agents are absent in the endometrium to treat CE, it is expedient to incorporate NSAIDs into combination treatment; the morphological efficiency is 94.7%; the conception rate is 63.2%.

chronic endometritis, therapy, antibiotic agents, nonsteroidal anti-inflammatory drugs