Chronic endometritis

Chronic endometritis is a chronic infectious inflammatory disease that leads to morphofunctional disorders of the endometrium. Chronic endometritis unlike acute one is almost asymptomatic and is rarely accompanied by specific clinical manifestations like pelvic pain, abnormal uterine bleeding, dyspareunia and leukorrhea. The incidence of chronic endometritis in infertile women ranges from 0.2 to 46%. Percent difference in the data is due to the lack of clear diagnostic criteria to verify the diagnosis. Morphologic examination is the diagnostic gold standard. Such pathomorphological signs as superficial edema, increased stromal density, unsynchronized differentiation between endometrial epithelium and stroma, and infiltration of the endometrium by stromal plasmacytes are the most informative. The simultaneous use of CD138 and MUM1 immunohistochemistry could potentially compensate for the weaknesses of the method in the histopathologic diagnosis of chronic endometritis. Overdiagnosis leads to unnecessary prescription of antibiotics. Antibiotic resistance has increased by 8.27 times in the last 5 years; therefore, it is necessary to search for additional alternative therapies. The study of efficacy of bovhyaluronidase azoximer in the therapy of patients who experienced chronic endometritis and had implantation failures showed that remodeling of connective tissue by bovhyaluronidase azoximer promotes improvement of reparative processes, normalization of blood circulation and receptor apparatus in the uterine cavity.

Conclusion: The absence of clear diagnostic criteria for verifying the diagnosis leads to overdiagnosis of chronic endometritis and unjustified prescription of antibacterial agents. Identifying the connection between the microbiome, chronic inflammation and the immune status of the body in the future can solve the problem of many reproductive failures, and miscarriage in particular.