Restoration of reproductive function in patients with uterine infertility due to chronic endometritis


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Abstract

Background. The prevalence of chronic endometritis (CE) in the population is recorded at the level of 14.1 to 24.4% but is significantly higher in patients with impaired reproductive function. CE is accompanied by increased production of cytokines and chemokines at the local level, the normalization of the secretion of which can contribute to the restoration of endometrial receptivity in infertile patients. Objective. Evaluation of the effectiveness of local immunotherapy using a complex of exogenous natural cytokines in patients with infertility caused by CE, according to follow-up data. Methods. A prospective randomized clinical trial was carried out. 76 women with CE (confirmed histologically) and infertility who underwent causal antibiotic therapy were examined. Further, group I (n=36) received Superlymph 25 IU vaginally daily for 20 days; group II (n=40) - no additional treatments. Treated patients were followed-up for 12 months. Data were available for 30 patients in group I and 24 in group II who became pregnant during this period. The data of history of childbirth, developmental histories of newborns and personal interviews were used. Results. Treatment with Superlymph had high clinical efficacy and the onset of pregnancy in 83.3% of patients within 12 months of follow-up versus 60% in patients who received only antibiotic therapy, and improved pregnancy outcomes - a 2-fold reduction in the frequency of preterm birth (60 versus 29 %, respectively; P=0.02) and spontaneous miscarriages by 2.5 times (17 vs. 42% at the early stages and 7 vs. 13% at the late ones, respectively; P=0.04). There was no effect of the drug on the course of pregnancy and the condition of the newborn. Conclusion. The use of Superlymph, which modulates the activity of cytokines, increases the body’s resistance and improves the results of treatment of patients with infertility in CE of a viral-bacterial nature.

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About the authors

G. B Dikke

Academy of Medical Education n.a. F.I. Inozemtsev

Email: galadikke@yandex.ru
St. Petersburg, Russia

A. A Sukhanov

Perinatal Center of the Tyumen region

Tyumen, Russia

I. I Kukarskaya

Perinatal Center of the Tyumen region; Tyumen State Medical University of the Ministry of Health of Russia

Tyumen, Russia

V. V Ostromensky

Academy of Medical Education n.a. F.I. Inozemtsev

St. Petersburg, Russia

References

  1. Cicinelli E., Trojano G., Mastromauro M., et al. Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link. Fertil Steril. 2017;108(2):289-95.e1. doi: 10.1016/j. fertnstert.2017.05.016
  2. Song D., Feng X., Zhang Q., et al. Prevalence and confounders of chronic endometritis in premenopausal women with abnormal bleeding or reproductive failure. Reprod Biomed Online. 2018;36(1):78-83. doi: 10.1016/j. rbmo.2017.09.008
  3. Bouet P.E., El Hachem H., Monceau E., et al. Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil Steril. 2016;105(1):106-10. doi: 10.1016/j. fertnstert.2015.09.025
  4. Kimura F., Takebayashi A., ishida M., et al. Review: Chronic endometritis and its effect on reproduction. J Obstet Gynaecol Res. 2019;45(5):951-60. doi: 10.1111/ jog.13937.
  5. Liu Y., Chen X., Huang J., et al.Comparison of the prevalence of chronic endometritis as determined by means of different diagnostic methods in women with and without reproductive failure. Fertil Steril. 2018;109(5):832-39. doi: 10.1016/j.fertnstert.2018.01.022.
  6. Hirata K, Kimura F., Nakamura A., et al. Histological diagnostic criterion for chronic endometritis based on the clinical outcome. BMC. Women's Health. 2021;21:94. doi: 10.1186/s12905-021-01239-y.
  7. Moreno i, Cicinelli E., Garcia-Grau i., et al. The diagnosis of chronic endometritis in infertile asymptomatic women: A comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology. Am J Obstet Gynecol. 2018;218:602.e1 -602.el6. doi: 10.1016/j. ajog.2018.02.012.
  8. Kitaya K., Takeuchi T., Mizuta S., et al. Endometritis: new time, new concepts. Fertil Steril. 2018;110(3):344-50. doi: 10.1016/j. fertnstert.2018.04.012.
  9. Marci R., Gentili V., Bortolotti D., et al. Presence of HHV-6A in Endometrial Epithelial Cells from Women with Primary Unexplained infertility. PLoS One. 2016;11(7):e0158304. doi: 10.1371/journal.pone.0158304.
  10. Pereira N., Kucharczyk K.M., Estes J.L., et al. Human Papillomavirus infection, infertility, and Assisted Reproductive Outcomes. J Pathog. 2015;2015:578423. doi: 10.1155/2015/578423.
  11. Kapranos N.C., Kotronias D.C. Detection of Herpes Simplex Virus in First Trimester Pregnancy Loss Using Molecular Techniques. in Vivo. 2009;23(5):839-42
  12. Sherkat R., Meidani M., Zarabian H., et al. Seropositivity of cytomegalovirus in patients with recurrent pregnancy loss. J Res Med Sci. 2014;19 (1):S22-5.
  13. Esber A, Vicetti M.R.D., Cherpes T.L., et al. Risk of bacterial vaginosis among women with herpes simplex virus Type 2 infection: a systematic review and meta-analysis. J inf Dis. 2015;212(1):8-17. doi: 10.1093/infdis/ jiv017.
  14. Сидельникова В.Н. Привычная потеря беременности. М., 2000. 304 с. @@Sidelnikova V.N. Habitual pregnancy loss. M., 2000. 304 p. (in Russ.).
  15. Дикке Г.Б., Остроменский В.В. Нарушение иммунного статуса при хроническом эндометрите и опыт его коррекции посредством локальной цитокинотерапии. Акушерство и гинекология. 2019;9:139-46. @@Dikke G.B., Ostromensky V.V. impaired immune status in chronic endometritis and experience of its correction through local cytokine therapy. Akusherstvo i ginekologiya=Obstet Gynecol. 2019;9:139-46. (in Russ.). doi: 10.18565/ aig.2019.9.139-146.
  16. Доброхотова Ю.Э., Ганковская Л.В., Боровкова Е.И., Нугуманова О.Р Экзогенная цитокинотерапия в лечении пациенток с хроническим эндометритом. Акушерство и гинекология. 2021;2:119-26. @@Dobrokhotova Yu.E., Gankovskaya L.V., Borovkova E.i., Nugumanova O.R. Exogenous cytokine therapy in the treatment of patients with chronic endometritis. Akusherstvo i ginekologiya=Obstet Gynecol. 2021;2:119-26. (in Russ.). doi: 10.18565/ aig.2021.2.119-126.
  17. Дикке Г.Б., Суханов А.А., Кукарская И.И., Остроменский В.В. Цитокиновый профиль пациенток с хроническим эндометритом и нарушением репродуктивной функции. Вопросы гинекологии, акушерства и перинатологии. 2021;20(6):82-91. @@Dikke G.B., Sukhanov A.A., Kukarskaya i.i., Ostromensky V.V. Cytokine profile of patients with chronic endometritis and reproductive dysfunction. Voprosy ginekologii, akusherstva i perinatologii. 2021;20(6):82-91. (in Russ.). doi: 10.20953/1726-1678-2021-6-82-91
  18. Polanski L.T., Barbosa M.A., Martins W.P, et al.interventions to improve reproductive outcomes in women with elevated natural killer cells undergoing assisted reproduction techniques: a systematic review of literature. Hum Reprod. 2014;29(1):65-75. doi: 10.1093/humrep/ det414.
  19. Mamedalieva N.M., Kurmanova A.M., Moshkalova G.N., Kim V. Local immunity status in patients with miscarriages and herpetic infection. Gynecol Endocrinol. 2016;32(2):45- doi: 10.1080/09513590.2016.1232772.
  20. Павленко В.И. Диагностика и лечение иммунодефицитных состояний: учебное пособие. Благовещенск, 2017. 232 с. @@Pavlenko V.I. Diagnostics and treatment of immunodeficiency states: a tutorial. Blagoveshchensk, 2017. 232 p. (in Russ.).
  21. Kremleva E.A., Sgibnev A.V Proinflammatory cytokines as regulators of vaginal microbiota. Bull Exp Biol Med. 2016;162:75-8. doi: 10.1007/s10517-016-3549-1.
  22. Ищенко А.И., Унанян А.Л., Коган Е.А. и др. Клинико-анамнестические, иммунологические, эхографические и гистероскопические особенности хронического эндометрита, ассоциированного с нарушением репродуктивной функции. Вестник РАМН. 2018;73(1):5-15. @@Ishchenko A.I., Unanyan A.L., Kogan E.A., et al. Clinical and anamnestic, immunological, echographic and hysteroscopic features of chronic endometritis associated with reproductive dysfunction. Vestnik RAMN. 2018;73(1):5-15. (in Russ.). doi: 10.15690/vramn927.
  23. Петров Ю.А., Алехина А.Г, Блесманович А.Е. Актуальные нюансы патогенеза хронического эндометрита. Современные проблемы науки и образования. 2018;6. @@Petrov Yu.A., Alekhina A.G., Blesmanovich A.E. Actual nuances of the pathogenesis of chronic endometritis. Sovremennye problemy nauki i obrazovaniya. 2018;6. (in Russ.). URL: https://www.scienceeducation.ru/pdf/p018/6/88T55.pdf.
  24. Kufud L., Lindhard A., Hviid T.V.F. implications of uterine NK cells and regulatory T cells in the endometrium of infertile women. Hum immunol. 8/18;79(9):893-7/1. doi: 1/.1/18/j.humimm.8/18./7.//3.
  25. Park H.J., Kim Y.S., Yoon T.K., Lee W.S. Chronic endometritis and infertility. Clin Exp Reprod Med. 8/18;43(4):185-98. doi: 10.5653/ cerm.2016.43.4.185.
  26. Cicinelli E., Matteo M., Trojano G., et al. Chronic endometritis in patients with unexplained infertility: Prevalence and effects of antibiotic treatment on spontaneous conception. Am J Reprod immunol. 8/18;79(1). Doi: 10.1111/ aji.12782.
  27. McQueen D.B., Bernardi L.A., Stephenson M.D. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril. 8/14;1/1:1/88-3/. doi: W.WW/j. fertnstert.8/13.18./31.
  28. Dizzell S., Nazli A., Reid G., Kaushic C. Protective Effect of Probiotic Bacteria and Estrogen in Preventing HiV-1-Mediated impairment of Epithelial Barrier integrity in Female Genital Tract. Cells. 8/19;8:118/. doi: 10.3390/cells81/118/.
  29. Molina N.M., Sola-Leyva A., Saez-Lara M.J, et al. New Opportunities for Endometrial Health by Modifying Uterine Microbial Composition: Present or Future? Biomolecul. 8/8/;1/(4):d93. doi: 1/.339//bium1//4/593.
  30. Тапильская Н.И., Толибова Г.Х., Савичева А.М. и др. Эффективность локальной цитокинотерапии хронического эндометрита пациенток с бесплодием. Акушерство и гинекология. 2/22;2:91-1//. @@Tapilskaya N.i., Tolibova G.Kh., Savicheva A.M. Efficiency of local cytokine therapy of chronic endometritis in patients with infertility. Akusherstvo i ginekobgiyabstet Gynecol. 2/22;2:91-1//. (in Russ.). Doi: 1/.18585/aig.2/22.2.
  31. Пестрикова Т.Ю., Юрасова Е.А., Панфилова Ю.О., Шматкова А.С. Новый подход к лечению рецидивирующего хронического цервицита, ассоциированного с ВПЧ-инфекцией, с помощью локальной цитокинотерапии.Вопросы гинекологии, акушерства и перинатологии. 2019;18(4):19-27. @@Pestrikova T.Yu, Yurasova E.A., Panfilova Yu.O., Shmatkova A.S. A new approach to the treatment of recurrent chronic cervicitis associated with HPV infection using local cytokine therapy. Voprosy ginekologii, akusherstva i perinatologii. 2019;18(4):19- 27. (In Russ.). doi: 10.20953/1726-16782019-4-19-27.
  32. Чернова Н.И., Перламутров Ю.Н., Петрова И.С. Эффективность комплекса противо-микробных пептидов в терапии рецидивирующих воспалительных заболеваний нижних отделов мочеполового тракта, обусловленных сочетанной инфекцией. Клиническая дерматология и венерология. 2018;17(3):70-9. @@Chernova N.I., Perlamutrov Yu.N., Petrova I.S. The effectiveness of the complex of antimicrobial peptides in the treatment of recurrent inflammatory diseases of the lower urinary tract due to co-infection. Klinicheskaya dermatologiya i venerologiya. 2018;17(3):70-9. (In Russ.). doi: 10.17116/ klinderma201817380.
  33. Свирщевская Е.В., Матушевская Е.В. Роль цитокинов в патогенезе и лечении герпесвирусных заболеваний. Клиническая дерматология и венерология. 2018;1:115-20. @@Svirshchevskaya E.V., Matushevskaya E.V. The role of cytokines in the pathogenesis and treatment of herpesvirus diseases. Klinicheskaya dermatologiya i venerologiya. 2018;1:115- (In Russ.). doi: 10.17116/klinderma 201817370.
  34. Доброхотова Ю.Э., Боровкова Е.И., Нугуманова О.Р. Улучшение процессов ангиогенеза и репродуктивных исходов у пациенток с хроническим эндометритом. Акушерство и гинекология. 2021;3:145- @@Dobrokhotova Yu.E., Borovkova E.I., Nugumanova O.R. Improving the processes of angiogenesis and reproductive outcomes in patients with chronic endometritis. Akusherstvo i ginekologiya=Obstetr Gynecol. 2021;3:145-52. (In Russ.). doi: 10.18565/ aig.2021.3.145-152.

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