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Investigation of the Relationship between Chronic Endometritis Manifestations under Hysteroscope and CD138 Expression
Shuang Wang1,2, FengHua Li2, Wei Zhang2
1School of Medicine, Shandong University, Jinan, Shandong, China.
Insights
Chronic endometritis (CE) diagnosis via hysteroscopy impacts in vitro fertilization success. Antibiotic treatment is more effective for CE with endometrial micropolyps or hyperplasia than diffuse hyperemia, showing lower CD138 positivity.
Area of Science:
- Reproductive Medicine
- Gynecology
- Infectious Diseases
Background:
- Chronic endometritis (CE) is a condition affecting the uterine lining.
- Hysteroscopy is a key diagnostic tool for CE in patients undergoing in vitro fertilization (IVF).
- Understanding CE subtypes and treatment responses is crucial for improving IVF outcomes.
Purpose of the Study:
- To retrospectively analyze clinical data of 523 CE patients.
- To evaluate the diagnostic utility of CD138 immunohistochemistry (IHC) in different CE hysteroscopic subtypes.
- To assess the efficacy of antibiotic treatment in CE patients based on hysteroscopic findings.
Main Methods:
- Retrospective analysis of 523 CE patients diagnosed via hysteroscopy (Jan 2018-June 2020).
- Classification of CE into hyperemia, endometrial micropolyp, and endometrial stroma edema/hyperplasia cohorts.
- CD138 IHC examination of endometrial tissue and assessment of antibiotic treatment (doxycycline) efficacy.
Main Results:
- CD138 positivity rates varied significantly across cohorts: hyperemia (10.06%), micropolyp (63.16%), and edema/hyperplasia (74%).
- Antibiotic treatment was largely ineffective in the hyperemia cohort (0% effective rate).
- Effective treatment rates were high in the micropolyp (73.61%) and edema/hyperplasia (83.24%) cohorts.
Conclusions:
- Diffuse endometrial hyperemia shows low CD138 positivity and poor response to antibiotics.
- Endometrial micropolyps and stroma edema/hyperplasia exhibit high CD138 positivity and better outcomes with antibiotic therapy.
- Hysteroscopic findings are critical for predicting CD138 status and guiding antibiotic treatment in CE.
Methods:
This study was performed to retrospectively analyze clinical cases of 523 CE patients from January 2018 to June 2020 that were confirmed by hysteroscopy before in vitro fertilization. Based on manifestations of CE under hysteroscopy, the cases were divided into three cohorts, i.e., hyperemia cohort where the patients had diffuse endometrium hyperemia; endometrial micropolyp cohort, and endometrial stroma edema and hyperplasia cohort. Small amount of endometrial tissue was collected from the patients, and CD138 IHC examination was performed. According to the results of CD138 IHC, positive patients were given antibiotic treatment (doxycycline 100 mg BID orally for 14 days), and hysteroscopy was performed again after treatment to check the efficacy of antibiotics.
Results:
In the comparison of overall status for all patient cohorts, infertility type, BMI, bFSH, bLH, bP, bT, PRL, AMH, and CA125 were varied markedly across all cohorts (P < 0.05), with predominant incidences of polycystic ovary syndrome (PCOS) peaking within hyperemia cohort. Incidence/diagnostic rate for CD138 within hyperemia cohort was 10.06%, which was lower than the 63.16% in micropolyp cohort and 74% in edema and hyperplasia cohort (P < 0.05). No major variation existed within CD138 across micropolyp cohort/edema and hyperplasia cohort (P > 0.05). After CD138-positive CE patients were treated with antibiotics, the effective rate (0/16) within hyperemia cohort was lower than micropolyp cohort (73.61%, 53/72) and edema and hyperplasia cohort (83.24%, 154/185) (P < 0.05). The effective rate across micropolyp cohort/edema and hyperplasia cohort was not significantly different (P > 0.05).
Conclusion:
Cases of diffuse endometrial hyperemia under hysteroscope had the lowest positive rate of CD138, and the effect of antibiotic treatment on these patients was poor. The positive rate of CD138 in patients with endometrial micropolyps and endometrial stroma edema and hyperplasia under hysteroscope was high, and the effect of antibiotic treatment was better.
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