Why is this important when planning a pregnancy?
The endometrium must be ready to receive an embryo: have the correct structure, sufficient thickness and a certain set of cells and signaling molecules. With chronic inflammation, this readiness is disrupted.
Inflammatory cells accumulate in the mucosa, the local immune response changes, blood supply and endometrial susceptibility to hormones are disrupted. As a result, the embryo either does not attach or does attach, but the pregnancy is terminated early.
That is why chronic endometritis is specifically sought for in women with repeated IVF failures and recurrent miscarriage. In some of these patients, pregnancy occurs after treatment without any additional interventions.
Reasons
- Intrauterine interventions: curettage, abortion, hysteroscopy
- Complicated childbirth and postpartum conditions
- Long-term wearing of an intrauterine device
- Past sexually transmitted infections
- Ascending infection in cervicitis and vaginosis
- Remains of the fertilized egg or placenta after termination of pregnancy and childbirth
- Endometrial polyps and submucosal nodes that support inflammation
- Synechiae of the uterine cavity
- Chronic foci of infection in the body
- Opportunistic flora that has penetrated the uterine cavity
Symptoms
Their scarcity is the main feature of the disease. This is why it is so often missed.
- Spotting before and after menstruation
- Bloody discharge mid-cycle
- Change in the nature of menstruation: scanty or, conversely, heavy
- Nagging pain in the lower abdomen, often mild
- Discomfort during sexual intercourse
- Mucopurulent discharge
- Infertility and implantation failure
- Recurrent miscarriage
- Often - complete absence of complaints
Diagnostics
- Pipelle endometrial biopsy - outpatient tissue sampling without anesthesia; performed at a certain phase of the cycle
- Histological examination - detection of plasma cells in the endometrial stroma is a key feature
- Immunohistochemical study with the CD138 marker significantly increases diagnostic accuracy
- Hysteroscopy - characteristic picture: pinpoint hemorrhages, uneven thickening, micropolyps
- Ultrasound - unevenness and discrepancy between the thickness of the endometrium and the phase of the cycle; auxiliary method
- PCR and culture of the contents of the uterine cavity for flora
- Screening for sexually transmitted infections
- Assessment of vaginal microflora
- Hormonal examination for cycle disorders
Treatment
- Antibacterial therapy selected based on culture and PCR results
- In the absence of an identified pathogen, an empirical regimen as prescribed by a doctor
- Treatment of concomitant vaginosis and cervicitis
- Removal of factors that support inflammation: polyps, synechiae, tissue debris, and, if necessary, coils
- Second stage: restoration of the endometrial structure - hormonal therapy, drugs that improve blood circulation
- Physiotherapy as prescribed by a doctor
- Control biopsy to confirm cure before planning pregnancy
- Restoration of vaginal microflora
- Planning pregnancy or IVF program after confirmation of remission
A control biopsy is an important step that is sometimes skipped. Without it, you cannot be sure that the inflammation has really been eliminated, and entering the IVF protocol occurs blindly.
Prevention
- Minimizing intrauterine interventions without strict indications
- Reliable contraception to prevent abortions
- Timely and complete treatment of vaginitis and cervicitis
- Screening for STIs when changing partners
- Compliance with the timing of wearing an intrauterine device
- Comprehensive treatment of postpartum and post-abortion complications
- Screening for infections before planned intrauterine interventions
- Observation after childbirth and termination of pregnancy
Where to get examined in Tashkent
Requires the ability to perform pipette biopsy or hysteroscopy with biopsy and a histology laboratory that performs CD138 testing.
In Tashkent, such examination and treatment of chronic endometritis is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have had two or more failed IVF attempts or repeated early miscarriages, be sure to discuss an endometrial biopsy with your doctor. This is one of those reasons that is found only with a targeted search. Clinic contacts are below.
