Diagnosis And Treatment Of Chronic Endometritis Under Hysteroscopy And Its Effect On The Outcome Of Embryo Transfer

Objective:By comparing the differences in pregnancy outcomes of CE patients diagnosed by hysteroscopy and CD138 immunohistochemistry,to analyze the significance of the two methods in CE diagnosis,and to analyze the different treatment regimens for CE patients with assisted reproductive pregnancy outcomes.Method:Infertile patients who were treated at the Reproductive Hospital of Qingdao University Affiliated Hospital from January 2019 to June 2021 were collected for focal or diffuse endometrial hyperemia,endometrial stromal edema,endometrial micropolyps,Endometrial vascular thickening is a characteristic feature of hysteroscopic diagnosis of CE,and CD138 positivity is used as the standard for pathological diagnosis of CE.(1)According to the different diagnostic methods,the CE patients were divided into the positive group of CD138 diagnosis alone(103 cases),the positive group of pure hysteroscopy diagnosis(136 cases)and the positive group of combined diagnosis(427 cases),and the general conditions of the three groups of patients were compared.and assisted reproductive pregnancy outcomes.(2)Selected CE patients(427 cases)after antibiotic treatment diagnosed by the combination of CD138 and hysteroscopy,and compared with non-CE patients(194cases)who were both negative by hysteroscopy and CD138 examination.(3)According to the different endometrial preparation schemes of patients,CE patients with positive combined diagnosis were divided into down-regulation +artificial cycle group(219 cases)and artificial cycle group(208 cases)for comparison.(4)According to whether dydrogesterone treatment was added or not,CE patients with positive combined diagnosis were divided into dydrogesterone + antibiotic treatment group(69 cases)and antibiotic treatment group(427 cases)for comparison.Results:(1)The implantation rate of CE patients in the combined diagnosis positive group(26.11%)was lower than that in the CD138 single-positive group(38.25%)and the hysteroscopy single-positive group(35.53%),and the difference was statistically significant(P<0.05).There was no statistical difference between the pregnancy outcomes of the hysteroscopy group and the hysteroscopy single positive group.(2)The implantation rate(26.11%)and clinical pregnancy rate(25.29%)of patients with positive combined diagnosis after antibiotic treatment were lower than those of non-CE patients with negative hysteroscopy and CD138 examination(43.24%)and clinical pregnancy rate(45.88%).(3)The implantation rate(31.48%)and clinical pregnancy rate(30.14%)of CE patients who used down-regulation + artificial cycle to prepare the endometrium were significantly higher than those of CE patients who used simple artificial cycle to prepare the endometrium(20.21%)and clinical pregnancy rate(20.19%).(4)The clinical pregnancy rate of CE patients treated with dydrogesterone +antibiotics(34.78%)was significantly higher than that of CE patients treated with antibiotics only(25.29%).Conclusion:(1)The clinical pregnancy outcomes of CE patients with positive diagnosis of combined CD138 immunohistochemistry and hysteroscopy after treatment are worse than those of single-positive CE patients,which indicates that combined-positive CE patients may have more severe endometrial lesions than single-positive CE patients.Clinically,more attention should be paid to the treatment of this part of patients.(2)Compared with non-CE patients,the CE patients with positive combined diagnosis had worse embryo transfer outcomes,which indicated that CE could adversely affect the pregnancy outcomes of infertile patients.(3)For CE patients undergoing embryo transfer,the down-regulated artificial cycle is more suitable for CE patients than the simple artificial cycle.(4)In the course of CE treatment,the addition of dydrogesterone is more beneficial to the pregnancy outcome of CE patients than antibiotics alone.