Study On The Treatment Of Ureaplasma Urealyticum And Its Relationship With Chronic Endometritis In Infertile Patients

BackgroundInfertility is a global public health problem,and its incidence is increasing year by year.Reproductive tract infection is one of the important causes of female infertility.Among the many pathogens,the effect of genital Ureaplasma Urealyticum(UU)infection on infertility is a common concern in the reproductive community.In clinical infertility patients,the detection rate of UU in reproductive tract is high,and there is unreasonable use or even abuse of antibiotic treatment,which will not only increase the drug resistance of UU but also increase the economic burden and psychological pressure of patients.At present,the pathogenicity and clinical treatment of UU and its effect on in vitro fertilization and embryo transfer(IVF-ET)need to be further studied.The relationship between UU and infertility and chronic endometritis(CE)is still inconclusive.Whether infertility patients need UU examination and treatment is also controversial.ObjectiveTo explore the infection of Ureaplasma Urealyticum,the therapeutic effect and its effect on IVF-ET in infertile patients,and to explore the relationship between Ureaplasma Urealyticum and chronic endometritis,so as to provide scientific basis for clinical examination and treatment of UU and diagnosis and treatment of CE.Materials and Methods1.All infertile patients who received IVF/ICSI-ET-assisted pregnancy for the first time in the Reproductive Center of Guangdong Maternal and Child Health Hospital from January 2017 to September 2020 were selected.A total of 4172 patients were found to meet the inclusion criteria.According to the results of Ureaplasma Urealyticum test,they were divided into infection group(n=1804)and uninfected group(n=2368).The treatment and drug sensitivity test of the infection group were analyzed,and differences in the general clinical data and the pregnancy outcome of IVF-ET between the two groups were compared.2.All infertile patients who received IVF/ICSI-ET for the first time in the Reproductive Center of Guangdong Maternal and Child Health Hospital from January 2017 to September 2020 and underwent hysteroscopy and intimal CD138 immunohistochemical pathological examination before assisted pregnancy.A total of2165 patients were found to meet the inclusion criteria.According to the results of UU test,they were divided into infection group(n=755)and non-infection group(n=1410).To compare the difference of CE prevalence rate between two groups.According to the pathological results of CD138,the patients were re-divided into CE group(n=680)and non-CE group(n=1485).Univariate analysis and binary Logistic regression were used to analyze the related factors of CE.The experimental data were analyzed by SPSS21.0software,and the results(P<0.05)were considered to be statistically significant.Results1.There was no significant difference in age,BMI,years of infertility and history of ectopic pregnancy between the two groups(P>0.05).But secondary infertility and tubal infertility were associated with UU infection,and difference was statistically significant(P<0.05).2.In the UU infection group,the negative conversion rate in the first course of empirical treatment was 82.98%(1497/1804),the cumulative negative conversion rate in the second course was 96.56%(1742/1804),and the cumulative negative conversion rate in the third course was 98.83%(1768/1789).The negative conversion rates of doxycycline,levofloxacin,azithromycin and roxithromycin in the first course of UU were 95.16%,50.00%,28.00% and 0,respectively.The negative conversion rate of UU treated with doxycycline was significantly higher than that of azithromycin(95.16% vs28.00%)(P<0.05).3.The results of UU drug sensitivity test showed that the sensitivity of seven antibiotics from strong to weak were as follows: josamycin,doxycycline,azithromycin,clarithromycin,levofloxacin,roxithromycin,clindamycin,which were 99.07%,93.22%,83.41%,78.97%,52.10%,51.64% and 4.91%,respectively.Except for josamycin,the sensitivity of UU antimicrobial agents showed an overall downward trend from 2017 to2020.4.There was no significant difference in the number of follicles,number of eggs obtained,fertilization rate and high quality embryo rate between the two groups(P>0.05).And there was no significant difference in biochemical pregnancy rate,clinical pregnancy,ectopic pregnancy rate,early abortion rate,live birth rate,preterm delivery rate between the two groups(P>0.05).5.There was no significant difference in the prevalence of chronic endometritis between the UU infection group and the non-infection group(32.14% vs 30.99%)after treatment(P<0.05).6.Univariate analysis showed that tubal blockage,history of hydrosalpinx and history of endometrial polyps(EPs)were related to CE(P<0.05).There was no significant difference in age,BMI,years of infertility,secondary infertility,UU infection,EMT and history of ectopic pregnancy(P>0.05).Binary Logistic regression analysis showed that tubal obstruction(OR=1.271,95%CI 1.048-1.542,P=0.015),history of fallopian tube effusion(OR=2.109,95%CI 1.351-3.292,P=0.001)and history of EPs(OR=1.610,95%CI 1.211-2.140,P=0.001)were independent risk factors for CE.Conclusions1.Ureaplasma Urealyticum infection is closely related to secondary infertility and tubal infertility.UU test should be included as a routine examination for women with fertility requirements.2.The negative conversion rate of Ureaplasma Urealyticum after antibiotic treatment was high,but its antimicrobial sensitivity showed an downward trend.UU is highly sensitive to doxycycline and doxycycline is recommended as a first-line drug for Ureaplasma Urealyticum infection.3.Ureaplasma Urealyticum treatment does not affect the pregnancy outcome of IVF-ET,and cervical UU examination could not be repeated before IVF-ET.4.After the treatment of cervical UU infection,patients do not need routine endometrial biopsy to exclude chronic endometritis.