Abstract：
OBJECTIVE: A review of current knowledge on the pathophysiology, diagnostic and treatment options for chronic endometritis in infertile women.
RESULTS: One of the major causes of failed in vitro fertilization (IVF) is undiagnosed intrauterine pathologies, including chronic inflammation of the uterine mucosa - chronic endometritis. However, some authors relativize the negative impact of chronic endometritis on reproductive outcomes. The etiopathogenesis of chronic endometritis is due to qualitative and quantitative changes in the endometrial microbiome with abnormal multiplication of microorganisms naturally occurring in the uterine cavity or vagina. There is no uniform consensus on the most common pathogen causing chronic endometritis. It is characterized by infiltration of plasma cells into the endometrial stroma outside the menstrual cycle, accompanied by hyperaemia and endometrial oedema. Clinical symptoms are very mild or absent. The diagnosis of chronic endometritis is often difficult because there is no specific clinical or laboratory diagnostic method. The following investigative options are commonly used for the diagnosis of chronic endometritis: diagnostic hysteroscopy, histopathological examination of the endometrium including CD 138 immunohistochemistry and culture from the uterine cavity. However, standardised international hysteroscopic and histopathological criteria for accurate diagnosis of chronic endometritis are still lacking. Empirically administered antibiotic therapy improves the success rate of pregnancy and delivery of a viable foetus in infertile patients with proven chronic endometritis. In addition to reviewing the current knowledge of chronic endometritis, this article discusses the importance of hysteroscopy in the diagnostic process.
CONCLUSIONS: Chronic endometritis is often a clinically silent disease with negative impact on reproduction in infertile women. Although there are still many unresolved issues, the introduction of hysteroscopy into the diagnostic process is important for clinical practice; however, hysteroscopy even in combination with histological examination of the endometrium, often does not allow an unequivocal diagnosis of chronic endometritis. Further prospective randomised studies in a selected group of women with proven chronic endometritis and repeated failure to implant proven euploid embryos should refine this knowledge.
RESULTS: One of the major causes of failed in vitro fertilization (IVF) is undiagnosed intrauterine pathologies, including chronic inflammation of the uterine mucosa - chronic endometritis. However, some authors relativize the negative impact of chronic endometritis on reproductive outcomes. The etiopathogenesis of chronic endometritis is due to qualitative and quantitative changes in the endometrial microbiome with abnormal multiplication of microorganisms naturally occurring in the uterine cavity or vagina. There is no uniform consensus on the most common pathogen causing chronic endometritis. It is characterized by infiltration of plasma cells into the endometrial stroma outside the menstrual cycle, accompanied by hyperaemia and endometrial oedema. Clinical symptoms are very mild or absent. The diagnosis of chronic endometritis is often difficult because there is no specific clinical or laboratory diagnostic method. The following investigative options are commonly used for the diagnosis of chronic endometritis: diagnostic hysteroscopy, histopathological examination of the endometrium including CD 138 immunohistochemistry and culture from the uterine cavity. However, standardised international hysteroscopic and histopathological criteria for accurate diagnosis of chronic endometritis are still lacking. Empirically administered antibiotic therapy improves the success rate of pregnancy and delivery of a viable foetus in infertile patients with proven chronic endometritis. In addition to reviewing the current knowledge of chronic endometritis, this article discusses the importance of hysteroscopy in the diagnostic process.
CONCLUSIONS: Chronic endometritis is often a clinically silent disease with negative impact on reproduction in infertile women. Although there are still many unresolved issues, the introduction of hysteroscopy into the diagnostic process is important for clinical practice; however, hysteroscopy even in combination with histological examination of the endometrium, often does not allow an unequivocal diagnosis of chronic endometritis. Further prospective randomised studies in a selected group of women with proven chronic endometritis and repeated failure to implant proven euploid embryos should refine this knowledge.
摘要：
目的：对病理生理学的最新知识进行综述，不孕妇女慢性子宫内膜炎的诊断和治疗选择。
结果：体外受精（IVF）失败的主要原因之一是未诊断的宫内病变，包括子宫粘膜的慢性炎症-慢性子宫内膜炎。然而,一些作者比较了慢性子宫内膜炎对生殖结局的负面影响.慢性子宫内膜炎的病因是由于子宫内膜微生物组的定性和定量变化以及在子宫腔或阴道中天然存在的微生物的异常繁殖。关于引起慢性子宫内膜炎的最常见病原体没有统一的共识。它的特征是浆细胞浸润到月经周期外的子宫内膜基质中，伴有充血和子宫内膜水肿。临床症状非常轻微或不存在。慢性子宫内膜炎的诊断通常很困难，因为没有特定的临床或实验室诊断方法。以下研究选项通常用于诊断慢性子宫内膜炎：诊断性宫腔镜检查，子宫内膜的组织病理学检查，包括CD138免疫组织化学和子宫腔培养。然而,目前仍缺乏准确诊断慢性子宫内膜炎的标准化国际宫腔镜和组织病理学标准。经验给药的抗生素治疗可提高经证实为慢性子宫内膜炎的不育患者的妊娠和分娩成功率。除了回顾慢性子宫内膜炎的最新知识，本文讨论了宫腔镜在诊断过程中的重要性。
结论：慢性子宫内膜炎通常是一种临床上无症状的疾病，对不育妇女的生殖有负面影响。尽管仍有许多未解决的问题，将宫腔镜引入诊断过程对临床实践很重要；然而，宫腔镜即使与子宫内膜组织学检查相结合，通常不允许明确诊断慢性子宫内膜炎。在一组经过证实的慢性子宫内膜炎和反复植入经证实的整倍体胚胎失败的女性中，进一步的前瞻性随机研究应该完善这一知识。
结果：体外受精（IVF）失败的主要原因之一是未诊断的宫内病变，包括子宫粘膜的慢性炎症-慢性子宫内膜炎。然而,一些作者比较了慢性子宫内膜炎对生殖结局的负面影响.慢性子宫内膜炎的病因是由于子宫内膜微生物组的定性和定量变化以及在子宫腔或阴道中天然存在的微生物的异常繁殖。关于引起慢性子宫内膜炎的最常见病原体没有统一的共识。它的特征是浆细胞浸润到月经周期外的子宫内膜基质中，伴有充血和子宫内膜水肿。临床症状非常轻微或不存在。慢性子宫内膜炎的诊断通常很困难，因为没有特定的临床或实验室诊断方法。以下研究选项通常用于诊断慢性子宫内膜炎：诊断性宫腔镜检查，子宫内膜的组织病理学检查，包括CD138免疫组织化学和子宫腔培养。然而,目前仍缺乏准确诊断慢性子宫内膜炎的标准化国际宫腔镜和组织病理学标准。经验给药的抗生素治疗可提高经证实为慢性子宫内膜炎的不育患者的妊娠和分娩成功率。除了回顾慢性子宫内膜炎的最新知识，本文讨论了宫腔镜在诊断过程中的重要性。
结论：慢性子宫内膜炎通常是一种临床上无症状的疾病，对不育妇女的生殖有负面影响。尽管仍有许多未解决的问题，将宫腔镜引入诊断过程对临床实践很重要；然而，宫腔镜即使与子宫内膜组织学检查相结合，通常不允许明确诊断慢性子宫内膜炎。在一组经过证实的慢性子宫内膜炎和反复植入经证实的整倍体胚胎失败的女性中，进一步的前瞻性随机研究应该完善这一知识。
