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Abstract：
OBJECTIVE: To investigate the impact of antibiotic treatment for chronic endometritis (CE) on the pregnancy outcome of frozen-thawed embryo transfer (FET) cycles and the relevant clinical risk factors associated with CE.
METHODS: A retrospective cohort analysis was conducted on 1352 patients who underwent hysteroscopy and diagnostic curettage at Nanjing Maternal and Child Health Hospital from July 2020 to December 2021. All patients underwent CD138 immunohistochemical (IHC) testing to diagnose CE, and a subset of them underwent FET after hysteroscopy. Patient histories were collected, and reproductive prognosis was followed up.
RESULTS: Out of 1088 patients, 443 (40.7%) were diagnosed with CE. Univariate and multivariate binary logistic regression analyses revealed that parity ≥ 2, a history of ectopic pregnancy, moderate-to-severe dysmenorrhea, hydrosalpinx, endometrial polyps, a history of ≥ 2 uterine operations, and RIF were significantly associated with an elevated risk of CE (P < 0.05). Analysis of the effect of CE on pregnancy outcomes in FET cycles after antibiotic treatment indicated that treated CE patients exhibited a significantly lower miscarriage rate (8.7%) and early miscarriage rate (2.9%) than untreated non-CE patients (20.2%, 16.8%). Moreover, the singleton live birth rate (45.5%) was significantly higher in treated CE patients than in untreated non-CE patients (32.7%). Survival analysis revealed a statistically significant difference in the first clinical pregnancy time between treated CE and untreated non-CE patients after hysteroscopy (P = 0.0019). Stratified analysis based on the presence of recurrent implantation failure (RIF) demonstrated that in the RIF group, treated CE patients were more likely to achieve clinical pregnancy than untreated non-CE patients (P = 0.0021). Among hysteroscopy-positive patients, no significant difference was noted in pregnancy outcomes between the treatment and control groups (P > 0.05).
CONCLUSIONS: Infertile patients with a history of parity ≥ 2, hydrosalpinx, a history of ectopic pregnancy, moderate-to-severe dysmenorrhea, endometrial polyps, a history of ≥ 2 uterine operations, and RIF are at an increased risk of CE; these patients should be recommended to undergo hysteroscopy combined with CD138 examination before embryo transfer. Antibiotic treatment can improve the reproductive outcomes of FET in patients with CE, especially those with RIF.
METHODS: A retrospective cohort analysis was conducted on 1352 patients who underwent hysteroscopy and diagnostic curettage at Nanjing Maternal and Child Health Hospital from July 2020 to December 2021. All patients underwent CD138 immunohistochemical (IHC) testing to diagnose CE, and a subset of them underwent FET after hysteroscopy. Patient histories were collected, and reproductive prognosis was followed up.
RESULTS: Out of 1088 patients, 443 (40.7%) were diagnosed with CE. Univariate and multivariate binary logistic regression analyses revealed that parity ≥ 2, a history of ectopic pregnancy, moderate-to-severe dysmenorrhea, hydrosalpinx, endometrial polyps, a history of ≥ 2 uterine operations, and RIF were significantly associated with an elevated risk of CE (P < 0.05). Analysis of the effect of CE on pregnancy outcomes in FET cycles after antibiotic treatment indicated that treated CE patients exhibited a significantly lower miscarriage rate (8.7%) and early miscarriage rate (2.9%) than untreated non-CE patients (20.2%, 16.8%). Moreover, the singleton live birth rate (45.5%) was significantly higher in treated CE patients than in untreated non-CE patients (32.7%). Survival analysis revealed a statistically significant difference in the first clinical pregnancy time between treated CE and untreated non-CE patients after hysteroscopy (P = 0.0019). Stratified analysis based on the presence of recurrent implantation failure (RIF) demonstrated that in the RIF group, treated CE patients were more likely to achieve clinical pregnancy than untreated non-CE patients (P = 0.0021). Among hysteroscopy-positive patients, no significant difference was noted in pregnancy outcomes between the treatment and control groups (P > 0.05).
CONCLUSIONS: Infertile patients with a history of parity ≥ 2, hydrosalpinx, a history of ectopic pregnancy, moderate-to-severe dysmenorrhea, endometrial polyps, a history of ≥ 2 uterine operations, and RIF are at an increased risk of CE; these patients should be recommended to undergo hysteroscopy combined with CD138 examination before embryo transfer. Antibiotic treatment can improve the reproductive outcomes of FET in patients with CE, especially those with RIF.
摘要：
目的：探讨抗生素治疗慢性子宫内膜炎(CE)对冻融胚胎移植(FET)周期妊娠结局的影响及与CE相关的临床危险因素。
方法：对2020年7月至2021年12月在南京市妇幼保健院接受宫腔镜及诊断性刮宫术的1352例患者进行回顾性队列分析。所有患者均接受CD138免疫组织化学（IHC）检测以诊断CE，其中一部分在宫腔镜检查后接受了FET。收集患者病史，并随访生殖预后。
结果：在1088名患者中，443例（40.7%）被诊断为CE。单变量和多变量二元逻辑回归分析显示，胎次≥2，异位妊娠史，中度至重度痛经，输卵管积水,子宫内膜息肉,≥2次子宫手术史，RIF与CE风险升高显著相关(P<0.05)。抗生素治疗后，CE对FET周期妊娠结局的影响分析表明，接受治疗的CE患者的流产率（8.7％）和早期流产率（2.9％）明显低于未经治疗的非CE患者（20.2％，16.8%）。此外，接受治疗的CE患者的单胎活产率(45.5%)显著高于未经治疗的非CE患者(32.7%).生存分析显示，宫腔镜检查后，接受治疗的CE患者和未经治疗的非CE患者的首次临床妊娠时间差异具有统计学意义（P=0.0019）。基于反复植入失败（RIF）的分层分析显示，在RIF组中，接受治疗的CE患者比未经治疗的非CE患者更有可能实现临床妊娠(P=0.0021).在宫腔镜检查阳性的患者中，治疗组与对照组的妊娠结局差异无统计学意义(P>0.05)。
结论：生育史≥2的不孕患者，输卵管积水，有异位妊娠史,中度至重度痛经，子宫内膜息肉,≥2次子宫手术史，RIF和CE的风险增加;这些患者应建议在胚胎移植前接受宫腔镜联合CD138检查。抗生素治疗可以改善CE患者FET的生殖结局，尤其是那些RIF。
方法：对2020年7月至2021年12月在南京市妇幼保健院接受宫腔镜及诊断性刮宫术的1352例患者进行回顾性队列分析。所有患者均接受CD138免疫组织化学（IHC）检测以诊断CE，其中一部分在宫腔镜检查后接受了FET。收集患者病史，并随访生殖预后。
结果：在1088名患者中，443例（40.7%）被诊断为CE。单变量和多变量二元逻辑回归分析显示，胎次≥2，异位妊娠史，中度至重度痛经，输卵管积水,子宫内膜息肉,≥2次子宫手术史，RIF与CE风险升高显著相关(P<0.05)。抗生素治疗后，CE对FET周期妊娠结局的影响分析表明，接受治疗的CE患者的流产率（8.7％）和早期流产率（2.9％）明显低于未经治疗的非CE患者（20.2％，16.8%）。此外，接受治疗的CE患者的单胎活产率(45.5%)显著高于未经治疗的非CE患者(32.7%).生存分析显示，宫腔镜检查后，接受治疗的CE患者和未经治疗的非CE患者的首次临床妊娠时间差异具有统计学意义（P=0.0019）。基于反复植入失败（RIF）的分层分析显示，在RIF组中，接受治疗的CE患者比未经治疗的非CE患者更有可能实现临床妊娠(P=0.0021).在宫腔镜检查阳性的患者中，治疗组与对照组的妊娠结局差异无统计学意义(P>0.05)。
结论：生育史≥2的不孕患者，输卵管积水，有异位妊娠史,中度至重度痛经，子宫内膜息肉,≥2次子宫手术史，RIF和CE的风险增加;这些患者应建议在胚胎移植前接受宫腔镜联合CD138检查。抗生素治疗可以改善CE患者FET的生殖结局，尤其是那些RIF。
