Abstract：
OBJECTIVE: To investigate variation in the diagnosis and treatment of chronic endometritis (CE) at the national level in Japan.
METHODS: We performed a nationwide survey targeting all assisted reproductive technology (ART) facilities across Japan between 2021 and 2022. Diagnostic methods, criteria, and first- and second-line treatment protocols for CE were collected via a questionnaire.
RESULTS: Among 616 ART facilities, 437 responded to the survey (response rate: 70.9%) of which 339 (77.6%) implemented diagnosis and treatment of CE. In the diagnosis of CE, 214 (63.1%) facilities used CD138 immunohistochemical staining of endometrial tissue, while hysteroscopy was the most frequently used as an adjunct diagnostic method (241 facilities, 71.1%). The most frequent cutoff value of CD138-positive cells for diagnosing CE was 3-5 cells/20 high-power fields (50%), but 7.9% (17 facilities) and 5.1% (11 facilities) used cutoff values of 1 and 2 cells, respectively. The most common first- and second-line treatment methods were doxycycline (210 facilities, 61.9%) and ciprofloxacin + metronidazole (164 facilities, 48.0%), respectively.
CONCLUSIONS: There is considerable variation in the number of CD138-positive cells used for diagnosing CE. Establishing unified diagnostic criteria and therapeutic methods for CE is essential to provide standardized medicine for CE at the national level.
METHODS: We performed a nationwide survey targeting all assisted reproductive technology (ART) facilities across Japan between 2021 and 2022. Diagnostic methods, criteria, and first- and second-line treatment protocols for CE were collected via a questionnaire.
RESULTS: Among 616 ART facilities, 437 responded to the survey (response rate: 70.9%) of which 339 (77.6%) implemented diagnosis and treatment of CE. In the diagnosis of CE, 214 (63.1%) facilities used CD138 immunohistochemical staining of endometrial tissue, while hysteroscopy was the most frequently used as an adjunct diagnostic method (241 facilities, 71.1%). The most frequent cutoff value of CD138-positive cells for diagnosing CE was 3-5 cells/20 high-power fields (50%), but 7.9% (17 facilities) and 5.1% (11 facilities) used cutoff values of 1 and 2 cells, respectively. The most common first- and second-line treatment methods were doxycycline (210 facilities, 61.9%) and ciprofloxacin + metronidazole (164 facilities, 48.0%), respectively.
CONCLUSIONS: There is considerable variation in the number of CD138-positive cells used for diagnosing CE. Establishing unified diagnostic criteria and therapeutic methods for CE is essential to provide standardized medicine for CE at the national level.
摘要：
目的：探讨日本国内慢性子宫内膜炎（CE）诊断和治疗的变化。
方法：我们在2021年至2022年间针对日本所有辅助生殖技术（ART）设施进行了全国性调查。诊断方法,标准,并通过问卷调查收集了CE的一线和二线治疗方案。
结果：在616个ART设施中，437人回答调查（应答率：70.9%），其中339人（77.6%）实施CE诊断和治疗。在CE的诊断中，214（63.1%）设施使用CD138子宫内膜组织免疫组织化学染色，而宫腔镜检查是最常用的辅助诊断方法(241个设施，71.1%）。CD138阳性细胞诊断CE的最常见截止值为3-5个细胞/20个高功率场（50％），但7.9%(17个设施)和5.1%(11个设施)使用1个和2个细胞的截止值，分别。最常见的一线和二线治疗方法是多西环素（210个设施，61.9%)和环丙沙星+甲硝唑(164个设施，48.0%），分别。
结论：用于诊断CE的CD138阳性细胞的数量存在相当大的差异。建立统一的CE诊断标准和治疗方法对于在国家层面为CE提供标准化药物至关重要。
方法：我们在2021年至2022年间针对日本所有辅助生殖技术（ART）设施进行了全国性调查。诊断方法,标准,并通过问卷调查收集了CE的一线和二线治疗方案。
结果：在616个ART设施中，437人回答调查（应答率：70.9%），其中339人（77.6%）实施CE诊断和治疗。在CE的诊断中，214（63.1%）设施使用CD138子宫内膜组织免疫组织化学染色，而宫腔镜检查是最常用的辅助诊断方法(241个设施，71.1%）。CD138阳性细胞诊断CE的最常见截止值为3-5个细胞/20个高功率场（50％），但7.9%(17个设施)和5.1%(11个设施)使用1个和2个细胞的截止值，分别。最常见的一线和二线治疗方法是多西环素（210个设施，61.9%)和环丙沙星+甲硝唑(164个设施，48.0%），分别。
结论：用于诊断CE的CD138阳性细胞的数量存在相当大的差异。建立统一的CE诊断标准和治疗方法对于在国家层面为CE提供标准化药物至关重要。
