Title : Possibilities of using glucocorticosteroids in the treatment of chronic autoimmune endometritis
Abstract:
Chronic endometritis is a chronic long–term disease of the endometrium, accompanied by inflammation and causing such pathologies of the reproductive system as menstrual irregularities, infertility and miscarriage.
Because of the widespread prevalence of chronic endometritis among women of reproductive age, the issues of diagnosis and treatment have not lost their relevance and pose significant difficulties for clinicians. Special attention should be paid to the correct diagnosis and successful treatment of chronic endometritis in preparing women to entry into ART programs.
In modern conditions, chronic endometritis is characterized by a change in the etiological structure of the disease with an increase in the importance of viral or opportunistic flora, the predominance of associations of several types of microorganisms in the endometrium, as well as an increase in the resistance of microflora to pharmacotherapy.
Thus, therapeutic tactics should be aimed primarily at relieving clinical symptoms, eliminating the pathogen and minimizing the risks of long-term consequences.
When the inflammatory process in the endometrium lasts for years, therapy becomes multi-stage and complex.
The essence of the first stage is to eliminate the microbial factor damaging the endometrium and/or reduce the activity of viral invasion through etiotropic therapy with broad-spectrum antibiotics and/or antiviral drugs.
At the second stage, therapeutic measures involve restoring the morphofunctional potential of the endometrium by eliminating the results of secondary tissue damage, including restoring the activity of the endometrial receptor apparatus, full-fledged proliferation and secretory transformation of the endometrium.
Treatment of autoimmune chronic endometritis can begin immediately from the second stage, provided a sterile biopsy of the endometrium.
The purpose of our study is to evaluate the effectiveness of local administration of glucocorticosteroids for restoring the structure of the endometrium in women with chronic autoimmune endometritis.
We examined 22 women with implantation failures who had chronic autoimmune endometritis according to the results of an immunocytochemical examination of the endometrium. Depending on the identified microbial agent, antibacterial and antiviral therapy was performed.
At the second stage, to increase the effectiveness of therapy, local effects on the endometrium were performed by intrauterine administration of glucocorticosteroids. This treatment method has proven to be a highly effective and reliable method of treating of autoimmune processes in the endometrium.
The control of cure was carried out according to the data of immunocytochemical assessment of endometrial biopsies, ultrasound assessment of the pelvic organs, with determination of the thickness and structure of the endometrium.
Positive results after the phased therapy were observed in 17 (79%) patients. After treatment, 9 (40%) women became pregnant, both in a spontaneous cycle and after in vitro fertilization and embryo transfer into the uterine cavity. The rest of the patients had a normal menstrual cycle.
Adequate treatment of chronic endometritis during pre-gravity training of women with implantation failures, which helps eliminate infectious agents and restore the structure and function of the endometrium, is the key to successful implantation and a successful course of subsequent pregnancy.
