Chronic endometritis: pathogenesis, diagnosis, management and associated infertility
Chronic endometritis (CE) is characterized by continuous subclinical inflammation and plasma cell infiltration in the endometrial stroma. The CE overall prevalence varies widely. Proliferation and differentiation disorders, immune response alterations in the endometrium, as well as aberrant expression of mediators, lead to CE complications associated with the female fertility. Immunohistochemistry for detecting plasma cells in the endometrium is the gold standard for diagnosis. Hysteroscopy in combination with microscopical analysis may be considered as a favorable combination for the CE diagnostics. Antibiotic therapy of CE is currently considered the method of choice, although there are many conflicting opinions about its effectiveness in overcoming infertility in the presence of CE. The aim of this work was to characterize the pathophysiology of chronic endometritis (CE) and its relationship with infertility, as well as to discuss existing methods in CE diagnostics and management. Conclusion. Despite the abundance of accumulated information, high-quality clinical and morphological studies with a strong evidence base are still required to overcome the ambiguities of the CE etiology, pathophysiology, diagnostic methods and treatment in women with CE induced fertility.