Improving the effectiveness of therapy for chronic endometritis
Objective. To study the effectiveness of combination therapy for chronic endometritis using standard antibiotic treatment regimen and immunomodulators (exogenous cytokine therapy). Patients and methods. This prospective randomized clinical trial enrolled 40 patients with a histologically verified diagnosis of chronic endometritis. Patients were randomized into two groups; the study group (n = 20) received combination therapy (antibiotics + Superlymph 25 units), and the control group (n = 20) received monotherapy with antibiotics. The course of antibiotic therapy included a 10-day use of ofloxacin 400 mg twice daily with metronidazole 500 mg twice daily. General methods of clinical investigation, histological and immunohistochemical examinations, and statistical measures of variation were used. Results. Mild endometritis was diagnosed in 30% (6/20) of patients in the study group and in 25% (5/20) of patients (p = 0.363) in the control group, moderate endometritis - in 45% (9/20) and 55% (11/20) (p = 0.264), and severe endometritis -_| in 25% (5/20) and 20% (4/20) (p = 0.351), respectively. After the end of therapy, the control histological and immunohistochemical examinations showed positive dynamics in both groups. The signs of chronic endometritis were absent in 90% (18/20) of patients in the study group and in 70% (14/20) of patients in the control group (p = 0.05). In the study group, two patients had signs of mild (1/20, 5%) and moderate (1/20, 5%) endometritis. In the control group, histologically mild endometritis persisted in 20% (4/20) of patients and moderate endometritis - in 10% (2/20) of patients (in comparison with the study group, p < 0.05). In six months after the end of therapy, pregnancy occurred in 45% of patients in the study group, of which 22.2% were the result of using assisted reproductive technologies (ART) and 77.8% - spontaneous pregnancy. In the control group, pregnancy occurred in 25% of patients, and in 20% it was achieved by ART. In one patient, pregnancy was terminated at 12 weeks due to fetal malformations.