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Nevertheless, standardization of the criteria for histopathological diagnosis and immunohistochemistry technique needs to be defined.
In this regards, many factors involved in the implantation are not yet fully understood and it seems that endometrium plays much more relevant role than the other recognized factors 5 - 7. Endometrium is a unique tissue that undergoes monthly cyclical changes resulting in menstruation, proliferation, secretion and decidualization under the influence of ovarian steroids.Proton pump inhibitors are used to studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including esophagitis a severe form of heartburn.
Endometrium contains a large variety of immunocompetent cells, natural killers NKs, macrophages, T cells and neutrophils, whose composition and density fluctuates periodically 8. The cycle-dependent changes in these subpopulations of leukocytes and their mediators probably play a crucial role in implantation.
In contrast, antibody-bearing B-lymphocytes and plasma cells are rarely found in endometrial tissue 9. Chronic endometritis CE is defined as localized inflammation of the endometrial mucosa characterized by the presence of edema, increased stromal cell density, dissociated maturation between epithelial cells and stroma fibroblasts, as well as the presence of plasma cell infiltrate in the stroma 10.
These changes at the level of endometrial microenvironment could affect endometrial receptivity 11.
CE is often asymptomatic or present with non-specific clinical symptoms, such as pelvic pain, dysfunctional uterine bleeding, dyspareunia, vaginal discharge, vaginitis, recurrent cystitis and mild gastro-intestinal discomfort 12.
Nonspecific quality of the symptoms and importance of performing endometrial biopsy to confirm diagnosis makes it difficult to estimate the prevalence of this condition. As far as infertile patients are concerned, the prevalence varies greatly depending on the utilized biopsy method and investigated population.
In a prospective study published by Cicinelli et al. However, Kasius et al. CE can be due to the presence of foreign bodies or structural pathology of the endometrial cavity, such as the presence of intrauterine device IUD, submucous myomas, polyps, retained products of conception, incomplete abortion or infectious agents.
The presence of Chlamydia trachomatis is only 2.
In certain areas of the world, Mycobacterium tuberculosis is highly prevalent. Today, it is well accepted that the uterus is not a sterile cavity, and that presence of the microorganisms is not equal to inflammation 23.
Asymptomatic presence of bacteria in the endometrial cavity in either transcervical samples, or cultures obtained in post-hysterectomy specimens, has been reported by several investigators 24.
As described by Espinoza et al.
Therefore, presence of pathology is also determined by interaction of the infectious agent with the endometrial microenvironment 28. Considering that the published data has not yet been able to draw a firm conclusion in this regard, in this paper we aim to review the current pieces of evidence regarding diagnosis, impact on reproductive outcomes and management of CE.
Conversely, in CE a large population of B cells lymphocytes are present at the both basal layer of the endometrium and glandular epithelium, as well as in the lumen of endometrial glands 29. Recent data suggest that a lipopolysaccharide derived from E.
In this microenvironment, gram-negative bacteria within the endometrium induce an abnormal immune response with migration of circulating B lymphocytes to the endometrial stromal compartment 8.
In a study performed by Di Pietro et al. These altered gene expressions could affect, at least in part, the embryonic implantation and they also explained presence of endometrial hyperplastic lesions.
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