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The effects of chronic endometritis on the pregnancy outcomes

MORIMUNE Aina 60757219 滋賀医科大学 DOI:10.1111/aji.13357

2021.03

概要

Problem:
Chronic endometritis (CE) influences the clinical outcomes of assisted reproductive technology. However, the effect of CE on the pregnancy outcome is still unknown.
Method of study:
A retrospective case-control study was conducted in a single university. Subjects who conceived by in vitro fertilization within a year after a histological diagnosis of CE under 40 years of age from September 2013 to December 2017 were extracted. The rates of miscarriage, preterm birth, term birth, and live birth per pregnancy according to the presence or absence of CE were analyzed. A logistic regression analysis was performed for miscarriage, preterm birth, term birth, and live birth for eight explanatory variables of seven infertility factors and CE.
Results:
A total of 39 pregnancies in 38 subjects with non-CE and 35 pregnancies in 32 subjects with CE were ultimately analyzed. The rates of miscarriage, preterm birth, term birth, and live birth per pregnancy were 12.8% and 40.0% (P < .03), 2.6% and 14.3% (P = .1), 84.6% and 45.7% (P < .001) and 84.6% and 57.1% (P < .03) in the Non-CE and CE groups, respectively, although only the analysis for tem birth rate had sufficient power to exclude Type II error. In logistic analysis, CE was a factor affecting the objective variables of miscarriage, term birth, and live birth.
Conclusions:
The term birth rate among pregnancies decreased mainly due to an increase in miscarriages when CE was detected before pregnancy in patients treated with in vitro fertilization. A histopathological diagnosis of CE adversely affected the term birth rate per pregnancy.

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Table 1. Characteristics and pregnancy outcomes of pregnancy

Non-CE

CE

P value

N=39

Age (y)

Power

N=35

35.2±0.51

34.3±0.55

NS

Gravidity

0 (0-4)

0 (0-3)

NS

Parity

0 (0-1)

0 (0-1)

NS

7.1 (4.3-18.4)

8.8 (5.4-14.8)

.06

1 (1-9)

1 (1-6)

NS

20.7 (16.91-32.81)

21.82 (17.0-32.81)

NS

NS

Miscarriage / pregnancy

12.8% (5/39)

40.0% (14/35)

<.03

.674

Preterm birth / pregnancy

2.6% (1/39)

14.3% (5/35)

.095

.29

Term birth / pregnancy

84.6% (33/39)

45.7% (16/35)

<.001

.922

Live birth / pregnancy

84.6% (33/39)

57.1% (20/35)

<.03

.657

The level of serum FSH

Previous OPU cycles

BMI (kg/m2)

Smoking

Cause of infertility

NS

Male factor

Tubal factor

11

Endometriosis

10

10

Ovarian factor

Antisperm antibody

Fertilization failure

Unknown

15

Embryo quality

NS

Good quality blastocyst

65% (26/40)

68.4% (26/38)

Poor quality blastocyst

32.5% (13/40)

23.7% (9/38)

Good cleaved embryo

2.5% (1/40)

7.9% (3/38)

BMI: body mass index, CE: Chronic endometritis, FSH: follicle-stimulating hormone, OPU: ova pick

up, NS: not significance

Table 2. Characteristics and pregnancy outcomes of ongoing pregnancy

Non-CE

CE

P value

N=34

Power

N=21

Age (y)

35.2±0.55

34.5±0.70

NS

Gravity

0 (0-4)

0 (0-3)

NS

Parity

0 (0-1)

0 (0-1)

NS

7.1 (4.3-18.4)

8.5 (5.4-11.9)

NS

1 (1-9)

1 (1-6)

NS

20.79 (16.91-32.81)

21.5 (17.0-32.81)

NS

NS

2.9% (1/34)

23.8% (5/21)

<.03

.505

97.1% (33/34)

76.2% (16/21)

<.03

.625

100% (34/34)

95.2% (20/21)

NS

.301

The level of serum FSH

Previous OPU cycles

BMI (kg/m2)

Smoking

Preterm birth / ongoing

pregnancy

Term birth / ongoing

pregnancy

Live birth / ongoing

pregnancy

Cause of infertility

NS

Male factor

Tubal factor

Endometriosis

Ovarian factor

Antisperm antibody

Fertilization failure

Unknown

14

Good quality blastocyst

66.7% (24/36)

79.2% (19/24)

Poor quality blastocyst

30.1% (11/36)

8.3% (2/24)

Good cleaved embryo

2.8% (1/36)

12.5% (3/24)

Embryo quality

.08

BMI: body mass index, CE: Chronic endometritis, FSH: follicle-stimulating hormone, OPU: ova pick

up, NS: not significance

10

Table 3. Clinical courses of preterm birth

Presence

Gestational

of CE

age at

Delivery

Causes and details of preterm birth

style

delivery

Birth

Apgar

weight

score

(g)

Non-CE

36w2d

Placenta previa

CS

2452

CE

22w5d

PROM at 22 weeks 5 days of gestation

VD

566

8/9

Still

birth

CE

36w0d

CE

36w6d

PROM at 35 weeks 4 days ofgestation

Preterm labor admitted for long-term

VD

2696

8/9

CS

3206

8/9

CS

2110

9/10

CS

2568

8/9

tocolysis from 33 weeks of gestation

CE

36w2d

Severe hypertensive disorder of

pregnancy

CE

36w3d

Fetal pleural effusion

11

CE: chronic endometritis, PROM: preterm rapture of membrane, CS: caesarian section, VD: vaginal

12

delivery

13

14

15

Table 4. Logistic analysis of patients who became pregnant

Variable

Odds ratio

95% CI

P value

Miscarriage

CE

4.8

1.4-16.3

<.03

Preterm birth

CE

9.6

0.77-121.0

.08

Term birth

CE

0.11

0.03-0.39

<.001

Male factor

21.7

1.3-359.0

<.05

Tubal factor

34.5

1.7-683.0

<.03

Endometriosis

16.5

0.85-321.5

.07

Unknown

54.2

2.3-1263.9

<.03

CE

0.18

0.052-0.61

<.01

Unknown

10

0.69-144.3

.09

Live birth

16

CE: chronic endometritis, CI: confidential interval, NS: not significance

17

18

Table 5. Logistic analysis of patients with ongoing pregnancy

Variable

Odds ratio

95% CI

P value

Preterm birth

CE

16.3

1.3-204.6

<.05

Term birth

CE

0.61

0.005-0.77

<.05

Live birth

19

NS

CE: chronic endometritis, NS: not significance

20

21

22

Supplemental table 1. Characteristics and fertility and pregnancy outcomes of all patients by

group

Non-CE

CE

P value

N=40

Age (y)

35.2±0.48

34.8±0.49

NS

Gravidity

0 (0-4)

0 (0-3)

NS

Parity

0 (0-1)

0 (0-1)

NS

7.3 (4.3-18.4)

8.7 (5.4-14.8)

0.06

1 (1-9)

1 (1-6)

NS

20.79 (16.91-32.81)

21.85 (16.38-35.74)

NS

NS

The level of serum FSH

Previous OPU cycles

BMI (kg/m2)

Smoking

Power

N=44

Pregnancy / total

95% (38/40)

72.7% (32/44)

<.01

0.700

Miscarriage / total

12.6% (5/40)

31.8% (14/44)

<.03

0.450

Preterm birth / total

2.5% (1/40)

11.3% (5/44)

NS

0.197

Term birth / total

82.5% (33/40)

36.4% (16/44)

<.0001

0.992

Live birth / total

85% (34/40)

45.4% (20/44)

<.0003

0.962

NS

Cause of infertility

Male factor

10

Tubal factor

13

Endometriosis

10

12

Ovarian factor

Antisperm antibody

Fertilization failure

Unknown

13

Embryo quality

NS

Good quality blastocyst

37

50

Poor quality blastocyst

15

25

Good cleaved embryo

11

BMI: body mass index, CE: Chronic endometritis, FSH: follicle-stimulating hormone,

OPU: ova pick up, NS: not significance

Supplemental table 2. Logistic analysis of the total patient group

Variable

Odds ratio

95% CI

P value

Pregnancy

CE

0.13

0.024-0.74

<.03

Miscarriage

CE

3.5

1.1-11.5

<.05

Preterm birth

Term birth

Live birth

NS

CE

0.091

0.03-0.29

<.0001

Tubal factor

1.05-103.4

<.05

Endometriosis

10.4

1.36-108.0

<.03

Unknown

36.2

2.8-470.0

<.01

CE

0.11

0.034-0.39

<.0001

Unknown

24.2

1.8-331.8

<.03

CE: chronic endometritis, CI: confidential interval, NS: not significance

...

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