akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2025.654akusherstvo-2517Research ArticleОRIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИThe uterine cavity state in older reproductive age patientsСостояние полости матки у пациенток старшего репродуктивного возрастаhttps://orcid.org/0000-0002-4792-5380ЛокшинВ. Н.LokshinV. N.

Локшин Вячеслав Нотанович - д.м.н., проф., академик Национальной академии наук Республики Казахстан.

005060 Алматы, ул. Утепова, д. 32а

Scopus Author ID 56357942200

Vyacheslav N. Lokshin - MD, Dr Sci Med, Prof., Academician of the National Academy of Sciences of the Republic of Kazakhstan.

32а Utepov Str., Almaty 005060

Scopus Author ID 56357942200

https://orcid.org/0000-0002-9368-6683РыбинаА. Н.RybinaA. N.

Рыбина Анастасия Николаевна - магистр медицины.

005060 Алматы, ул. Утепова, д. 32а; 050012 Алматы, ул. Толе би, д. 94

Scopus Author ID 57215966657

Anastassiya N. Rybina - MD, ММed.

32а Utepov Str., Almaty 005060; 94 Tole bi Str., Almaty 050012

Scopus Author ID 57215966657

oedema@mail.ruhttps://orcid.org/0000-0002-3138-6650АбшекеноваА. Т.AbshekenovaA. T.

Абшекенова Айгерим Темирхановна.

005060 Алматы, ул. Утепова, д. 32а; 050012 Алматы, ул. Толе би, д. 94

Scopus Author ID 57798585800

Aigerim T. Abshekenova - MD.

32а Utepov Str., Almaty 005060; 94 Tole bi Str., Almaty 050012

Scopus Author ID 57798585800

https://orcid.org/0000-0002-2538-3728АскарЕ.AskarY.

Аскар Енлик - к.м.н.

005060 Алматы, ул. Утепова, д. 32а; 050012 Алматы, ул. Толе би, д. 94

Scopus Author ID 58476819300

Yenglik Askar - MD, PhD.

32а Utepov Str., Almaty 005060; 94 Tole bi Str., Almaty 050012

Scopus Author ID 58476819300

https://orcid.org/0000-0001-5691-8652КарибаеваШ. К.KaribaevaSh. K.

Карибаева Шолпан Кенесовна - к.м.н.

005060 Алматы, ул. Утепова, д. 32а; 050012 Алматы, ул. Толе би, д. 94

Scopus Author ID 57216159167

Sholpan K. Karibaeva - MD, PhD.

32а Utepov Str., Almaty 005060; 94 Tole bi Str., Almaty 050012

Scopus Author ID 57216159167

https://orcid.org/0000-0003-2526-4291ВалиевР. К.ValievR. K.

Валиев Равиль Камилевич - к.м.н.

005060 Алматы, ул. Утепова, д. 32а

Scopus Author ID 57215968453

Ravil K. Valiev - MD, PhD.

32а Utepov Str., Almaty 005060

Scopus Author ID 57215968453

ТОО «Международный клинический центр репродуктологии "PERSONA"»Казахстан«PERSONA» International Clinic of Reproductive Health, LLPKazakhstanТОО «Международный клинический центр репродуктологии "PERSONA"»; НАО «Казахский национальный медицинский университет имени С.Д. Асфендиярова»Казахстан«PERSONA» International Clinic of Reproductive Health, LLP; Asfendiyarov Kazakh National Medical UniversityKazakhstan202510092025194506513Copyright © Lokshin V.N., Rybina A.N., Abshekenova A.T., Askar Y., Karibaeva S.K., Valiev R.K., 20252025Локшин В.Н., Рыбина А.Н., Абшекенова А.Т., Аскар Е., Карибаева Ш.К., Валиев Р.К.Lokshin V.N., Rybina A.N., Abshekenova A.T., Askar Y., Karibaeva S.K., Valiev R.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2517Introduction

Introduction. Successful completion of in vitro fertilization (IVF) program is characterized by pregnancy achievement, suggesting that an implantation-competent embryo has reached a receptive endometrium. Chronic endometritis (CE) often being asymptomatic or presented with non-specific symptoms represents one of the main causes for impaired endometrial receptivity. CE treatment and normalization of CD138 expression are related to improved outcomes in assisted reproductive technology (ART) programs, primarily in women of advanced reproductive age.

Aim

Aim: to analyze the frequency and severity of pathological endometrial changes by using hysteroscopy with biopsy and immunohistochemical examination (IHC) in women of advanced ( 35 years old) vs. younger (< 35 years old) reproductive age.

Materials and Methods

Materials and Methods. A retrospective descriptive continuous cross-sectional study was conducted to analyze 569 hysteroscopy protocols with biopsy and IHC performed at the "PERSONA" clinic in 2020–2022. Clinical and anamnestic data (age, frequency of primary and secondary infertility), frequency, structure and severity of uterine cavity pathology, age-related pattern were assessed according to histological and IHC studies in two age groups: < 35 years and ≥ 35 years.

Results

Results. CE was identified in 80.47 % of younger and 85.3 % of older patients. Severe CE was significantly more common in ≥ 35-year-old women (12.73 % vs. 3.6 %; p = 0.021). No significant inter-group differences were found in CD138 expression levels. Common endometrial abnormalities included fibrosis and mixed lesions.

Conclusion

Conclusion. While overall endometrial pathology was commonly observed in both age groups, severe CE forms were significantly more frequent in women of advanced reproductive age. Office hysteroscopy is recommended prior to ART initiation in this population to optimize outcomes.

Введение

Введение. Успешное завершение программы экстракорпорального оплодотворения (ЭКО) характеризуется наступлением беременности; это означает, что эмбрион, способный к имплантации, попал в рецептивный эндометрий. Одной из частых причин нарушения его рецептивности является хронический эндометрит (ХЭ), который протекает бессимптомно или с неясными проявлениями. Лечение ХЭ с нормализацией CD138 повышает шансы на успешную имплантацию в программах вспомогательных репродуктивных технологий (ВРТ), особенно у пациенток старшего репродуктивного возраста.

Цель

Цель: провести анализ частоты и выраженности патологических изменений эндометрия по данным гистероскопии с биопсией и иммуногистохимическим исследованием (ИГХ) у женщин старшего репродуктивного возраста (35 лет и старше) в сравнении с женщинами младше 35 лет.

Материалы и методы

Материалы и методы. Проведено ретроспективное описательное сплошное поперечное исследование. Проанализированы 569 протоколов гистероскопии с биопсией и ИГХ, выполненных в клинике «PERSONA» в 2020–2022 гг. Оценены клинико-анамнестические данные (возраст, частота первичного и вторичного бесплодия), частота, структура и выраженность патологии полости матки в зависимости от возраста женщины по данным гистологического и ИГХ исследования. Проведено разделение на 2 возрастные группы: < 35 лет и ≥ 35 лет.

Результаты

Результаты. ХЭ выявлен в 80,47 % случаев в младшей и в 85,3 % в старшей возрастной группе. Выраженный ХЭ достоверно чаще встречался у женщин ≥ 35 лет (12,73 % против 3,6 %; p = 0,021). Различий в выраженности CD138 клеток не обнаружено. Наиболее частыми патологиями были фиброз и сочетанные формы.

Заключение

Заключение. Выраженный ХЭ чаще встречается у женщин старшего возраста, что требует обязательной гистероскопии перед программами ВРТ.

бесплодиестарший репродуктивный возрастполость маткихронический эндометритinfertilityadvanced reproductive ageuterine cavitychronic endometritisАвторы выражают благодарность персоналу клиники «PERSONA» за помощь в сборе клинических данных и техническую поддержкуThe authors are grateful to the staff of the "PERSONA" clinic for assistance in collecting clinical data and technical support.ReferencesThe endometrial factor: a reproductive precision medicine approach. Eds. C. Simón, L.C. Giudice, CRC Press, 2017. 288 p.The endometrial factor: a reproductive precision medicine approach. Eds. C. Simón, L.C. Giudice, CRC Press, 2017. 288 p.Greenwood S.M., Moran J.J. Chronic endometritis: morphologic and clinical observations. Obstet Gynecol. 1981;58(2):176–84.Greenwood S.M., Moran J.J. Chronic endometritis: morphologic and clinical observations. Obstet Gynecol. 1981;58(2):176–84.Kitaya K., Takeuchi T., Mizuta S. et al. Endometritis: new time, new concepts. Fertil Steril. 2018;110(3):344–50. https://doi.org/10.1016/j.fertnstert.2018.04.012.Kitaya K., Takeuchi T., Mizuta S. et al. Endometritis: new time, new concepts. Fertil Steril. 2018;110(3):344–50. https://doi.org/10.1016/j.fertnstert.2018.04.012.Romero R., Espinoza J., Mazor M. Can endometrial infection/ inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization? Fertil Steril. 2004;82(4):799–804. https://doi.org/10.1016/j.fertnstert.2004.05.076.Romero R., Espinoza J., Mazor M. Can endometrial infection/ inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization? Fertil Steril. 2004;82(4):799–804. https://doi.org/10.1016/j.fertnstert.2004.05.076.Zolghadri J., Momtahan M., Aminian K. et al. The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. Eur J Obstet Gynecol Reprod Biol. 2011;155(2):217–20. https://doi.org/10.1016/j.ejogrb.2010.12.010.Zolghadri J., Momtahan M., Aminian K. et al. The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. Eur J Obstet Gynecol Reprod Biol. 2011;155(2):217–20. https://doi.org/10.1016/j.ejogrb.2010.12.010.Bouet P.-E., El Hachem H., Monceau E. et al. Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil Steril. 2016;105(1):106–10. https://doi.org/10.1016/j.fertnstert.2015.09.025.Bouet P.-E., El Hachem H., Monceau E. et al. Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil Steril. 2016;105(1):106–10. https://doi.org/10.1016/j.fertnstert.2015.09.025.Kasius J.C., Broekmans F.J.M., Sie-Go D.M.D.S. et al. The reliability of the histological diagnosis of endometritis in asymptomatic IVF cases: a multicenter observer study. Hum Reprod. 2012;27(1):153–8. https://doi.org/10.1093/humrep/der341.Kasius J.C., Broekmans F.J.M., Sie-Go D.M.D.S. et al. The reliability of the histological diagnosis of endometritis in asymptomatic IVF cases: a multicenter observer study. Hum Reprod. 2012;27(1):153–8. https://doi.org/10.1093/humrep/der341.McQueen D.B., Bernardi L.A., Stephenson M.D. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril. 2014;101(4):1026–30. https://doi.org/10.1016/j.fertnstert.2013.12.031.McQueen D.B., Bernardi L.A., Stephenson M.D. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril. 2014;101(4):1026–30. https://doi.org/10.1016/j.fertnstert.2013.12.031.Kannar V., Lingaiah H.K.M., Sunita V. Evaluation of endometrium for chronic endometritis by using syndecan-1 in abnormal uterine bleeding. J Lab Physicians. 2012;4(2):69–73.Kannar V., Lingaiah H.K.M., Sunita V. Evaluation of endometrium for chronic endometritis by using syndecan-1 in abnormal uterine bleeding. J Lab Physicians. 2012;4(2):69–73.McQueen D.B., Perfetto C.O., Hazard F.K., Lathi R.B. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril. 2015;104(4):927–31. https://doi.org/10.1016/j.fertnstert.2015.06.044.McQueen D.B., Perfetto C.O., Hazard F.K., Lathi R.B. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril. 2015;104(4):927–31. https://doi.org/10.1016/j.fertnstert.2015.06.044.Cicinelli E., Matteo M., Tinelli R. et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod. 2015;30(2):323–30. https://doi.org/10.1093/humrep/deu292.Cicinelli E., Matteo M., Tinelli R. et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod. 2015;30(2):323–30. https://doi.org/10.1093/humrep/deu292.Vitagliano A., Saccardi C., Noventa M. et al. Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis. Fertil Steril. 2018;110(1):103–112.e1. https://doi.org/10.1016/j.fertnstert.2018.03.017.Vitagliano A., Saccardi C., Noventa M. et al. Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis. Fertil Steril. 2018;110(1):103–112.e1. https://doi.org/10.1016/j.fertnstert.2018.03.017.Yang R., Du X., Wang Y. et al. The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients. Arch Gynecol Obstet. 2014;289(6):1363–9. https://doi.org/10.1007/s00404-013-3131-2.Yang R., Du X., Wang Y. et al. The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients. Arch Gynecol Obstet. 2014;289(6):1363–9. https://doi.org/10.1007/s00404-013-3131-2.Park H.J., Kim Y.S., Yoon T.K., Lee W.S. Chronic endometritis and infertility. Clin Exp Reprod Med. 2016;43(4):185–92. https://doi.org/10.5653/cerm.2016.43.4.185.Park H.J., Kim Y.S., Yoon T.K., Lee W.S. Chronic endometritis and infertility. Clin Exp Reprod Med. 2016;43(4):185–92. https://doi.org/10.5653/cerm.2016.43.4.185.Ma J., Gao W., Li D. Recurrent implantation failure: a comprehensive summary from etiology to treatment. Front Endocrinol (Lausanne). 2023;13:1061766. https://doi.org/10.3389/fendo.2022.1061766.Ma J., Gao W., Li D. Recurrent implantation failure: a comprehensive summary from etiology to treatment. Front Endocrinol (Lausanne). 2023;13:1061766. https://doi.org/10.3389/fendo.2022.1061766.Oshina K., Kuroda K., Nakabayashi K. et al. Gene expression signatures associated with chronic endometritis revealed by RNA sequencing. Front Med. 2023;10:1185284. https://doi.org/10.3389/fmed.2023.1185284.Oshina K., Kuroda K., Nakabayashi K. et al. Gene expression signatures associated with chronic endometritis revealed by RNA sequencing. Front Med. 2023;10:1185284. https://doi.org/10.3389/fmed.2023.1185284.Cicinelli E., Matteo M., Tinelli R. et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014;21(5):640–7. https://doi.org/10.1177/1933719113508817.Cicinelli E., Matteo M., Tinelli R. et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014;21(5):640–7. https://doi.org/10.1177/1933719113508817.Johnston-MacAnanny E.B., Hartnett J., Engmann L.L. et al. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril. 2010;93(2):437–41. https://doi.org/10.1016/j.fertnstert.2008.12.131.Johnston-MacAnanny E.B., Hartnett J., Engmann L.L. et al. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril. 2010;93(2):437–41. https://doi.org/10.1016/j.fertnstert.2008.12.131.Kitaya K., Tada Y., Taguchi S. et al. Local mononuclear cell infiltrates in infertile patients with endometrial macropolyps versus micropolyps. Hum Reprod. 2012;27(12):3474–80. https://doi.org/10.1093/humrep/des323.Kitaya K., Tada Y., Taguchi S. et al. Local mononuclear cell infiltrates in infertile patients with endometrial macropolyps versus micropolyps. Hum Reprod. 2012;27(12):3474–80. https://doi.org/10.1093/humrep/des323.Cheng X., Huang Z., Xiao Z., Bai Y. Does antibiotic therapy for chronic endometritis improve clinical outcomes of patients with recurrent implantation failure in subsequent IVF cycles? A systematic review and meta-analysis. J Assist Reprod Genet. 2022;39(8):1797–813. https://doi.org/10.1007/s10815-022-02558-1.Cheng X., Huang Z., Xiao Z., Bai Y. Does antibiotic therapy for chronic endometritis improve clinical outcomes of patients with recurrent implantation failure in subsequent IVF cycles? A systematic review and meta-analysis. J Assist Reprod Genet. 2022;39(8):1797–813. https://doi.org/10.1007/s10815-022-02558-1.Lundin K., Bentzen J.G., Bozdag G. et al. Good practice recommendations on add-ons in reproductive medicine. Hum Reprod. 2023;38(11):2062–104. https://doi.org/10.1093/humrep/dead186.Lundin K., Bentzen J.G., Bozdag G. et al. Good practice recommendations on add-ons in reproductive medicine. Hum Reprod. 2023;38(11):2062–104. https://doi.org/10.1093/humrep/dead186.Дикке Г.Б., Олина А.А., Кузнецова И.В. и др. Алгоритм лечения бесплодия маточного происхождения у пациенток с эндометриальной дисфункцией, обусловленной хроническим эндометритом. Акушерство и гинекология. 2024;9(Приложение):4–20. https://doi.org/10.18565/aig.2024.205.Dikke G.B., Olina A.A., Kuznetsova I.V. et al. Algorithm for treating uterine factor infertility in patients with endometrial dysfunction secondary to chronic endometritis. [Algoritm lecheniya besplodiya matochnogo proiskhozhdeniya u pacientok s endometrial'noj disfunkciej, obuslovlennoj hronicheskim endometritom]. Akusherstvo i ginekologiya. 2024;9(Suppl):4–20 (In Russ.). https://doi.org/10.18565/aig.2024.205.

The authors declare that there are no conflicts of interest present.