Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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Chronic endometritis and infertility

  • Park, Hyun Jong (Department of Obstetrics and Gynecology, Fertility Center of CHA Gumi Medical Center, CHA University) ;
  • Kim, You Shin (Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University) ;
  • Yoon, Tae Ki (Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University) ;
  • Lee, Woo Sik (Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University)
  • Received : 2016.05.19
  • Accepted : 2016.06.30
  • Published : 2016.12.31
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Abstract

Chronic endometritis (CE) is a condition involving the breakdown of the peaceful co-existence between microorganisms and the host immune system in the endometrium. A majority of CE cases produce no noticeable signs or mild symptoms, and the prevalence rate of CE has been found to be approximately 10%. Gynecologists and pathologists often do not focus much clinical attention on CE due to the time-consuming microscopic examinations necessary to diagnose CE, its mild clinical manifestations, and the benign nature of the disease. However, the relationship between CE and infertility-related conditions such as repeated implantation failure and recurrent miscarriage has recently emerged as an area of inquiry. In this study, we reviewed the literature on the pathophysiology of CE and how it may be associated with infertility, as well as the literature regarding the diagnosis and treatment of CE. In addition, we discuss the value of hysteroscopic procedures in the diagnosis and treatment of CE.

Keywords

References

  1. Greenwood SM, Moran JJ. Chronic endometritis: morphologic and clinical observations. Obstet Gynecol 1981;58:176-84.
  2. Kitaya K, Yasuo T. Immunohistochemistrical and clinicopathological characterization of chronic endometritis. Am J Reprod Immunol 2011;66:410-5. https://doi.org/10.1111/j.1600-0897.2011.01051.x
  3. Polisseni F, Bambirra EA, Camargos AF. Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients. Gynecol Obstet Invest 2003;55:205-10. https://doi.org/10.1159/000072075
  4. Bayer-Garner IB, Korourian S. Plasma cells in chronic endometritis are easily identified when stained with syndecan-1. Mod Pathol 2001;14:877-9. https://doi.org/10.1038/modpathol.3880405
  5. Yorukoglu K, Kuyucouglu F. Chronic nonspecific endometritis. Gen Diagn Pathol 1998;143:287-90.
  6. Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T, et al. Chronic endometritis: potential cause of infertility and obstetric and neonatal complications. Am J Reprod Immunol 2016;75:13-22. https://doi.org/10.1111/aji.12438
  7. 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;82:799-804. https://doi.org/10.1016/j.fertnstert.2004.05.076
  8. Zolghadri J, Momtahan M, Aminian K, Ghaffarpasand F, Tavana Z. The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. Eur J Obstet Gynecol Reprod Biol 2011;155:217-20. https://doi.org/10.1016/j.ejogrb.2010.12.010
  9. Bouet PE, El Hachem H, Monceau E, Gariepy G, Kadoch IJ, Sylvestre C. 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;105:106-10. https://doi.org/10.1016/j.fertnstert.2015.09.025
  10. Kasius JC, Fatemi HM, Bourgain C, Sie-Go DM, Eijkemans RJ, Fauser BC, et al. The impact of chronic endometritis on reproductive outcome. Fertil Steril 2011;96:1451-6. https://doi.org/10.1016/j.fertnstert.2011.09.039
  11. Kasius JC, Broekmans FJ, Sie-Go DM, Bourgain C, Eijkemans MJ, Fauser BC, et al. The reliability of the histological diagnosis of endometritis in asymptomatic IVF cases: a multicenter observer study. Hum Reprod 2012;27:153-8. https://doi.org/10.1093/humrep/der341
  12. Crum CP, Egawa K, Fenoglio CM, Richart RM. Chronic endometritis: the role of immunohistochemistry in the detection of plasma cells. Am J Obstet Gynecol 1983;147:812-5. https://doi.org/10.1016/0002-9378(83)90045-5
  13. Adegboyega PA, Pei Y, McLarty J. Relationship between eosinophils and chronic endometritis. Hum Pathol 2010;41:33-7. https://doi.org/10.1016/j.humpath.2009.07.008
  14. McQueen DB, Bernardi LA, Stephenson MD. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril 2014;101:1026-30. https://doi.org/10.1016/j.fertnstert.2013.12.031
  15. Bayer-Garner IB, Nickell JA, Korourian S. Routine syndecan-1 immunohistochemistry aids in the diagnosis of chronic endometritis. Arch Pathol Lab Med 2004;128:1000-3.
  16. McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril 2015;104:927-31. https://doi.org/10.1016/j.fertnstert.2015.06.044
  17. Andrews WW, Goldenberg RL, Hauth JC, Cliver SP, Conner M, Goepfert AR. Endometrial microbial colonization and plasma cell endometritis after spontaneous or indicated preterm versus term delivery. Am J Obstet Gynecol 2005;193:739-45. https://doi.org/10.1016/j.ajog.2005.02.128
  18. Korn AP, Hessol N, Padian N, Bolan G, Muzsnai D, Donegan E, et al. Commonly used diagnostic criteria for pelvic inflammatory disease have poor sensitivity for plasma cell endometritis. Sex Transm Dis 1995;22:335-41. https://doi.org/10.1097/00007435-199511000-00002
  19. Haggerty CL, Ness RB, Amortegui A, Hendrix SL, Hillier SL, Holley RL, et al. Endometritis does not predict reproductive morbidity after pelvic inflammatory disease. Am J Obstet Gynecol 2003;188:141-8. https://doi.org/10.1067/mob.2003.87
  20. Cicinelli E, Resta L, Nicoletti R, Zappimbulso V, Tartagni M, Saliani N. Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod 2005;20:1386-9. https://doi.org/10.1093/humrep/deh779
  21. Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L, et al. Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. Fertil Steril 2008;89:677-84. https://doi.org/10.1016/j.fertnstert.2007.03.074
  22. Cicinelli E, Matteo M, Tinelli R, Lepera A, Alfonso R, Indraccolo U, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod 2015;30:323-30. https://doi.org/10.1093/humrep/deu292
  23. Cicinelli E, Tinelli R, Lepera A, Pinto V, Fucci M, Resta L. Correspondence between hysteroscopic and histologic findings in women with chronic endometritis. Acta Obstet Gynecol Scand 2010;89:1061-5. https://doi.org/10.3109/00016349.2010.498496
  24. Cicinelli E, Matteo M, Tinelli R, Pinto V, Marinaccio M, Indraccolo U, 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;21:640-7. https://doi.org/10.1177/1933719113508817
  25. Yang R, Du X, Wang Y, Song X, Yang Y, Qiao J. The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients. Arch Gynecol Obstet 2014;289:1363-9. https://doi.org/10.1007/s00404-013-3131-2
  26. Nelson LH, Nichols SB. Effectiveness of the Isaacs cell sampler for endometrial cultures. J Reprod Med 1986;31:473-7.
  27. Ansbacher R, Boyson WA, Morris JA. Sterility of the uterine cavity. Am J Obstet Gynecol 1967;99:394-6. https://doi.org/10.1016/S0002-9378(16)34549-5
  28. Cowling P, McCoy DR, Marshall RJ, Padfield CJ, Reeves DS. Bacterial colonization of the non-pregnant uterus: a study of premenopausal abdominal hysterectomy specimens. Eur J Clin Microbiol Infect Dis 1992;11:204-5. https://doi.org/10.1007/BF01967084
  29. Moller BR, Kristiansen FV, Thorsen P, Frost L, Mogensen SC. Sterility of the uterine cavity. Acta Obstet Gynecol Scand 1995;74:216-9. https://doi.org/10.3109/00016349509008942
  30. Simhan HN, Caritis SN, Krohn MA, Hillier SL. Elevated vaginal pH and neutrophils are associated strongly with early spontaneous preterm birth. Am J Obstet Gynecol 2003;189:1150-4. https://doi.org/10.1067/S0002-9378(03)00582-9
  31. Zuckerman H, Kahana A, Carmel S. Antibacterial activity of human cervical mucus. Gynecol Invest 1975;6:265-71. https://doi.org/10.1159/000301522
  32. Svinarich DM, Wolf NA, Gomez R, Gonik B, Romero R. Detection of human defensin 5 in reproductive tissues. Am J Obstet Gynecol 1997;176:470-5. https://doi.org/10.1016/S0002-9378(97)70517-9
  33. Hein M, Helmig RB, Schonheyder HC, Ganz T, Uldbjerg N. An in vitro study of antibacterial properties of the cervical mucus plug in pregnancy. Am J Obstet Gynecol 2001;185:586-92. https://doi.org/10.1067/mob.2001.116685
  34. Hein M, Valore EV, Helmig RB, Uldbjerg N, Ganz T. Antimicrobial factors in the cervical mucus plug. Am J Obstet Gynecol 2002;187:137-44. https://doi.org/10.1067/mob.2002.123034
  35. Quayle AJ, Porter EM, Nussbaum AA, Wang YM, Brabec C, Yip KP, et al. Gene expression, immunolocalization, and secretion of human defensin-5 in human female reproductive tract. Am J Pathol 1998;152:1247-58.
  36. King AE, Critchley HO, Kelly RW. Innate immune defences in the human endometrium. Reprod Biol Endocrinol 2003;1:116. https://doi.org/10.1186/1477-7827-1-116
  37. King AE, Fleming DC, Critchley HO, Kelly RW. Differential expression of the natural antimicrobials, beta-defensins 3 and 4, in human endometrium. J Reprod Immunol 2003;59:1-16. https://doi.org/10.1016/S0165-0378(02)00083-9
  38. Profet M. Menstruation as a defense against pathogens transported by sperm. Q Rev Biol 1993;68:335-86.
  39. Donlan RM. Role of biofilms in antimicrobial resistance. ASAIO J 2000;46:S47-52. https://doi.org/10.1097/00002480-200011000-00037
  40. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 2002;15:167-93. https://doi.org/10.1128/CMR.15.2.167-193.2002
  41. Costerton W, Veeh R, Shirtliff M, Pasmore M, Post C, Ehrlich G. The application of biofilm science to the study and control of chronic bacterial infections. J Clin Invest 2003;112:1466-77. https://doi.org/10.1172/JCI200320365
  42. Stepanovic S, Jovanovic M, Lavadinovic L, Stosovic B, Pelemis M. Enterococcus durans endocarditis in a patient with transposition of the great vessels. J Med Microbiol 2004;53:259-61. https://doi.org/10.1099/jmm.0.05382-0
  43. Fergie N, Bayston R, Pearson JP, Birchall JP. Is otitis media with effusion a biofilm infection? Clin Otolaryngol Allied Sci 2004;29:38-46. https://doi.org/10.1111/j.1365-2273.2004.00767.x
  44. Post JC. Direct evidence of bacterial biofilms in otitis media. Laryngoscope 2001;111:2083-94. https://doi.org/10.1097/00005537-200112000-00001
  45. Domingue GJ Sr, Hellstrom WJ. Prostatitis. Clin Microbiol Rev 1998;11:604-13.
  46. Lamont RJ, El-Sabaeny A, Park Y, Cook GS, Costerton JW, Demuth DR. Role of the Streptococcus gordonii SspB protein in the development of Porphyromonas gingivalis biofilms on streptococcal substrates. Microbiology 2002;148:1627-36. https://doi.org/10.1099/00221287-148-6-1627
  47. Haffajee AD, Arguello EI, Ximenez-Fyvie LA, Socransky SS. Controlling the plaque biofilm. Int Dent J 2003;53 Suppl 3:191-9. https://doi.org/10.1111/j.1875-595X.2003.tb00770.x
  48. Eckert LO, Moore DE, Patton DL, Agnew KJ, Eschenbach DA. Relationship of vaginal bacteria and inflammation with conception and early pregnancy loss following in-vitro fertilization. Infect Dis Obstet Gynecol 2003;11:11-7. https://doi.org/10.1155/S1064744903000024
  49. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med 2003;348:138-50. https://doi.org/10.1056/NEJMra021333
  50. Barton GM, Medzhitov R. Toll-like receptor signaling pathways. Science 2003;300:1524-5. https://doi.org/10.1126/science.1085536
  51. Medzhitov R, Janeway C Jr. Innate immune recognition: mechanisms and pathways. Immunol Rev 2000;173:89-97. https://doi.org/10.1034/j.1600-065X.2000.917309.x
  52. Fazeli A, Bruce C, Anumba DO. Characterization of Toll-like receptors in the female reproductive tract in humans. Hum Reprod 2005;20:1372-8. https://doi.org/10.1093/humrep/deh775
  53. Kim YM, Romero R, Chaiworapongsa T, Kim GJ, Kim MR, Kuivaniemi H, et al. Toll-like receptor-2 and -4 in the chorioamniotic membranes in spontaneous labor at term and in preterm parturition that are associated with chorioamnionitis. Am J Obstet Gynecol 2004;191:1346-55. https://doi.org/10.1016/j.ajog.2004.07.009
  54. Abrahams VM, Bole-Aldo P, Kim YM, Straszewski-Chavez SL, Chaiworapongsa T, Romero R, et al. Divergent trophoblast responses to bacterial products mediated by TLRs. J Immunol 2004;173:4286-96. https://doi.org/10.4049/jimmunol.173.7.4286
  55. Jin LP, Fan DX, Zhang T, Guo PF, Li DJ. The costimulatory signal upregulation is associated with Th1 bias at the maternal-fetal interface in human miscarriage. Am J Reprod Immunol 2011;66:270-8. https://doi.org/10.1111/j.1600-0897.2011.00997.x
  56. Guzeloglu-Kayisli O, Kayisli UA, Taylor HS. The role of growth factors and cytokines during implantation: endocrine and paracrine interactions. Semin Reprod Med 2009;27:62-79. https://doi.org/10.1055/s-0028-1108011
  57. Kitaya K, Nakayama T, Okubo T, Kuroboshi H, Fushiki S, Honjo H. Expression of macrophage inflammatory protein-1beta in human endometrium: its role in endometrial recruitment of natural killer cells. J Clin Endocrinol Metab 2003;88:1809-14. https://doi.org/10.1210/jc.2002-020980
  58. Jones RL, Hannan NJ, Kaitu’u TJ, Zhang J, Salamonsen LA. Identification of chemokines important for leukocyte recruitment to the human endometrium at the times of embryo implantation and menstruation. J Clin Endocrinol Metab 2004;89:6155-67. https://doi.org/10.1210/jc.2004-0507
  59. Fowler DJ, Nicolaides KH, Miell JP. Insulin-like growth factor binding protein-1 (IGFBP-1): a multifunctional role in the human female reproductive tract. Hum Reprod Update 2000;6:495-504. https://doi.org/10.1093/humupd/6.5.495
  60. Matteo M, Cicinelli E, Greco P, Massenzio F, Baldini D, Falagario T, et al. Abnormal pattern of lymphocyte subpopulations in the endometrium of infertile women with chronic endometritis. Am J Reprod Immunol 2009;61:322-9. https://doi.org/10.1111/j.1600-0897.2009.00698.x
  61. Bulmer JN, Williams PJ, Lash GE. Immune cells in the placental bed. Int J Dev Biol 2010;54:281-94. https://doi.org/10.1387/ijdb.082763jb
  62. Tortorella C, Piazzolla G, Matteo M, Pinto V, Tinelli R, Sabba C, et al. Interleukin-6, interleukin-$1{\beta}$, and tumor necrosis factor ${\alpha}$ in menstrual effluents as biomarkers of chronic endometritis. Fertil Steril 2014;101:242-7. https://doi.org/10.1016/j.fertnstert.2013.09.041
  63. Kamiyama S, Teruya Y, Nohara M, Kanazawa K. Bacterial endotoxin in the endometrium and its clinical significance in reproduction. Fertil Steril 2004;82:805. https://doi.org/10.1016/j.fertnstert.2004.06.030
  64. Shahzad S. Investigation of the prevalence of female genital tract tuberculosis and its relation to female infertility: an observational analytical study. Iran J Reprod Med 2012;10:581-8.
  65. Ulusoy AN, Karabicak I, Dicle K, Kefeli M, Tosun M, Cetinkaya M, et al. Peritoneal tuberculosis in premenopausal patients with elevated serum CA 125. Arch Gynecol Obstet 2010;282:639-42. https://doi.org/10.1007/s00404-009-1283-x
  66. Di Pietro C, Cicinelli E, Guglielmino MR, Ragusa M, Farina M, Palumbo MA, et al. Altered transcriptional regulation of cytokines, growth factors, and apoptotic proteins in the endometrium of infertile women with chronic endometritis. Am J Reprod Immunol 2013;69:509-17. https://doi.org/10.1111/aji.12076
  67. Fazleabas AT, Kim JJ, Strakova Z. Implantation: embryonic signals and the modulation of the uterine environment. A review. Placenta 2004;25 Suppl A:S26-31. https://doi.org/10.1016/j.placenta.2004.01.014
  68. Lathi RB, Hess AP, Tulac S, Nayak NR, Conti M, Giudice LC. Dosedependent insulin regulation of insulin-like growth factor binding protein-1 in human endometrial stromal cells is mediated by distinct signaling pathways. J Clin Endocrinol Metab 2005;90:1599-606. https://doi.org/10.1210/jc.2004-1676
  69. Dimitriadis E, White CA, Jones RL, Salamonsen LA. Cytokines, chemokines and growth factors in endometrium related to implantation. Hum Reprod Update 2005;11:613-30. https://doi.org/10.1093/humupd/dmi023
  70. von Rango U, Alfer J, Kertschanska S, Kemp B, Muller-Newen G, Heinrich PC, et al. Interleukin-11 expression: its significance in eutopic and ectopic human implantation. Mol Hum Reprod 2004;10:783-92. https://doi.org/10.1093/molehr/gah107
  71. Dimitriadis E, Robb L, Liu YX, Enders AC, Martin H, Stoikos C, et al. IL-11 and IL-11Ralpha immunolocalisation at primate implantation sites supports a role for IL-11 in placentation and fetal development. Reprod Biol Endocrinol 2003;1:34. https://doi.org/10.1186/1477-7827-1-34
  72. Fest S, Aldo PB, Abrahams VM, Visintin I, Alvero A, Chen R, et al. Trophoblast-macrophage interactions: a regulatory network for the protection of pregnancy. Am J Reprod Immunol 2007;57:55-66. https://doi.org/10.1111/j.1600-0897.2006.00446.x
  73. Maybin JA, Critchley HO, Jabbour HN. Inflammatory pathways in endometrial disorders. Mol Cell Endocrinol 2011;335:42-51. https://doi.org/10.1016/j.mce.2010.08.006
  74. Kitaya K, Yasuo T. Aberrant expression of selectin E, CXCL1, and CXCL13 in chronic endometritis. Mod Pathol 2010;23:1136-46. https://doi.org/10.1038/modpathol.2010.98
  75. Pickartz H, Beckmann R, Fleige B, Due W, Gerdes J, Stein H. Steroid receptors and proliferative activity in non-neoplastic and neoplastic endometria. Virchows Arch A Pathol Anat Histopathol 1990;417:163-71. https://doi.org/10.1007/BF02190535
  76. Mishra K, Wadhwa N, Guleria K, Agarwal S. ER, PR and Ki-67 expression status in granulomatous and chronic non-specific endometritis. J Obstet Gynaecol Res 2008;34:371-8. https://doi.org/10.1111/j.1447-0756.2007.00700.x
  77. Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) randomized trial. Am J Obstet Gynecol 2002;186:929-37. https://doi.org/10.1067/mob.2002.121625
  78. Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril 2010;93:437-41. https://doi.org/10.1016/j.fertnstert.2008.12.131
  79. Kitaya K, Tada Y, Taguchi S, Funabiki M, Hayashi T, Nakamura Y. Local mononuclear cell infiltrates in infertile patients with endometrial macropolyps versus micropolyps. Hum Reprod 2012;27:3474-80. https://doi.org/10.1093/humrep/des323
  80. Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization. Fertil Steril 2003;79:1317-22. https://doi.org/10.1016/S0015-0282(03)00345-5
  81. Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reprod Biomed Online 2004;8:590-4. https://doi.org/10.1016/S1472-6483(10)61108-X
  82. Makrakis E, Pantos K. The outcomes of hysteroscopy in women with implantation failures after in-vitro fertilization: findings and effect on subsequent pregnancy rates. Curr Opin Obstet Gynecol 2010;22:339-43.
  83. Gibreel A, El-Adawi N, Elgindy E, Al-Inany H, Allakany N, Tournaye H. Endometrial scratching for women with previous IVF failure undergoing IVF treatment. Gynecol Endocrinol 2015;31:313-6. https://doi.org/10.3109/09513590.2014.994603
  84. Almog B, Shalom-Paz E, Dufort D, Tulandi T. Promoting implantation by local injury to the endometrium. Fertil Steril 2010;94:2026-9. https://doi.org/10.1016/j.fertnstert.2009.12.075
  85. Bosteels J, Weyers S, Puttemans P, Panayotidis C, Van Herendael B, Gomel V, et al. The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. Hum Reprod Update 2010;16:1-11. https://doi.org/10.1093/humupd/dmp033
  86. Simon C, Bellver J. Scratching beneath 'The Scratching Case': systematic reviews and meta-analyses, the back door for evidencebased medicine. Hum Reprod 2014;29:1618-21. https://doi.org/10.1093/humrep/deu126
  87. Di Spiezio Sardo A, Di Carlo C, Minozzi S, Spinelli M, Pistotti V, Alviggi C, et al. Efficacy of hysteroscopy in improving reproductive outcomes of infertile couples: a systematic review and metaanalysis. Hum Reprod Update 2016;22:479-96. https://doi.org/10.1093/humupd/dmw008
  88. Lensen SF, Manders M, Nastri CO, Gibreel A, Martins WP, Templer GE, et al. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database Syst Rev 2016;(6):CD011424.

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  20. Chronic endometritis in women with suspected retained products of conception and their reproductive outcomes vol.86, pp.2, 2021, https://doi.org/10.1111/aji.13410
  21. Honokiol inhibits endoplasmic reticulum stress‑associated lipopolysaccharide-induced inflammation and apoptosis in bovine endometrial epithelial cells vol.22, pp.6, 2016, https://doi.org/10.3892/etm.2021.10911
  22. Influence of systemic inflammation predictors on the premature labor of hiv-infected women living in Subarctic region vol.13, pp.3, 2016, https://doi.org/10.22328/2077-9828-2021-13-3-61-72