Effect and Mechanism Analysis of Antibiotics Combined with Intrauterine Perfusion on Patients with Chronic Endometritis after Repeated Implanta-tion Failure

LIU Rongna; WANG Kai; BAO Lili; WEI Ruixia

doi:10.3969/j.issn.1002-3429.2024.05.012

Abstract：Objective To study the effect and mechanism of antibiotics combined with intrauterine perfusion on pa-tients with repeated implantation failure(RIF)complicated with chronic endometritis(CE).Methods A total of 160 pa-tients with RIF who underwent assisted reproduction and assisted pregnancy from January 2021 to May 2022 were selected and divided into CE group(n=80)and non-CE group(n=80)according to combination of CE.The baseline data of the two groups were compared and the related factors affecting CE in RIF patients were analyzed.Eighty patients with RIF combined with CE were divided into group A and group B according to random number table method,with 40 cases in each group.Group A was treated with oral antibiotics,and group B was treated with oral antibiotics combined with intrauterine perfusion.The lev-els of inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)]in uterine fluid of groups A and B before and after treatment were compared,and the flow parameters of uterine artery under ultrasound[pulse index,blood flow branches,and the proportion of low echo area in endometrial-myometrial interface(EMI)in myometral lay-er]were compared.The implantation rate,clinical pregnancy rate,biochemical pregnancy rate and early abortion rate of groups A and B after treatment were analyzed.Results Older age,intrauterine space occupying lesion,hydrosalpinx,uterine adenomyosis,prolonged infertility,multiple induced abortions,secondary infertility and abnormal hysteroscopy might be the influencing factors of CE in RIF patients(P＜0.05,P＜0.01).Compared with those before treatment,the levels of IL-6,IL-8 and TNF-α in uterine fluid of groups A and group B were decreased after treatment,and pulse index and the proportion of low echo area in EMI in myometral layer was also decreased,and lower in group B than in group A.After treatment,blood flow branches in groups A and B were increased,which was more in group B than in group A(P＜0.05).Compared with group A,the implantation rate and clinical pregnancy rate of group B were higher(P＜0.05),and the biochemical pregnancy rate and early abortion rate had no significant difference(P＞0.05).Conclusion Older age,intrauterine space occupying disease,hydrosalpinx,uterine adenomyosis,prolonged infertility,multiple induced abortions,secondary infertility and abnor-mal hysteroscopy are the factors that may cause CE in RIF patients.Antibiotics combined with intrauterine perfusion can re-duce inflammatory response and improve pregnancy rate in patients with RIF and CE.