P-428 Fertility outcomes following treatment of chronic endometritis: a systematic review and meta-analysis
Notice bibliographique
Résumé
Abstract Study question To determine if treatment of chronic endometritis (CE) impacts fertility outcomes Summary answer Treatment of CE in women with infertility, recurrent pregnancy loss, or recurrent implantation failure, improves live birth outcomes What is known already Chronic endometritis is an inflammatory condition that involves plasma cells invading the endometrial stroma. Prevalence of CE is high among patients with recurrent pregnancy loss (RPL), recurrent implantation failure (RIF), and infertility. Proposed treatment strategies include oral antibiotics, intrauterine antibiotic infusion, platelet-rich plasma, and hysteroscopic surgery, among others. Although treatment-associated CE cure rates have been high, few studies have reported on fertility outcomes following treatment of CE. Previously published systematic reviews have also yielded widely conflicting outcomes regarding the impact of CE treatment on fertility outcomes. Study design, size, duration We conducted a systematic search of the literature until late December 2021 across the Cochrane, EMBASE, and Medline databases. We used a DerSimonian and Laird random-effects meta-analysis model for the quantitative analysis. Participants/materials, setting, methods Clinical trials, prospective and retrospective observational studies that examined the treatment outcomes of CE were included. Study eligibility assessment, data extraction, and risk of bias assessment were independently performed by two reviewers. Comparisons were made between the groups of treated versus untreated CE, treated versus persistent CE, and between specific treatment strategies. Pooled risk ratios (RR) for the impact of CE treatment on outcomes such as live birth, clinical pregnancy, and miscarriage rates were assessed Main results and the role of chance Twelve studies totalling 1,539 women were included in our systematic review (3 randomized controlled trials and 9 observational studies), and 5 studies were included in the quantitative meta-analysis. Patients all had confirmed CE and a history of infertility, RPL, or RIF. Cure rates ranged between 37.2-91.8%. Live birth rate in the treated CE group ranged from 27.1-84.6%, from 16.4-44.4% in the non-treated CE group, and from 6.7-30.8% in the persistent CE group. Clinical pregnancy rate in the treated CE group ranged from 29.3-76.3%, from 11.1-30% in the non-treated CE group, and from 20-42.3% in the persistent CE group. Miscarriage rate in the treated CE group ranged from 6.7-23.8%, from 35.7-55.6% in the non-treated CE group, and from 27.3-66.7% in the persistent CE group. Risk ratio for the pooled effect of successful CE treatment compared to persistent CE on live birth was 2.98 (95% confidence ratio [CI] 1.51-5.91, I2=36.8%), on clinical pregnancy rate was 2.25 (95% CI 1.59-3.18, I2=40.1%), and on miscarriage rate was 0.55 (95% CI 0.28-1.10, I2=0.0%). Insufficient studies compared specific treatment subtypes to allow for any substantive qualitative or quantitative analysis. Limitations, reasons for caution Our results are limited by significant between-study heterogeneity in the study design, patient population, and comparisons used. Subgroup analysis by categories of comparisons mitigates some of this heterogeneity Wider implications of the findings Adequate treatment of CE significantly improves live birth rates in patients with RPL, RIF, and infertility. Assessment for CE should become part of routine fertility investigations, and resolution of CE must be confirmed prior to initiating fertility treatments. Trial registration number not applicable
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,014 | 0,006 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».