Restoring reproductive potential in patients with chronic endometritis: modern therapeutic strategies

   Summary. Chronic endometritis (CE) is a key problem in modern reproductive medicine. A complex of antimicrobial peptides and cytokines (AMPC), derived from pig mononuclear cells, exhibits pronounced anti-inflammatory, antimicrobial, and reparative effects, theoretically enabling simultaneous targeting of multiple pathways in CE pathogenesis.

    The purpose of the study. Develop and evaluate the effectiveness of an innovative treatment strategy for chronic endometritis (CE) during the period of preparation for pregnancy to restore fertility.

   Materials and methods. A two-stage prospective randomized controlled parallel-group study was conducted. The study included 2,252 patients with uterine infertility and morphological signs of chronic endometritis, divided into two main cohorts: the first group (n = 1,126), receiving combined therapy: an antibacterial drug + an immunomodulator (a complex of antimicrobial peptides and cytokines — AMPС), was divided into subgroups A (additionally included progestogens with the combined therapy) and B (without progestogens). The second group received antibacterial therapy (AB) and was also divided into subgroups A and B: with progestogen support and without it. Endometrial recovery was assessed based on histological and immunohistochemical examination, as well as the rate of spontaneous pregnancy and live births in each group.

   Results and discussion. The use of combination therapy with AMPT contributed to the resolution of HE in 85.3 % of patients compared with 60.3 % in the AB monotherapy group (p < 0.001). In the AMPT/AB/progestogen group, the frequency of spontaneous pregnancy reached 83.8 % versus 53.8 % in the AB/progestogen group (p < 0.001). Live births were significantly more frequent in the main group: 73.5 % versus 41.2 % (p < 0.001). When preparing for ART programmes, the use of AMPT increased the likelihood of pregnancy after cryotransfer by 1.5 times (83.8 % vs. 58.1 %) and live births by 2 times (72.1 % vs. 35.3 %). Two courses of AMPT demonstrated higher therapeutic efficacy. Based on neural network analysis, prognostic models were developed with an accuracy of 88.0 % for spontaneous pregnancy and 97.9 % for IVF outcomes.

   Conclusion. The proposed comprehensive pathogenetic therapy of chronic endometritis (CE) including AMPС demonstrates high efficacy compared to the group receiving only antibiotic therapy and significantly increases the frequency of conception and live births both in natural cycles and in ART programs, which allows this method to be recommended for implementation in clinical practice.

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