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Abstract: The patient had been married to her husband for 2 years, had a normal sex life, did not use contraception, but was infertile. She was given hysteroscopy and aspiration with anti-inflammatory treatment, and finally conceived and delivered successfully.
Basic information】Female, 33 years old
Type of disease】Chronic endometritis
Hospital】Wuhan Children’s Hospital affiliated with Tongji Medical College of Huazhong University of Science and Technology
Date of Consultation】September 2020
Treatment plan】Surgical treatment (hysteroscopy and aspiration) + medication (doxycycline hydrochloride tablets)
Treatment Period】Outpatient treatment, review after 2 weeks of medication
Results] Successful conception and delivery
I. Initial consultation
The patient and her husband had been married for 2 years, had a normal sex life, did not use contraception, but had not been pregnant. 2019, a hysterosalpingogram was performed outside the hospital, which showed that the tubes were patent bilaterally, AMH was 2.6ng/ml, and the husband’s semen routine and sperm DNA fragmentation rate were normal. In the same year, she had 3 cycles of ovulation monitoring in the outpatient clinic, all of which were ovulated, and she was not pregnant at intercourse. 3 cycles of IUI were performed in May-June 2020 without any pregnancy, and in September 2020, she came to our hospital for assisted reproductive technology to help her conception. Menstrual and marital history: regular menstruation, normal volume, occasional dysmenorrhea, G0P0, primary infertility was considered and the patient was advised to undergo relevant investigations.
II. Treatment history
The patient was considered to be infertile for 2 years, with primary infertility. 2 high-quality blastocysts were transferred without pregnancy, and immune-related tests (anticardiolipin antibody, antinuclear antibody, lupus anticoagulant, homocysteine, vitamin D, insulin release test) were recommended. After communication with the patient’s couple, it was suggested that 2-3 days after menstruation, the patient was scheduled for hysteroscopy, during which multiple cobblestone-shaped flora of various sizes were seen in the uterine cavity, the uterus was aspirated with a suction device, and the flora that were not aspirated were removed with foreign body forceps and sent for pathological examination. She was treated with doxycycline hydrochloride tablets for 2 weeks, and embryo transfer was performed again next month.
III. Treatment effect
The patient had no vaginal bleeding and abdominal pain after anti-inflammatory treatment and hysteroscopic treatment. After 2 weeks of medication, she was rechecked and recovered well. After returning to the hospital on the 3rd day of menstruation to check ultrasound + sex hormones there was no abnormality, the ovulation promotion protocol was prepared for endometrium and 1 blastocyst was transferred again. 14 days after the transfer the blood test for HCG (+) indicated successful conception and now the patient has successfully delivered a child. It can be seen that standardized anti-inflammatory treatment is necessary after the detection of chronic endometritis.
IV. Notes
We are glad that the patient successfully conceived and delivered after treatment. However, we still need to remind the patient to pay attention to the hygiene of the vagina and avoid sexual intercourse during vaginal bleeding or menstruation. Pay attention to rest and keep the vulva clean and hygienic. Eat less spicy and stimulating food, especially during menstruation. Have regular gynecological examinations and ultrasound examinations, and deal with any abnormalities in time.
V. Personal insight
Chronic endometritis is a common disease in gynecology, and its onset is mainly related to microbial infection, which can easily lead to infertility and recurrent miscarriage. In this case, the patient had primary infertility for 2 years and was diagnosed with chronic endometritis by hysteroscopy and pathological examination. Therefore, it is very important to treat patients with chronic endometritis with systemic antibiotics in a standardized manner.