CHRONIC ENDOMETRITIS AS A MULTIFACTORIAL CAUSE OF REPRODUCTIVE LOSS: MODERN DIAGNOSTIC CRITERIA AND THERAPEUTIC SOLUTIONS

Chronic endometritis (CE) is one of the most important and pressing issues in reproductive medicine. This disease is associated with a decreased pregnancy rate, as well as an increased risk of spontaneous miscarriages and IVF implantation failures. Chronic endometritis has a latent course, which complicates timely diagnosis and treatment. This literature review is devoted to the systematization of current concepts regarding the pathogenetic mechanisms, diagnostic capabilities, and therapeutic approaches to CE, as well as an assessment of their impact on reproductive outcomes. Data from 27 publications from 2021 to 2024, sourced from international and national databases — including meta-analyses, systematic reviews, and original clinical trials — were analyzed. It was found that the leading pathogenetic factors of CE are microbial dysbiosis with a predominance of polymicrobial associations, hyperactivation of neutrophils with the formation of extracellular traps (NETs), cytokine imbalance, and activation of the signaling cascades USF2/TREM1 and miR-92b/PTEN. These changes impair endometrial receptivity and hinder successful embryo implantation. Histology with the detection of CD138+ plasma cells remains the cornerstone of diagnosis; however, the variability of threshold values complicates interpretation. Diagnosis is complemented by hysteroscopy and promising non-invasive methods, such as the analysis of hysteroscopic images using artificial intelligence and the identification of serum biomarkers. Antibiotic therapy remains the mainstay of treatment, although its effectiveness is declining due to increasing resistance. Modern approaches include the use of recombinant type III collagen and antifibrotic therapy, which improve the structure and receptivity of the endometrium, increasing pregnancy rates to 73.9%. This review highlights the need for the standardization of diagnostic algorithms, the integration of molecular technologies, and the implementation of combined treatment strategies to enhance the effectiveness of CE correction and improve reproductive outcomes.