RECURRENT ENDOMETRIAL POLYPS AND INFERTILITY: THE ROLE OF CHRONIC ENDOMETRITIS AND THE EFFICACY OF JOSAMYCIN. A CLINICAL CASE REPORT

Аннотация

Chronic Endometritis (CE) is a persistent, often subclinical inflammatory condition of the endometrial lining, frequently underdiagnosed as a significant cause of implantation failure and infertility. It is commonly associated with microbial colonization by opportunistic and pathogenic bacteria, including Genital Mycoplasmas such as *Ureaplasma urealyticum*. This case report presents a 34-year-old female (Patient N.) with a five-year history of secondary infertility and recurrent pregnancy loss. Her medical history was significant for a missed abortion, multiple recurrent endometrial polyps, and a left hydrosalpinx treated with salpingectomy. Despite repeated surgical interventions, including hysteroscopies and polypectomies, pregnancy did not occur. A pivotal investigation revealed *Ureaplasma urealyticum* in the endometrial aspirate, diagnosing an underlying CE. This case illustrates the potential iatrogenic role of repetitive intrauterine procedures in exacerbating subclinical inflammation, leading to impaired endometrial receptivity. It underscores the critical need for a comprehensive microbiological assessment of the endometrium prior to surgical management of benign pathologies like polyps in infertile women. The administration of Josamycin, a macrolide antibiotic effective against intracellular pathogens, led to the resolution of the infection. This report discusses the pathophysiology of CE-related infertility, the rationale for antibiotic selection, and advocates for a conservative, diagnosis-first approach in the management of small endometrial polyps in women seeking fertility.