الفهرس 
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Abstract
Chronic endometritis (CE) is a chronic inflammatory condition of the endometrium, whose diagnosis is currently based on the demonstration of plasma cell infiltration within endometrial stromal tissue. The pathogenesis of chronic endometritis may be the result of qualitative and quantitative alteration of endometrial microbiome. According to recent studies, the main species of bacteria involved in the development of chronic endometritis are Enterococci, Streptococci, Staphylococci, Mycoplasma spp, Gardnerella vaginalis, Ureaplasma urealyticum, Chlamydia trachomatis and Neisseria gonorrhoeae. Clinically, chronic endometritis is a subtle pathology accompanied by only mild and unspecific disturbances, such as abnormal uterine bleeding (AUB), dyspareunia, pelvic discomfort and leukorrhea. Nevertheless, this condition may impair endometrial receptivity, resulting in unexplained infertility, recurrent spontaneous abortion (RSA) and repeated implantation failure (RIF) at IVF. In 2005, Cicinelli et al. first demonstrated that chronic endometritis was associated with small mucosal proliferations (<1 mm in diameter) which were similar to the endometrial polyps (EPs) at hysteroscopy, defined by the authors as ―micropolyps‖. This finding was subsequently confirmed by several studies. Endometrial polyps are localized, sessile or pedunculated projections of endometrial mucosa, resulting from the hyperplastic overgrowths of glands and stroma around a vascular core. EPs are common findings in both reproductive age and post-menopausal women. While the development of micropolyps has been definitely ascribed to chronic endometrial inflammation, the correlation between endometrial polyps (i.e., ―macropolyps‖) and chronic endometritis remains unclear. Although some studies have suggested a potential link between chronic endometritis and endometrial polyps. Currently, the pathogenesis of endometrial polyps is still believed to be mainly related to hormonal factors. As the relationship between chronic endometritis and endometrial polyps is far from being clear, the aim of this study is to analyze the possible association between endometrial polyps and chronic endometritis. Cicinelli et al. (2019) (122) reported for the first time that EP were associated with chronic endometritis (CE) and soon another study further confirmed this finding in infertile population (123). However, limited evidence was reported about the association between different subtypes of EP and CE, and whether multiple EP arise by a different etiology from single EP remains to be elucidated. Therefore, this study was designed to detect the possible association between endometrial polyps and chronic endometritis. This prospective cohort study was carried out on 60 women diagnosed to have endometrial polyp either by 2D or 3D, transabdominal or transvaginal ultrasound, during a diagnostic workup for abnormal uterine bleeding, infertility, or accidently discovered by ultrasound at the Obstetrics and Gynecology Department. All patients in these study were subjected to full history taking, full general examination, abdominal examination, gynecological examination, ultrasound investigations, and laboratory investigations. Summary of our Results: • The age of the patients with chronic endometritis ranged from 20 to 50 years and in patients without chronic endometritis ranged from 23 to 50 years. The age was significantly lower in patients with chronic endometritis than patients without chronic endometritis. • Obstetric history was non gravid in 16.67% patients. The median (IQR) of gravidity was 3. The median (IQR) of parity was 2. The median (IQR) of live birth was 2. Abortion was one in 25% patients, two in 8.33% patients and three in 3.33% patients. Previous cesarean section was one in 15% patients, two in 18.33% patients, three in 5% patients and four in 1.67% patient. Normal vaginal delivery was one in 6.67% patients, two in 5% patients, three in 11.67% patients, four in 10% patients, five in 3.33% patients and six in 1.67% patient. • AUB occurred in 60% of the patients, 1 ry infertility occurred in 16.67% of the patients and 2 ry infertility occurred in 13.33% of the patients and accidentally discovered in 10% of the patients. Clinical presentation was insignificantly different between patients with chronic endometritis and patients without chronic endometritis. • There was a significant relation between endometrial polyps and chronic endometritis (25% of the polyps patients had chronic endometritis). • Regarding patients with chronic endometritis, polyp number was single in 9 (60%) patients and multiple in 6 (40%) patients and polyp size ranged from 0.7 – 3.8*0.6 – 3.7 cm with a mean value (± SD) of 1.6 ± 0.77*1.33 ± 0.78 cm. • Regarding patients without chronic endometritis, polyp number was single in 33 (73.33%) patients and multiple in 12 (26.67%) patients and polyp size ranged from 0.6 – 4.7*0.5 – 2.7 cm with a mean value (± SD) of 1.51 ± 0.7*1.18 ± 0.43 cm. • Polyp number, polyp size and polyp shape were insignificantly different between patients with chronic endometritis and patients without chronic endometritis. • Regarding hysteroscopic description of the studied patients, suspecious manifestation of CE as (hyperemia and stromal edema) was significantly higher in patients with chronic endometritis than patients without chronic endometritis (P value<0.001). • Regarding histopathology, simple endometrial polyp was present in 33 (55%) patients, Adenomyomatous polyp was present in 8 (13.33%) patients, angiofibromatous polyp was present in 1 (1.67%) patients and polypoid endometrial hyperplasia was present in 18 (30%) patients. • Histopathology of the patients with chronic endometritis was simple endometrial polyp with chronic endometritis in 3 (20%) patients, simple endometrial polyp with chronic endometritis and chronic cervicitis in 2 (13.33%), simple endometrial polyps and endocervical polyp with chronic cervicitis and chronic endometritis in 1 (6.67%) patient, simple endometrial polyp with disordered proliferative endometrium and chronic endometritis in 1 (6.67%) patient, simple endometrial polyp with disordered proliferative endometrium with chronic endometritis and chronic cervicitis in 1 (6.67%) patient, polypoid endometrial hyperplasia with chronic endometritis 6 (40%) patients and angiofibromatous polyp with chronic endometritis in 1 (6.67%) patient. • Histopathology of the patients without chronic endometritis was simple endometrial polyp with progestational effect in 8 (17.78%) patients, simple endometrial polyp with cystic changes in 1 (2.22%) patient, simple endometrial polyp with proliferative endometrium in 16 (35.56%) patients, adenomyomatus polyp in 8 (17.78%) patients and polypoid endometrial hyperplasia in 12 (26.67%) patients.