Generally, yes. We should understand that antibiotics are the first-line treatment for endometritis, but it can be caused by infection and talking briefly by endometriosis, so also inflammatory disease but which is active and which is caused by non-infectious issues, so the treatment should be pathogenic. If endometritis is caused by a kind of inflammation, for example, acute inflammation after pregnancy loss or after some surgical interventions or as a kind of complication of some incident in a gynecological life, our first-line treatment will be hysteroscopy. With approval performance of surgical treatment and after that, we do a complex therapy, taking into account the histology result and immunohistochemistry investigation. We need a morphological evaluation to assess the activity process. After that, we provide one of the three algorithms for treating endometriosis. The first line is antibiotics, but sometimes you also make injections to prevent adhesions formations connections or the tissue endometrium. In endometritis cases, it is associated with endometriosis. We should cure, and we should treat the main problem, there is no doubt it is endometriosis. To answer this question, the treatment should be defined by the cause. First, we should understand which is the primary cause of this inflammation, and only after that, we should do the pathogenic treatment. Regarding a new biopsy, it will be reported after treatment.
Asherman’s syndrome is the result of chronic endometritis, this is a severe and very tough connection between layers of the endometrium. At this point, Asherman’s syndrome is one of the most severe situations, and antibiotics aren’t useful because the main thing is that the tissue of the endometrium was so compromised that it is poorly regenerated. In such situations, we usually recommend using means of regenerative medicine, which is called PRP – platelet-rich plasma therapy, it’s safe, and it’s approved with good results. However, regeneration of endometrium, unfortunately, doesn’t work in 100% of cases. If we’re talking about a very long history of Asherman’s syndrome, sometimes we’re talking about several surgical interventions to fix this problem. In these cases, unfortunately, sometimes, even PRP therapy doesn’t work. There are some investigations, some trials investigating stem cell therapy. There is some data about good results, but unfortunately, stem cell therapy at this moment is not approved. It is still considered an experiment. We are waiting for this, and our team is also working on it, but at this time to tell you the truth, we usually don’t use antibiotics in the situation because it’s not an active inflammation, we’re talking about the complications, the result of this inflammation. We usually implement regenerative medicine, but unfortunately, in the toughest cases, we have to talk about a surrogacy program.