By RRM Academy Reviewed by Dr. Naomi Whittaker, MD, Board-Certified OBGYN, MIGS, NFPMC, FCI Updated May 11, 2026

Chronic Endometritis (CE) is a persistent, low-grade inflammatory condition of the endometrial lining caused by abnormal bacterial colonization (e.g., Enterococcus, E. coli, Streptococcus). CE is often subclinical with no obvious symptoms. It significantly impairs endometrial receptivity and is strongly associated with recurrent implantation failure and recurrent pregnancy loss. Diagnosis requires office hysteroscopy (strawberry-pattern micropolypoid endometrium) confirmed by CD138 immunohistochemistry on endometrial biopsy. Treatment uses targeted antibiotics (typically doxycycline, amoxicillin, or based on culture). A cohort study found the biopsy and treatment group had significantly higher rates of pregnancy (HR 2.28) and live birth (HR 2.76) compared to hysteroscopy-only controls.¹²

Cited in this entry

Treatment following hysteroscopy and endometrial diagnostic biopsy. Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/aji.13482
Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure. PubMed. https://pubmed.ncbi.nlm.nih.gov/26456229/

This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.