Chronic Endometritis (CE)

Chronic endometritis (CE) is a mild, persistent infection of the endometrium, the lining of the uterus. Common bacteria cause it, such as E. coli, Enterococcus, and Streptococcus. The infection keeps the endometrium inflamed. Most women have no symptoms. An inflamed endometrium still makes it difficult for an embryo to implant and remain. CE is closely associated with repeated implantation failure and with recurrent pregnancy loss. Clinicians diagnose it with an endometrial biopsy, a small sample of the lining. A stain for CD138 identifies plasma cells, the immune cells that mark the infection.¹ Office hysteroscopy, an examination of the uterus with a small camera, can also help. It may show small polyps, red patches, or a spotted lining that resembles a strawberry. These signs suggest CE. They do not confirm it, and the diagnosis does not require them. Treatment is antibiotics, chosen by culture or by a standard first-line regimen. A repeat biopsy then checks that the infection has cleared. One cohort study followed women who had a hysteroscopy. Women who also had the biopsy and treatment were more likely to conceive (hazard ratio 2.28). They were also more likely to have a live birth (hazard ratio 2.76).²