Chronic Endometritis (CE)

By RRM Academy Reviewed by Dr. Naomi Whittaker, MD, Board-Certified OBGYN, MIGS, NFPMC, FCI Updated July 26, 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 rests on CD138 (syndecan-1) immunohistochemistry demonstrating plasma cells in an endometrial biopsy.¹ Office hysteroscopy showing micropolyps, focal hyperemia, or the strawberry-pattern endometrium is a useful adjunct, but it is suggestive rather than confirmatory and is not required to make the diagnosis. The treating clinician prescribes culture-directed or empiric antibiotic therapy, then confirms cure with a repeat CD138 biopsy. 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.²

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.