Account

Assisted Reproduction · Outcomes and Effectiveness

Analysis of pregnancy outcomes in patients with recurrent implantation failure complicated with chronic endometritis

Li J, Li X, Ding J, Zhao J, Chen J, Guan F, Deng H, Zhou M, Han Y, Xiao Z, Yang J

Published February 13, 2023 Frontiers in cell and developmental biology
DOI 10.3389/fcell.2023.1088586 PMID 36861040 PMC PMC9969095

RRM Academy Synopsis

Cleared chronic endometritis linked to more live births after transfer

About 6 out of 10 women with cleared chronic endometritis had a live birth after frozen embryo transfer, against about 4 out of 10 whose test stayed positive. This retrospective cohort followed 327 women at one hospital in Wuhan, China. All had recurrent implantation failure, and 117 had chronic endometritis.

Key Findings

  • Chronic endometritis was found in 117 of 327 women (35.78%): 89 strongly positive (27.22%) and 28 weakly positive (8.56%). After treatment, 83 of the 117 (70.94%) tested negative.
  • Clinical pregnancy rate was 75.90% (63/83) in the cleared group (CE (−)), 61.90% (130/210) in the non-CE group and 40.00% (12/30) in the persistent weak positive group (p < .01).
  • Live birth rate was 62.65% (52/83) in the cleared group, 58.10% (122/210) in the non-CE group and 36.67% (11/30) in the persistent weak positive group (p < .05).
  • The first trimester abortion rate was 12.70% (8/63 clinical pregnancies) in the cleared group, higher than in the persistent weak positive and non-CE groups (p < .05).
  • In adjusted analysis, chronic endometritis (OR 0.437, 95% CI 0.198–0.967, p = 0.041) and earlier failed cycles (OR 0.549, 95% CI 0.350–0.861, p = 0.009) were independently associated with live birth.

Interpretation

The study is a retrospective cohort from one hospital center, with no randomization. Women aged above 20 and below 40 with at least 2 failed transfer cycles were included. Groups formed after treatment by each woman's second endometrial test, so the cleared group held women who responded. No group with chronic endometritis went untreated. The persistent weak positive group held 30 women, and 4 women with persistent strong results were left out of the transfer analysis. The authors suggest the higher early abortion rate in the cleared group means embryo factors still need consideration, and they call for larger multicenter studies.

RRM Context

Restorative reproductive medicine looks for the cause first. Infertility labeled unexplained is undiagnosed until that search is done. The paper says chronic endometritis usually causes no symptoms or mild ones. Frozen embryo transfer goes ahead without establishing why earlier transfers failed. Here, women with repeated failed transfers had endometrial tissue tested for the condition before treatment and the next transfer.

Our editorial summary of this paper, not the article's abstract.

Abstract

Chronic endometritis (CE) has been considered to reduce uterine receptivity and negatively affect reproductive outcomes for in vitro fertilization-embryo transfer (IVF-ET) patients, especially for people undergoing recurrent implantation failure (RIF). To investigate the effects of antibiotic and platelet-rich plasma (PRP) therapy on pregnancy outcomes following frozen-thawed embryo transfer (FET) in RIF patients with CE, endometrial specimens of 327 patients with RIF obtained by endometrial scratching during mid-luteal phase were immunostained by multiple myeloma oncogene-1 (Mum-1)/syndecan-1 (CD138). RIF patients with CE were given antibiotics and PRP treatment. According to the Mum-1+/CD138+ plasmacytes after treatment, patients were divided into persistent weak positive CE (+) group, CE (-) group and non-CE group. FET was performed and the basic characteristics and pregnancy outcomes of patients in three groups were compared. Among 327 RIF patients, 117 patients were complicated with CE, the prevalence was 35.78%. The prevalence of strong positive was 27.22% and that of weak positive was 8.56%. 70.94% patients with CE converted to negative after treatment. There was no significant difference in the basic characteristics, including age, BMI, AMH, AFC, infertility years, infertility types, number of previous transplant cycles, endometrial thickness on transplantation day and number of transplanted embryos (p > 0.05); The positive rate of hCG, clinical pregnancy rate and implantation rate in CE (-) group were significantly increased compared with the weak CE (+) group and non-CE group (p < .01), and the live birth rate also improved (p < .05). Whereas, the rate of early abortion in CE (-) group was 12.70%, which was higher than that in weak CE (+) group and non-CE group (p < .05). After multivariate analysis, number of previous failed cycles and CE remained independent factors associated with live birth rate, while only CE remained to be the independent factor of clinical pregnancy rate. It is recommended to perform CE-related examination for patients with RIF. Antibiotic and PRP treatment can significantly improve pregnancy outcomes of patients with CE negative conversion in FET cycle.

Topics

Related research

Assisted Reproduction › Outcomes and Effectiveness › Outcomes by Diagnosis · Therapeutics › Emerging Therapies › Platelet-Rich Plasma · Infections and the Reproductive Microbiome › Chronic Endometritis › Endometritis and Reproductive Outcomes
Jie Li, Xueyao Li, Jinli Ding, Jing Zhao, Jiao Chen, Feng Guan, Haiyu Deng, Mengqi Zhou, Yiling Han, Zhuoni Xiao, Jing Yang
J Li, X Li, J Ding, J Zhao, J Chen, F Guan, H Deng, M Zhou, Y Han, Z Xiao, J Yang
PMID 36861040 36861040 DOI 10.3389/fcell.2023.1088586 10.3389/fcell.2023.1088586 Li et al. 2023, Li 2023

Learn

Resources

Tools

Help

Candid Platinum Transparency 2026

RRM Academy is a 501(c)(3) nonprofit providing free and low-cost education in restorative reproductive medicine for patients and healthcare professionals.

This site is an educational resource and does not provide medical advice. Inclusion of a study does not imply endorsement of its findings. Always consult a qualified healthcare provider for diagnosis and treatment.

© 2026 RRM Academy · All Rights Reserved

Restorative Reproductive Medicine Foundation · 3401 Hartzdale Dr, Ste 103B PMB 3518, Camp Hill, PA 17011 · EIN: 93-4594315
Sitemap AI Instructions Developers Terms of Use Medical Disclaimer Privacy Policy