Park, H. J., Kim, Y. S., Yoon, T. K., & Lee, W. S. (2016). Chronic endometritis and infertility. Clinical and Experimental Reproductive Medicine, 43(4), 185-192. https://doi.org/10.5653/cerm.2016.43.4.185
Park HJ, Kim YS, Yoon TK, Lee WS. Chronic endometritis and infertility. Clin Exp Reprod Med. 2016;43(4):185-192. doi:10.5653/cerm.2016.43.4.185
Park, Hyun Jong, et al. "Chronic endometritis and infertility." Clinical and Experimental Reproductive Medicine, vol. 43, no. 4, 2016, pp. 185-192.
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Chronic endometritis is linked to repeated miscarriage and implantation failure
A 2016 review of past studies links chronic endometritis to repeated miscarriage and failed implantation. The condition is long-lasting inflammation of the womb lining, which the review ties to infection. In women with repeated loss or failed implantation, some studies saw more pregnancies after antibiotics. The authors call their own new idea a hypothesis.
Nearly 3 in 10 women with recurrent pregnancy loss had chronic endometritis. Source: Park HJ et al., 2016, PMID 28090456.Study at a glance, 2016 review of past studies: Chronic endometritis is linked to repeated miscarriage and failed implantation. Source: Park HJ et al., 2016, PMID 28090456.
Key Findings
Studies cited in the review put chronic endometritis at approximately 10% to 11% of biopsies taken after hysterectomy for benign gynecologic conditions.
One prospective study found chronic endometritis in 14% (six of 43) of women with repeated implantation failure and 27% (14 of 51) with recurrent pregnancy loss.
Fluid hysteroscopy showed a diagnostic accuracy of 93.4% when compared with the histologic diagnosis of chronic endometritis.
In a retrospective study of unexplained recurrent pregnancy loss, clinical pregnancy was 74.8% (88 of 118) after findings normalized on treatment, against 24.4% (22 of 90) without.
Interpretation
This 2016 review searched PubMed and links chronic endometritis to higher pregnancy rates after antibiotics in women with repeated loss or failed implantation. The authors note their hysteroscopy treatment idea remains a hypothesis. The findings support larger studies of this approach.
RRM Context
Repeated miscarriage and failed implantation can get filed as unexplained infertility, which RRM reads as undiagnosed. Chronic endometritis is one named condition of the uterine lining that can be tested for. The restorative approach looks for the cause first. IVF proceeds without establishing why the lining fails to support a pregnancy.
Our editorial summary of this paper, not the article's abstract.
Abstract
Chronic endometritis (CE) is a condition involving the breakdown of the peaceful co-existence between microorganisms and the host immune system in the endometrium. A majority of CE cases produce no noticeable signs or mild symptoms, and the prevalence rate of CE has been found to be approximately 10%. Gynecologists and pathologists often do not focus much clinical attention on CE due to the time-consuming microscopic examinations necessary to diagnose CE, its mild clinical manifestations, and the benign nature of the disease. However, the relationship between CE and infertility-related conditions such as repeated implantation failure and recurrent miscarriage has recently emerged as an area of inquiry. In this study, we reviewed the literature on the pathophysiology of CE and how it may be associated with infertility, as well as the literature regarding the diagnosis and treatment of CE. In addition, we discuss the value of hysteroscopic procedures in the diagnosis and treatment of CE.
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