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Infections and the Reproductive Microbiome Chronic Endometritis

Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications

Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T, Yasuo T, Yamada H

Published January 2016 American Journal of Reproductive Immunology (New York, N.Y. : 1989), 75(1), 13-22
DOI 10.1111/aji.12438 PMID 26478517

RRM Academy Synopsis

Chronic endometritis may be linked to infertility and miscarriage

A 2015 review suggests chronic endometritis is linked to infertility and pregnancy complications. The condition is inflammation of the womb lining.

Key Findings

  • In one study the review cites, immunostaining for CD138 found endometrial plasma cells with sensitivity of 100% versus 75% and specificity of 100% versus 65% for conventional staining.
  • One study using a dilute antibody found chronic endometritis in 2.8% of infertile women without symptoms who went on to IVF. Studies using stronger staining reported 12% to 30%.
  • Women with repeated implantation failure and chronic endometritis had an implantation rate of 15.0% in the IVF cycle after biopsy, versus 46.2% without it.
  • In women with recurrent miscarriage and chronic endometritis, the live birth rate per pregnancy was 7% (7/98) before antibiotic treatment and 56% (28/50) after.
  • In the authors' own group of women with repeated implantation failure, one antibiotic cleared endometrial plasma cells in 96% (22/23).

Interpretation

This review examines published studies on chronic endometritis. The authors link it to infertility, failed implantation, and miscarriage. The authors note that clear criteria for diagnosis do not yet exist. The findings support larger, randomized trials of antibiotic treatment for chronic endometritis.

RRM Context

Restorative reproductive medicine treats unexplained infertility as undiagnosed. The review describes a missed finding: an inflamed uterine lining that causes few symptoms and needs demanding lab work to diagnose. IVF proceeds without establishing why implantation fails. A question about the lining belongs ahead of any procedure. The review also cites a research group suggesting a link with endometriosis.

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

Abstract

Chronic endometritis (CE) is a local inflammatory disease characterized by unusual plasmacyte infiltration in the endometrial stromal areas. CE has been neglected in gynecologic practice, as it is a less symptomatic benign disease that requires demanding and time-consuming histopathologic examinations for the definite diagnosis. Recent studies, however, suggest the association of CE with infertility and obstetric and neonatal complications. In this review article, we aimed to update the knowledge on epidemiology, etiology, and pathogenesis of CE as well as discuss its clinical management from diagnosis to treatment.

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Related research

Infections and the Reproductive Microbiome › Chronic Endometritis › Endometritis and Reproductive Outcomes · General Gynecology › Infections › Pelvic Inflammatory Disease · Diagnostics › Endometrial Assessment › Endometrial Infection
Kotaro Kitaya, Hidehiko Matsubayashi, Kohei Yamaguchi, Rie Nishiyama, Yukiko Takaya, Tomomoto Ishikawa, Tadahiro Yasuo, Hisao Yamada
K Kitaya, H Matsubayashi, K Yamaguchi, R Nishiyama, Y Takaya, T Ishikawa, T Yasuo, H Yamada
PMID 26478517 26478517 DOI 10.1111/aji.12438 10.1111/aji.12438 Kitaya et al. 2016, Kitaya 2016

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