Relationship between chronic endometritis and fallopian tube obstruction and its  influence on pregnancy outcome after fallopian tubal recanalization

Yu Sun; Dongyan Li; Shuaihong Zhao; Mukun Yang; Guangxia Cui; Wenpei Bai

doi:10.1177/26334941241308413

Infertility · Tubal Factor

Relationship between chronic endometritis and fallopian tube obstruction and its influence on pregnancy outcome after fallopian tubal recanalization

Sun Y, Li D, Zhao S, Yang M, Cui G, Bai W

Published December 30, 2024 Therapeutic Advances in Reproductive Health, 18, 26334941241308413

DOI 10.1177/26334941241308413 PMID 39734748 PMC PMC11672398

RRM Academy Synopsis

Chronic endometritis is more common with tubes blocked near the womb

Chronic endometritis is inflammation of the womb lining. It showed up in about 3 out of 10 women with tubes blocked near the womb, and 1 out of 10 with open tubes. The retrospective study covered women having infertility surgery. Of 168 women tracked for a year after tube reopening, those who did not conceive more often had it.

Key Findings

Chronic endometritis was found in 30.5% of women with proximal tubal obstruction and 10.75% of women with open tubes (p < 0.001).
In regression analysis, chronic endometritis was related to tubal obstruction, with an odds ratio (OR) of 2.54 (95% CI: 1.368–4.717, p = 0.003).
Of 168 women followed for 12 months after tube reopening, 61 (36.3%) had a spontaneous pregnancy.
Among the 107 women who did not conceive, 43 (40.18%) had chronic endometritis, compared with 13.11% of women who conceived.
Regression listed chronic endometritis as a risk factor for infertility after tube reopening (OR: 4.730, 95% CI: 2.012–11.122).

Interpretation

This retrospective study examined surgery records of women treated for infertility. Doctors found chronic endometritis by testing tissue taken during surgery. Women with blocked tubes had the condition far more often than women with open tubes. Women who did not get pregnant after tube reopening had it far more often than women who did. The authors note their sample came from one center and call for larger, multicenter studies to confirm the findings.

RRM Context

Chronic endometritis often has no symptoms, so it goes unnoticed unless someone looks for it. Restorative reproductive medicine asks why a tube blocked, and why pregnancy did not follow a reopened tube. This field considers the womb lining and the tubes as one system. The study links chronic endometritis to both tubal blockage and the chance of pregnancy after surgery.

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

Abstract

Background

Chronic endometritis (CE), frequently asymptomatic, is associated with female infertility. Fallopian tube obstruction (FTO) is also one of the factors contributing to female infertility. More than 90% of cases of proximal FTO can be successfully treated after fallopian tubal recanalization (FTR) and the spontaneous pregnancy rate of treated women after FTR is only about 30%. Potential factors affecting the success rate of FTR remain unclear. We speculate that CE may be one of the reasons affecting the recanalization of the fallopian tubes.

Objectives

To identify the correlation between CE and FTO, as well as the influence of CE on pregnancy outcomes following FTR.

Design

Retrospective observational study.

Methods

We retrospectively analyzed 498 women of childbearing age who underwent laparoscopy and hysteroscopy surgery for infertility. Endometrial samples were collected during surgery for CD138 immunohistochemistry staining for the diagnosis of CE. Based on the results of the tubal patency test, they were divided into two groups: the fallopian tubal patency group and the proximal FTO group. The prevalence of CE was compared between these two groups. All women with FTO underwent FTR during the operation until successful treatment was achieved. Pregnancy outcomes were assessed after a 12-month follow-up period following the procedures. Logistic regression was used to analyze factors that might affect pregnancy after FTR.

Results

The prevalence of CE in women with tubal obstruction was 30.5%, which was significantly higher than that in the fallopian tubal patency group (10.75%), p < 0.001. After FTR, the prevalence of CE in non-pregnant women was 40.18%, which was higher than that in pregnant women (40.18% vs 13.11%), and the difference was significant (p < 0.001). Multiple regression analysis showed that CE was a significant risk factor for FTO (OR: 2.54, 95% CI: 1.368-4.717, p < 0.05). In addition, CE was identified as a risk factor for infertility after FTR (OR: 4.730, 95% CI: 2.012-11.122).

Conclusion

The presence of CE seems to decrease the likelihood of achieving spontaneous pregnancy following FTR. This observation underscores the clinical importance of early detection and treatment of CE, emphasizing the necessity for immediate intervention to prevent potential fertility complications.

Topics

Infertility › Tubal Factor › Proximal Tubal Obstruction · Infections and the Reproductive Microbiome › Chronic Endometritis › Endometritis and Reproductive Outcomes · Reproductive Surgery › Tubal Surgery › Tubal Cannulation

Yu Sun, Dongyan Li, Shuaihong Zhao, Mukun Yang, Guangxia Cui, Wenpei Bai

Y Sun, D Li, S Zhao, M Yang, G Cui, W Bai

PMID 39734748 39734748 DOI 10.1177/26334941241308413 10.1177/26334941241308413 Sun et al. 2024, Sun 2024