Chronic Endometritis: Old Problem, Novel Insights and Future Challenges
Elena Puente1, Luis Alonso2, Antonio Simone Laganà3
1Assisted Reproduction Unit, Fertia Clinic, Fuengirola, Málaga, Spain.
International Journal of Fertility & Sterility
|November 12, 2019
Summary
Chronic endometritis (CE), an underdiagnosed uterine condition, is linked to infertility and pregnancy loss. Effective antibiotic treatment and improved diagnostic methods like hysteroscopy can enhance reproductive outcomes.
Area of Science:
- Reproductive Medicine
- Gynecology
- Pathology
Background:
- Chronic endometritis (CE) is an understudied uterine condition associated with adverse reproductive outcomes, including implantation failure and recurrent miscarriage.
- CE is frequently observed in infertile patients, suggesting a significant link between endometrial health and fertility.
- The condition often remains asymptomatic, leading to underdiagnosis and delayed treatment.
Purpose of the Study:
- To provide a comprehensive overview of the diagnosis, etiology, pathophysiology, and treatment of chronic endometritis.
- To elucidate the impact of CE on the endometrial microenvironment and its association with infertility.
- To review current literature on CE, synthesizing findings on its prevalence, diagnostic accuracy, and treatment efficacy.
Main Methods:
- A narrative review of existing literature was conducted.
- Searches of computerized databases were performed to identify relevant studies on chronic endometritis.
- Findings were synthesized to provide an overview of CE's various aspects.
Main Results:
- Chronic endometritis is more prevalent in infertile populations.
- Antibiotic treatment for CE has shown potential to improve pregnancy and live birth rates in patients with recurrent pregnancy loss and recurrent implantation failure.
- Immunohistochemistry and hysteroscopy are recommended to improve diagnostic accuracy, with hysteroscopy showing high correlation with histological findings.
Conclusions:
- Chronic endometritis negatively impacts endometrial receptivity through bacterial interaction with the endometrial microenvironment, affecting leukocyte populations, cytokine production, and growth factors.
- Effective antibiotic therapy for CE may improve pregnancy outcomes in patients experiencing infertility and pregnancy loss.
- Standardization of histopathological diagnosis and immunohistochemistry techniques for CE is necessary to improve diagnostic consistency and clinical application.
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