Evaluating Chronic Endometritis in Unexplained Infertility Through Hysteroscopy and Immunohistochemistry

To evaluate the prevalence of chronic endometritis (CE) in women with unexplained infertility compared to healthy controls, with diagnostic assessments conducted during the embryo implantation window.

Prospective observational cohort study.

University hospital.

Women with unexplained infertility and healthy controls.

Endometrial biopsies were obtained during the implantation window and analyzed using immunohistochemical staining for syndecan-1 (CD138) to identify plasma cell infiltration.

Prevalence of CE, as determined by hysteroscopic features, conventional histology, and immunohistochemical staining.

CE was more frequently identified in women with unexplained infertility than in healthy controls. Immunohistochemical analysis detected plasma cell infiltration in 40.63% of infertile women and 23.08% of controls. Hysteroscopic findings suggestive of CE were observed in 53.12% of infertile women, showing a sensitivity of 68.75% and a negative predictive value of 80.76%. Diagnostic concordance between hysteroscopic evaluation and immunohistochemistry was 71.1%.

CE may be more prevalent among women with unexplained infertility during the embryo implantation window. Although hysteroscopy-directed biopsy combined with immunohistochemical analysis may improve diagnostic accuracy, further studies are needed to compare different biopsy techniques and assess potential impact on fertility outcomes.