Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis

To determine the prevalence of chronic endometritis (CE) in patients with recurrent implantation failure (RIF) after IVF and unexplained recurrent pregnancy loss (RPL).

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Authors

Pierre-Emmanuel Bouet, M.D., M.Sc., Hady El Hachem, M.D., M.Sc., Elise Monceau, M.D., Gilles Gariépy, M.D., Isaac-Jacques Kadoch, M.D., Camille Sylvestre, M.D.

Volume 105, Issue 1, Pages 106–110

Abstract

Objective:

To determine the prevalence of chronic endometritis (CE) in patients with recurrent implantation failure (RIF) after IVF and unexplained recurrent pregnancy loss (RPL).

Design:

Prospective observational study between November 2012 and March 2015.

Setting:

University-affiliated private IVF clinic.

Patient(s):

Women with RIF after IVF (group 1) and unexplained RPL (group 2).

Intervention(s):

Office hysteroscopy followed by an endometrial biopsy was performed as part of the workup for RIF and RPL. The diagnosis of CE was histologically confirmed using immunohistochemistry stains for syndecan-1 (CD138).

Main Outcome Measure(s):

The prevalence of CE in each group and the sensitivity/specificity of office hysteroscopy in the diagnosis of CE.

Result(s):

Ninety-nine patients were included (46 in group 1 and 53 in group 2). The mean age was 36.3 ± 4.9 years in group 1 and 34.5 ± 4.9 years in group 2. Five biopsies were uninterpretable (three in group 1 and two in group 2) because of insufficient specimen. The prevalence of CE was 14% (6/43) in group 1 and 27% (14/51) in group 2. The sensitivity and specificity of office hysteroscopy in the diagnosis of CE were 40% (8/20) and 80% (59/74), respectively.

Conclusion(s):

We found a high prevalence of immunohistochemically confirmed CE in women with RIF and RPL. Office hysteroscopy is a useful diagnostic tool but should be complemented by an endometrial biopsy for the diagnosis of CE.

Clinical Trial Registration No.:

www.clinicaltrials.gov, NCT01762098.

Read the full text at: http://www.fertstert.org/article/S0015-0282(15)01953-6/fulltext

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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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