Interleukin 6 interleukin 1β and tumor necrosis factor α in menstrual effluents as biomarkers of chronic endometritis

Proinflammatory cytokines are increased in menstrual effluents of women with chronic endometritis (CE). A test measuring interleukin-6 and tumor necrosis factor a might offer a reliable tool for screening CE.


Cosimo Tortorella, M.D., Ph.D., Giuseppina Piazzolla, M.D., Maria Matteo, M.D., Vincenzo Pinto, M.D., Raffaele Tinelli, M.D., Carlo Sabbà, M.D., Margherita Fanelli, Ettore Cicinelli, M.D.

Volume 101, Issue 1, Pages 242-247, January 2014



To assess the relationship between chronic endometritis (CE) and proinflammatory cytokine levels in menstrual effluents and to develop a simple noninvasive test for screening CE.


Case-control study.


Academic center.


Sixty-four women referred to our center for infertility.


Office hysteroscopy; endometrial biopsy; collection of menstrual blood at subsequent cycle.

Main Outcome Measure(s):

Interleukin (IL) 6, IL-1β, and tumor necrosis factor (TNF) α concentrations in menstrual effluents.


Thirty-six out of 64 infertile women had histologically proven CE. The remaining 28 women were included as controls. IL-6, IL-1β, and TNF-α levels were markedly higher in menstrual effluents of women with CE compared with control subjects. Receiver operating characteristic curve analysis revealed a good CE screening capacity for all of the cytokines. The combined evaluation of either IL-6/TNF-α or IL-6/IL-1β increased the diagnostic capacity of the test, which reached a 100% sensitivity and a negative predictive value of 100 when at least one cytokine was found to exceed its cutoff value; it also reached a 100% specificity and a positive predictive value of 100 in cases of positivity of both cytokines. Logistic regression analysis confirmed the IL-6/TNF-α–based model as a significant predictor of CE.


Proinflammatory cytokine levels are increased in menstrual effluents of women with CE. A test dosing IL-6 and TNF-α seems to have a high screening capacity for CE.

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