Redefining chronic endometritis: the importance of endometrial stromal changes

We propose that chronic endometritis be defined as the presence of one or more plasma cells per 10 high-power fields in the setting of endometrial stromal changes.

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VOLUME 116, ISSUE 3, P855-861

Authors:

Dana B. McQueen, M.D., M.A.S., Kruti P. Maniar, M.D., Anne Hutchinson, M.D., Rafael Confino, B.S., Lia Bernardi, M.D., Mary Ellen Pavone, M.D., M.S.C.I. 

Abstract:

Objective

To develop diagnostic criteria for chronic endometritis and compare the prevalence of chronic endometritis between women with recurrent pregnancy loss (RPL) and controls.


Design

Cohort study.


Setting

Single academic fertility center.


Patients

Women with unexplained RPL (two or more pregnancy losses) and prospectively recruited controls without a history of RPL or infertility.


Interventions

Endometrial samples were stained with hematoxylin and eosin and CD138. A pathologist blinded to patient history recorded the number of plasma cells per 10 high-power fields (HPFs). In addition, the presence or absence of endometrial stromal changes was documented.


Main Outcome Measure

Prevalence of chronic endometritis.


Results

Endometrial samples from 50 women with unexplained RPL and 26 controls were evaluated. When chronic endometritis was defined as the presence of one or more plasma cells per 10 HPFs, 31% of controls and 56% of women with RPL met the criterion. When both endometrial stromal changes and plasma cells were required for a diagnosis of chronic endometritis, no controls and 30% of women with RPL met the criteria.


Conclusions

Although rare plasma cells were found in biopsy samples from controls, the presence of both plasma cells and endometrial stromal changes was limited to the RPL cohort. We propose that chronic endometritis be defined as the presence of one or more plasma cells per 10 HPFs in the setting of endometrial stromal changes. With the use of these strict diagnostic criteria, women with RPL have a significantly higher rate of chronic endometritis, supporting an association between chronic endometritis and RPL.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

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. 

Comments

Go to the profile of MARTA RIBEIRO HENTSCHKE
about 2 months ago

At what point in the menstrual cycle was the biopsy performed? When do you think is the best time in the cycle for a biopsy and why? Thank you.