Background
Chronic endometritis (CE) has been associated with recurrent miscarriage (RM). However diagnosis is challenging and data on successful treatment still lacking. Detection of Syndecan-1 (CD138) via immunohistochemistry on endometrial plasma cells has been shown to provide an accurate diagnosis of CE.
Objective
The aim of this study was to identify CD138+ uterine plasma cells in RM patients in order to determine the prevalence of CE. Further a correlation to uterine natural killer (uNK) cells as well as the success of CE treatment was analyzed.
Methods
In n=125 non-pregnant patients with ≥3 consecutive miscarriages an endometrial biopsy was performed in the mid-luteal phase. The biopsy was taken to evaluate CD138+ uterine plasma cells and CD56+ uNK cells by immunohistochemistry. Patients showing elevated CD138+ plasma cells (>5/mm2) were treated with doxycycline (200mg day 1, 100mg for the next 20 days). To control success of treatment, a second biopsy and analysis of CD138+ plasma cells was performed after treatment.
Results
Out of 125 patients, n=12 (9.6%) showed elevated CD138+ plasma cells and were diagnosed with CE. Out of these, n=8 patients showed >10 CD138+ plasma cells indicating a high elevation. There was no correlation between CD56+ uNK and CD138+ plasma cells (p=0.68). All RM patients (n=12) diagnosed with CE received antibiotic treatment and success of treatment was confirmed in 92% of the cases with post-treatment CD138+ plasma cells <5/mm2.
Conclusion
In our cohort of RM patients a high prevalence of CE was detected. Endometrial biopsies might be implemented in RM diagnostics to detect and treat CE.