CHRONIC ENDOMETRITIS IN PATIENTS WITH RECURRENT IMPLANTATION FAILURE: DIAGNOSIS AND REPRODUCTIVE OUTCOMES FROM A PROSPECTIVE COHORT.

Problem statement

Chronic endometritis(CE) has been related with recurrent implantation failure(RIF) and is consider one of the possible causes of failing to concieve. The main problem of CE mangement is that there are different tests available for the diagnosis and there is no consensus on the diagnostic criteria.

Methods

Prospective, longitudinal, cohort study that includes all patients with RIF between May2019 and August2021.

RIF was defined as the failure to conceive after three single embryo transferences of good quality blastocysts in women under 40 or two euploid blastocysts in women over 40.

All patients underwent hysteroscopy, histopathological endometrial study with CD138, endometrial and vaginal cultures.

Women with an antiphospholipid syndrome and other haematological or immunological issues were excluded if they had not received the treatment in the previous transferences.

Results

103 women were included. 33%(34) showed CE signs in hysteroscopy, 30.1%(31) had plasma cells in the histopathological study and 33.6%(32) resulted in positive endometrial culture. 56%(58) revealed a positive outcome in at least one test.

The degree of agreement was moderate between hysteroscopy and histology(kappa=0,48), and low between culture and histology(kappa=0,257) and culture and hysteroscopy(kappa=0,294). The global rate of agreement between the three tests was 57.28%.

All women with at least one positive exam received antibiotic therapy. Patients with positive culture were treated according to the antibiogram, and those with negative cultures received Doxycyclin 100mg/12h.

Treatment was repeated until every patient presented normal hysteroscopy, histology and endometrial culture.

Before CE treatment, implantation rate(IR) was 16.8%, clinical pregnancy rate(CPR) was 3.9% and live birth rate(LBR) was zero.

After CE treatment, 49patients underwent embryo transfer, with 72.5% IR, 68.8% CPR and 60% LBR. This increase in IR, CPR and LBR is statistically significant(p<0.05).

In an effort to dismiss intercurrent factors, no differences in PGTA, egg donation and endometrial thickness were found between transferences previous to the CE treatment and subsequent.

Conclusion

According to our results, it may be convenient to assess chronic endometritis by hysteroscopy, histopathology and endometrial culture, as these tests do not achieve a good agreement.

Antibiotic treatment of chronic endometritis improves reproductive outcomes in patients with recurrent implantation failure.