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

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: NCT01762098.

Keywords: Chronic endometritis; implantation failure; office hysteroscopy; plasma cells; recurrent pregnancy loss.