Evaluating Chronic Endometritis in Women with Recurrent Implantation Failure and Recurrent Pregnancy Loss by Hysteroscopy and Immunohistochemistry

J Minim Invasive Gynecol. 2020 Jan;27(1):116-121. doi: 10.1016/j.jmig.2019.02.016. Epub 2019 Mar 6.


Study objective: The identification of less invasive methods with acceptable diagnostic value for evaluating intrauterine abnormalities can improve the satisfaction of patients and physicians. Although hysteroscopy plus biopsy has favorable predictive and diagnostic values, limited studies have evaluated its value, and the exact value of this method is not completely understood. The aim of this study was to evaluate the prevalence of chronic endometritis in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) by hysteroscopy and immunohistochemistry.

Design: A cross-sectional study.

Setting: An infertility clinic at Jundishapur University Hospital, Ahvaz, Iran.

Patients: Women with RIF after IVF and RPL.

Interventions: Hysteroscopy on the third to fifth day after finishing the menstruation cycle and then a biopsy for immunohistochemistry by a specific monoclonal antibody against the CD138 marker.

Measurements and main results: In total, 85 patients with a mean age of 36.08 ± 5.76 years underwent hysteroscopy on the third to fifth day after finishing the menstruation cycle. At the end of hysteroscopy, a biopsy was taken and assessed using immunohistochemistry by a specific monoclonal antibody against the CD138 marker. Immunohistochemical staining findings of >5 plasma cells per 20 high-power fields were considered the gold standard. The prevalence of chronic endometritis (CE) in both groups and the diagnostic value of hysteroscopy were evaluated. All data were analyzed using the Fisher exact test and analysis of variance. The prevalence of RIF-related CE was 23.4% (11); 21.3% (10) of the cases were diagnosed by hysteroscopy. The prevalence of RPL-related CE was 36.8% (14) and 31.6% (12) based on hysteroscopy and immunohistochemistry staining, respectively. Subsequently, 10 patients (RIF/RPL-related CE with a positive hysteroscopic outcome) were selected randomly for in vitro fertilization therapy, and 3 (30%) of them eventually became pregnant. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy in diagnosing CE were 86.36%, 87.30%, 70.37%, and 94.82%, respectively.

Conclusion: Hysteroscopy is a reliable diagnostic technique in patients with RIF after in vitro fertilization and RPL that can reliably diagnose chronic endometritis.

Keywords: Endometritis; Hysteroscopy; Immunohistochemistry; Recurrent implantation failure.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Habitual / diagnosis*
  • Abortion, Habitual / epidemiology
  • Abortion, Habitual / etiology
  • Adult
  • Biopsy
  • Chronic Disease
  • Cross-Sectional Studies
  • Embryo Loss / diagnosis*
  • Embryo Loss / epidemiology
  • Embryo Loss / etiology
  • Endometritis / complications
  • Endometritis / diagnosis*
  • Endometritis / epidemiology
  • Endometrium / metabolism
  • Endometrium / pathology
  • Endometrium / surgery
  • Female
  • Fertilization in Vitro
  • Humans
  • Hysteroscopy* / methods
  • Immunohistochemistry* / methods
  • Pregnancy
  • Prevalence
  • Sensitivity and Specificity