Treatment following hysteroscopy and endometrial diagnostic biopsy increases the chance for live birth in women with chronic endometritis. (9th August 2021)

• Record Type: Journal Article
• Authors: Mitter, Vera R.; Meier, Sheila; Rau, Tilman T.; Gillon, Tessa; Mueller, Michael D.; Zwahlen, Marcel; von Wolff, Michael; Kohl Schwartz, Alexandra S.
• Is Part Of: American journal of reproductive immunology. Volume 86:Number 5(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-08-09
• Subjects: chronic endometritis -- endometrial diagnostic biopsy -- plasma cells -- recurrent pregnancy loss -- repeated implantation failure -- time to live birth -- time to pregnancy; Human reproduction -- Immunological aspects -- Periodicals; 616.69206
• DOI: 10.1111/aji.13482
• Languages: English
• ISSNs: 1046-7408

Abstract

Abstract: Problem: Repeated implantation failure and recurrent pregnancy loss are associated with chronic endometritis, a persistent endometrial inflammation. Its diagnosis and treatment may increase pregnancy and live birth rates. The aim of this study was to assess the effectiveness of endometrial diagnostic biopsy and subsequent antibiotic treatment in cases of chronic endometritis on reproductive outcomes over a long observation period. Method of Study: We conducted a historical cohort study (2014–2018) at our University‐based infertility center that included women ( n = 108) with repeated implantation failure or recurrent pregnancy loss without known pathologies associated with either condition. Forty‐one women underwent a hysteroscopy only (reference group); the remaining 67 women underwent, in addition to the hysteroscopy, an endometrial diagnostic biopsy with immunohistochemically staining for CD138 to detect plasma cells (biopsy group). If one or more plasma cells were detected, the women were treated with doxycycline 100 mg twice a day orally for 2 weeks. We performed stratified survival analysis (Kaplan‐Meier) and Cox regression. Results: The biopsy group had higher chances of pregnancy (hazard ratio 2.28; 95% confidence interval 1.23–4.24; p = .009) and of live birth (hazard ratio 2.76; 95% confidence interval 1.30–5.87; p = .008) compared with the reference group. In the sensitivity analysis, repeated implantation failure or recurrent pregnancy loss did not affect the outcome. Conclusion: Endometrial diagnostic biopsy followed by antibiotic treatment in case of chronic endometritis in women with repeated implantation failure or recurrent pregnancy loss may increase the chances for live birth.