Top

Published in:

01-06-2014 | Gynecologic Endocrinology and Reproductive Medicine

The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients

Authors: Rui Yang, Xiaoguo Du, Ying Wang, Xueling Song, Yan Yang, Jie Qiao

Published in: Archives of Gynecology and Obstetrics | Issue 6/2014

Purpose

To study the consistency of hysteroscopy findings and histological chronic endometritis (CE) in recurrent implantation failure (RIF) cases, and to compare their values in indicating antibiotic treatment.

Methods

Sixty RIF cases (January 2009–January 2010) and 202 consecutive RIF cases (May 2010–April 2012) in Peking University Third Hospital reproductive medical center were studied. 60 RIF patients’ endometrial samples redid section and CD38/CD138 immunohistochemical stain for CE screening. In 202 RIF cases, the presence of hyperemia, mucosal edema, and micropolyps under hysteroscopy were considered CE diagnostic parameters. Antibiotic was offered to part of the patients. The patients’ clinical outcomes were analyzed by statistical methods.

Results

In 202 RIF cases, the hysteroscopy CE rate was 66.3 %, while histological CE rate was 43.6 %. The sensitivity and specificity of hysteroscopy were 35.2 and 67.5 %. In histological CE patients, 68 cases underwent regular antibiotic treatment and 20 did not. Two groups had similar clinical pregnancy rates (35.3 vs. 30.0 %), embryo implantation rates (18.9 vs. 20.4 %) and ongoing pregnancy rates (29.4 vs. 25.0 %). In hysteroscopy CE patients, the implantation rate (18.6 vs. 4.9 %) and ongoing pregnancy rate (29.3 vs. 7.4 %) significantly increased (P < 0.05) with antibiotic treatment, and higher intrauterine pregnancy rate in treatment group (29.3 vs. 11.1 %). In reviewing the chosen 60 RIF cases, the histological CE rates were similar in both pregnancy and non-pregnancy group after subsequent embryo transfer.

Conclusions

CE occurs frequently in RIF patients; hysteroscopy has more diagnostic and treatment value for them.

Kiviat NB, Wolner-Hanssen P, Eschenbach DA et al (1990) Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. Am J Surg Pathol 14:167–175PubMedCrossRef

Cravello L, Porcu G, D’Ercole C et al (1997) Identification and treatment of endometritis. Contracept Fertil Sex 25:585–586PubMed

Feghali J, Bakar J, Mayenga JM et al (2003) Systematic hysteroscopy prior to in vitro fertilization. Gynecol Obstet Fertil 31:127–131PubMedCrossRef

Espinoza J, Erez O, Romero R (2006) Preconceptional antibiotic treatment to prevent preterm birth in women with a previous preterm delivery. Am J Obstet Gynecol 194:630–637PubMedCrossRef

Romero R, Espinoza J, Mazor M (2004) Can endometrial infection/inflammation explain implantation failure, spontaneous abortion and preterm birth after in vitro fertilization? Fertil Steril 82:799–804PubMedCrossRef

Ercan CM, Ozturk M, Dede M et al (2011) Narrow band imaging hysteroscopy: a new diagnostic technique in recurrent IVF failure? Arch Gynecol Obstet 283(Suppl 1):135–136PubMedCrossRef

Pedro A, Jorge M, Fonseca E et al (2004) What is the role of routine hysteroscopy in the evaluation of uterine cavity in infertile women? Int Congr Ser 1271:259–262CrossRef

Oliveira FG, Abdelmassih VG, Diamond MP et al (2003) Uterine cavity findings and hysteroscopic interventions in patients undergoing in vitro fertilization-embryo transfer who repeatedly cannot conceive. Fertil Steril 80(6):1371–1375PubMedCrossRef

Polisseni F, Bambirra EA, Camargos AF (2003) Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients. Gynecol Obstet Invest 55:205–210PubMedCrossRef

10.

Johnston-MacAnanny EB, Hartnett J, Engmann LL et al (2010) Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril 93(2):437–441PubMedCrossRef

11.

Rinehart J (2007) Recurrent implantation failure: definition. J Assist Reprod Genet 24:284–287PubMedCentralPubMedCrossRef

12.

Simon A, Laufer N (2012) Repeated implantation failure: clinical approach. Fertil Steril 97(5):1039–1043PubMedCrossRef

13.

Margalioth EJ, Ben-Chetrit A, Gal M et al (2006) Investigation and treatment of repeated implantation failure following IVF-ET. Hum Reprod 21:3036–3043PubMedCrossRef

14.

Neelam P, Vitthala S (2001) Are the causes of recurrent implantation failure a myth evidence based reality? Fertil Steril S279:P-582

15.

Conway DA, Ketefian A, Shamonki M (2010) Chronic endometritis: A common finding in good prognosis patients with failed implantation following IVF. Fertil Steril 94(4):S175

16.

Makled AK, Farghali MM, Shenouda DS (2014) Role of hysteroscopy and endometrial biopsy in women with unexplained infertility. Arch Gynecol Obstet 289(1):187–192

17.

Cicinelli E, Resta L, Nicoletti R et al (2005) Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod 20:1386–1389PubMedCrossRef

18.

Svirsky R, Smorgick N, Rozowski U et al (2008) Can we rely on blind endometrial biopsy for detection of focal intrauterine pathology? Am J Obstet Gynecol 199:115.e1–115.e3CrossRef

19.

Adegboyega PA, Pei Y, McLarty J (2010) Relationship between eosinophils and chronic endometritis. Hum Pathol 41:33–37PubMedCrossRef

20.

Bayer-Garner IB, Nickell JA, Korourian S (2004) Routine syndecanl immunohistochemistry aids in the diagnosis of endometritis. Arch Pathol Lab Med 128:1000–1003PubMed

21.

Cicinelli E, De Ziegler D, Nicoletti R et al (2008) Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. Fertil Steril 89:677–684PubMedCrossRef

22.

Kamiyama S, Teruya Y, Nohara M et al (2004) Bacterial endotoxin in the endometrium and its clinical significance in reproduction. Fertil Steril 82:805PubMedCrossRef

23.

Lamonica R, Hartnett J, Engmann LR et al (2006) Immunohistochemistry confirms the presence of chronic endometritis in patients with recurrent implantation failure. Fertil Steril 86:S280CrossRef

24.

Andrews WW, Goldenberg RL, Hauth JC et al (2006) Interconceptional antibiotics to prevent spontaneous preterm birth: a randomized clinical trial. Am J Obstet Gynecol 194:617–623PubMedCrossRef

25.

Fatemi HM, Popovic-Todorovic B, Ameryckx L et al (2009) In vitro fertilization pregnancy in a patient with proven chronic endometritis. Fertil Steril 91(4):1293.e9–1293.e11

26.

Kasius JC, Fatemi HM, Bourgain C et al (2011) The impact of chronic endometritis on reproductive outcome. Fertil Steril 96:1451–1456PubMedCrossRef

27.

Punnonen R, Lehtinen M, Teisala K et al (1989) The relation between serum sex steroid levels and plasma cell infiltrates in endometritis. Arch Gynecol Obstet 244(4):185–191PubMedCrossRef

Title: The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients
Authors: Rui Yang
Xiaoguo Du
Ying Wang
Xueling Song
Yan Yang
Jie Qiao
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 6/2014
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-013-3131-2

At a glance: The STEP trials

Springer Medicine

The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2014

Is maternal anemia associated with small placental volume in the first trimester?

Hormonal and functional biomarkers in ovarian response

Acute post-partum urinary retention: analysis of risk factors, a case–control study

Prophylactic mastectomy with immediate reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via a transmammary route: a novel surgical approach to female BRCA-mutation carriers

Assessment of oxidative stress markers in recurrent pregnancy loss: a prospective study

A multicentric randomized study comparing two techniques of magnification assisted loop excision of high-grade cervical intraepithelial neoplasia: video exoscopy and colposcopy