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

Authors:
Pierre-Emmanuel Bouet, M.D., M.Sc., Hady El Hachem, M.D., M.Sc., Elise Monceau, M.D., Gilles Gariépy, M.D., Isaac-Jacques Kadoch, M.D., Camille Sylvestre, M.D.

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.:
www.clinicaltrials.gov, NCT01762098.

  • Daniel J. Kaser, MD

    Dear Dr. Bouet and colleagues,

    What is the rate of chronic endometritis in the relevant negative control group–that is, among infertile patients with neither recurrent implantation failure nor RPL?

    Thanks very much for your comments.

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