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.

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