Impact of chronic endometritis in infertility: a SWOT analysis

Abstract

Barcelona and Professor of UAB. He is also co-founder of the interest group on Reproductive Endocrinology of the Spanish Fertility Society and President of the National Spanish Fertility Society Meeting held in Barcelona in 2014. KEY MESSAGE Pending new evidence, it would be advisable not to include chronic endometritis in the initial baseline study before assisted reproduction in order not to delay other assisted reproduction treatments. ABSTRACT (max. 200) Chronic endometritis (CE) is a pathology often associated with reproductive failure, but there are still no clear recommendations on whether its inclusion in the initial study of the infertile couple is necessary. In this discussion paper, based on a SWOT (strengths, weaknesses, opportunities, threats) analysis, the different aspects of the repercussions of CE in fertility are evaluated. To avoid possible subjectivity in the analysis and results of this study, researchers followed Oxford criteria for the evaluation of evidence. The results from the evaluation of the reviewed bibliography seem to indicate that, pending new evidence, it would be advisable not to include CE in the initial baseline study before assisted reproduction in order not to delay other assisted reproduction treatments. However, it would be advisable in those cases of repetitive implantation failure and pregnancy loss after having undergone IVF with viable embryos and before continuing with costly reproductive processes, since results could be improved. The development of randomized studies that assess the impact of antibiotic treatment as a possible therapeutic option in infertile women with CE as well as the possible impact on endometrial microbiota and receptivity/implantation would allow for the establishment of more precise clinical guidelines in this regard.

Relation between chronic endometritis and recurrent miscarriage

“…A recent SWOT analysis also recommended investigating and managing CE in women with RPL or repeated implantation failure after in vitro fertilization as it could improve outcomes [20]. This study found that the prevalence of CE in women with RM was 31.8% using CE-related hysteroscopic signs, while it was 38.2% using IHC staining and endometrial cultures (p = 0.4).…”

“…In addition, there are no clear guidelines on whether to include CE in the initial assessment of an infertile couple [20]. Therefore, future randomized trials are needed to determine whether to include CE in the initial assessment of an infertile couple, and the impact of antibiotic therapy in CE on endometrial receptivity/ implantation.…”

Should we stop screening for chronic endometritis?

“…The overall cure rates differ between 64 and 100%, potentially as a result of different regimens and repeated courses of treatment and as the definition of the cure differed among the studies. (Espinós et al 2021) In some studies the patients were considered as cured when a plasma cell negative histology/immunohistochemistry was reached (Kitaya et al 2018), while others considered a normalisation of the hysteroscopy findings to define a patient as cured. (Cicinelli et al 2021) Other studies have investigated adjuvant therapies such as anti-inflammatory drugs, probiotics to regulate the female reproductive tract microbiome, or progestogens as alternative treatment options, however the current evidence is insufficient to apply them in daily practice today.…”

Human papillomavirus prevalence in unexplained infertile women with chronic endometritis

“…CE chronically causes inflammation in the endometrium leading to infertility, mostly with or without symptoms such as dyspareunia, uterine bleeding, pelvic pain, and secretions (14). It also causes poor pregnancy outcomes such as abortion and labor preterm (15).…”