Introducing intrauterine antibiotic infusion as a novel approach in effectively treating chronic endometritis and restoring reproductive dynamics: a randomized pilot study

Abstract

The chronic nature of Chronic Endometritis (CE) along with the challenging management and infertility entailed, call for cutting-edge therapeutic approaches. This study introduces the novel treatment of intrauterine antibiotic infusion (IAI) combined with oral antibiotic administration (OAA), and it assesses respective performance against the gold standard treatment of OAA. Data sourced herein reports on treatment efficiency and fertility restoration for both patients aiming to conceive naturally or via In Vitro fertilization. Eighty CE patients, 40 presenting with recurrent implantation failure, and 40 with recurrent pregnancy loss, were enrolled in the IVF and the natural conception arm respectively. Treatment was subjected to randomization. Effectively treated patients proceeded with either a single IVF cycle or were invited to conceive naturally over a 6-month period. Combination of IAI and OAA provided a statistically significant enhanced effectiveness treatment rate (RR 1.40; 95%CI 1.07–1.82; p = 0.01). No statistically significant difference was observed regarding the side-effects rate (RR 1.33; 95%CI 0.80–2.22; p = 0.52). No statistically significant difference was observed for either arm regarding live-birth rate. Following an intention-to-treat analysis, employment of IAI corresponds to improved clinical pregnancy rate-albeit not reaching statistical significance. In conclusion, complimentary implementation of IAI could provide a statistically significant enhanced clinical treatment outcome.

Endometrial polyp is associated with a higher prevalence of chronic endometritis in infertile women

“…Antibiotic treatment of CE after polypectomy could be administered to reduce the recurrence of EP. Indeed, antibiotic administration after CE diagnosis could improve clinical outcomes 24,25 . Immunohistochemistry staining for CD138 of endometrial specimens to diagnose CE should be performed for infertile patients undergoing hysteroscopic operations, especially for infertile patients with EP.…”

“…Indeed, antibiotic administration after CE diagnosis could improve clinical outcomes. 24,25 Immunohistochemistry staining for CD138 of…”

The effectiveness of intrauterine antibiotic infusion versus oral antibiotic therapy in the treatment of chronic endometritis in patients during IVF (in vitro fertilization) procedures

“…The immune response against bacterial invasion of the uterine cavity during chronic endometritis rarely progresses to a systemic inflammatory response [ 21 ], therefore the necessity of systemic antibiotic therapy could be considered but may not be crucial. The local administration of antibiotics (uterine infusion) is described in case reports [ 22 ], as well as a recent clinical study [ 23 ].…”

The effectiveness of intrauterine antibiotic infusion vs oral antibiotic therapy in the treatment of Chronic Endometritis in patients during IVF (in vitro fertilization) procedures

“…The immune response against bacterial invasion of the uterine cavity during chronic endometritis rarely progresses to a systemic in ammatory response [20], therefore the necessity of systemic antibiotic therapy could be considered but may not be crucial. The local administration of antibiotics (uterine infusion) is described in case reports [21], as well as a recent clinical study [22].…”

“…After the administration of antibiotics we expect an improvement of the in ammatory changes and endometrial receptivity [19] [20][21] [22][23]. The immune response against bacterial invasion of the uterine cavity during chronic endometritis rarely progresses to a systemic in ammatory response [20], therefore the necessity of systemic antibiotic therapy could be considered but may not be crucial.…”