Should Endometrium be Sampled in Cases of Recurrent Pregnancy Loss?

Abstract

Aim:The aim was to determine the prevalence of chronic endometritis (CE) and luteal phase defect (LPD) in women with recurrent pregnancy loss (RPL). Materials and methods: It was an observational study done over 18 months in the tertiary care center in India. Women with two or more than two pregnancy losses were enrolled in the study and underwent an endometrial biopsy. Hematoxylin and eosin (H&E) staining was done on all endometrial biopsies and plasma cells were identified by their classical morphology. Immunohistochemical (IHC) staining was done for CD-138. Identification of one or more plasma cells on the biopsy was diagnosed as CE. Luteal phase defect was diagnosed as a morphological lag on endometrial biopsy dating of more than 2 days compared to the menstrual cycle day. Results: Sixty-five patients were included in the analysis. Approximately 32.31% were CD-138 positive for CE and 58.46% were positive for LPD. The sensitivity and specificity of H&E in diagnosing CE were 38.1% and 70.45%, respectively, taking IHC CD-138 as the gold standard. Approximately 61% with CE also showed LPD on endometrial biopsies. There was also a positive and statistically significant correlation between the number of pregnancy losses and the number of days' lag in LPD (p < 0.0001). Conclusion: Endometrial factors as a cause of unexplained RPL cannot be ignored. It is possible that CE may predispose to LPD or the two may have a cumulative effect leading to RPL. Endometrial biopsy is a cost-effective diagnostic tool, and the treatment of CE and LPD is established and economical. We believe that it is prudent to look for and treat these conditions, which can lead to improvement in pregnancy outcomes. Clinical significance: Endometrial biopsy provides an insight into the etiopathogenesis of RPL and should be a part of the routine workup.