Subsequent IVF outcomes following antibiotic therapy for chronic endometritis in patients with recurrent implantation failure

Abstract

Aim: The aim is to identify the chronic endometritis (CE) incidence in recurrent implantation failure (RIF) patients undergoing in vitro fertilization (IVF) treatment and compare the IVF outcomes of RIF patients with CE following antibiotic therapy with RIF patients without CE. Another purpose is to compare the IVF outcomes of described RIF patients with patients undergoing the first cycle of IVF. Methods: In this retrospective cohort study, CE was diagnosed with CD-138 immunohistochemical staining. Among RIF patients, two groups were formed as group 1, including patients diagnosed with CE and treated by antibiotics (n = 129), and group 2, including patients without CE (n = 103). Patients with the first IVF cycle having similar infertility etiologies with RIF patients were reviewed as group 3 (n = 932). Results: CE was diagnosed in 55.6% of RIF patients. The number of oocytes retrieved was not different between groups. Implantation rates (IR) were similar after antibiotic treatment in RIF patients with or without CE. However, Group 3 had a higher IR (41.1%) than group 1 and 2 (23.1% and 30.1%, respectively) (p < 0.001). Clinical pregnancy (CPR) and live birth rates (LBR) were comparable between RIF groups. However, CPR and LBR were significantly higher in group 3 (48.6% and 40.5%) than group 1 (36.4% and 27.9%), and group 2 (37.9% and 30.1%) (p = 0.007 and p = 0.005, respectively). Conclusion: Unidentified endometrial factors except CE may also affect the implantation process, although CE is a frequent finding in patients with RIF. Reproductive outcomes may not be improved only with antibiotics in RIF patients with CE.

Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome—A Systematic Review and Meta-Analysis

“…After the evaluation of the full text, a total number of ten studies [ 4 , 6 , 8 , 9 , 10 , 11 , 12 , 32 , 33 , 34 ] were included in the present meta-analysis ( Figure 1 ).…”

“…Studies included a total of 4145 patients. All studies were observational: four prospective studies [ 6 , 12 , 32 , 34 ], five retrospective studies [ 4 , 9 , 10 , 11 , 33 ], and one cross-sectional study [ 8 ].…”

“…One study compared patients with cured CE and patients with persistent CE [ 4 ]. Two studies compared non-CE patients, patients with cured CE, and patients not tested for CE [ 6 , 11 ]. Two studies compared patients with CE and patients without CE [ 32 , 33 ].…”

“…Four studies included patients with RIF [ 4 , 6 , 11 , 12 , 34 ]. RIF was defined as the failure of at least two or three previous (fresh or frozen-thawed) IVF-ET attempts, including at least one good-quality cleavage-stage embryo or blastocyst transferred per cycle.…”

“…Different theories have been proposed for explaining CE-related impaired endometrial receptivity [ 11 , 12 , 13 , 14 ], including the activation of local inflammatory processes with altered cytokine and chemokine secretion [ 13 , 15 , 16 , 17 , 18 ], abnormal leukocyte infiltration within the endometrium [ 19 , 20 ], altered uterine contractility [ 21 ], defective decidualization [ 17 , 22 ], and defective endometrial vascularization [ 13 , 23 ].…”