Chronic Endometritis: a Hidden Cause of Infertility
Chronic endometritis (CE), a persistent inflammation of the uterine lining, is increasingly recognized as a hidden culprit behind infertility, recurrent miscarriages, and failed IVF cycles. Here is a comprehensive overview of its causes, diagnosis, treatment, and impact on fertility.
What Is Chronic Endometritis?
CE is characterized by inflammation of the endometrium, often triggered by low-grade infections from bacteria such as Chlamydia, Mycoplasma, or Ureaplasma. Unlike acute infections, CE may present with subtle or no symptoms, making it challenging to detect without specialized testing. Studies suggest it affects 10–67% of women with recurrent implantation failure or miscarriages and up to 50% of those with unexplained infertility.
Symptoms and Diagnosis
Symptoms:
Often asymptomatic.
Possible signs include pelvic pain, abnormal uterine bleeding, or unusual vaginal discharge.
Diagnostic Methods:
Endometrial Biopsy: Gold standard for detecting plasma cells (via CD138 marker) in the endometrial stroma.
Hysteroscopy: Identifies micro polyps, stromal edema, or hyperemia.
Molecular Testing: PCR or microbial cultures to pinpoint pathogens.
Women with recurrent pregnancy loss (RPL), implantation failure, or unexplained infertility are prime candidates for CE screening.
Impact on Fertility
CE disrupts endometrial receptivity, the critical window when the embryo implants. Key findings:
Reduced Pregnancy Rates: Untreated CE correlates with lower clinical pregnancy rates (e.g., 43% vs. 61% post-treatment) and higher miscarriage rates (16% vs. 2%).
IVF Outcomes: CE treatment can double live birth rates following IVF.
Natural Conception: Antibiotic therapy improves spontaneous pregnancy rates from 9.5% to 76% in CE patients.
Notably, some studies report minimal impact of CE on asymptomatic IVF patients, highlighting the need for individualized assessment.
Treatment Options
Antibiotics:
First-line therapy (e.g., doxycycline for 14–21 days) resolves CE in >80% of cases.
Intrauterine antibiotic infusion shows promise for resistant cases, with case studies reporting successful pregnancies post-treatment.
Hysteroscopy: Removes biofilms or polyps, enhancing endometrial health.
Follow-Up Testing: A repeat biopsy confirms resolution, though practices vary.
Key Takeaways
CE is a silent but treatable barrier to fertility.
Diagnosis requires targeted testing (endometrial biopsy or hysteroscopy).
Antibiotics significantly improve pregnancy outcomes, especially in recurrent loss cases.
Collaborative care with a fertility specialist optimizes success.
For those struggling with infertility, addressing CE could be the missing piece in their journey. Always consult a reproductive specialist to tailor testing and treatment to your needs.
