January 2, 2021
Endometrium plays a pivotal role in the success of an ART procedure. It is the site where the embryo is implanted and a key place not only for supporting fetal growth but also protecting fetus from microbial invasion during pregnancy. Chronic endometritis is a persistent inflammation of the lining of the uterus caused by microorganisms in uterine cavity. Chronic endometritis is often clinically silent and rarely suspected and diagnosed, although it can be accompanied by symptoms like pelvic pain, dysfunctional uterine bleeding, vaginal discharge. Even if clinically silent, it has been suggested to diminish the success rate of both spontaneous and assisted reproductive technology conceptions as well as contributing to repeated miscarriages and repeated implantation failures. The prevalence of chronic endometritis in infertile patients has been estimated at 2.8 to 39%, but can be as high as 60% to 66% in women diagnosed with unexplained recurrent miscarriage or repeated implantation failure, respectively.
The diagnosis of chronic endometritis is difficult because there are no typical clinical or ultrasound findings.Common diagnostic modalities available are:
1. Endometrial Biopsy – the presence of plasma cells in the endometrial stroma is the generally accepted histological diagnostic criterion for CE. Endometrium sampling is performed using an endometrial suction biopsy device, which is inserted through the cervix to obtain a small piece of endometrial tissue. This is generally a simple, well-tolerated procedure, can be performed in an outpatient setting.
2. Hysteroscopy – Hysteroscopic findings suggestive of chronic endometritis are focal or diffuse hyperaemia,stromal edema and /or the presence of micropolyps.
3. Microbial culture – The identification of endometrial pathogens by microbial culture is the only method that provides objective information on targeted therapy.
4. Molecular Studies – newer technique, molecular studies using RT-PCR for detection of accurate organism are also recently made available.
1. Patient with unexplained repeated implantation failure
2. Patient with unexplained repeated miscarriages
3. Patient with persistent thin endometrium
4. Patient with hysteroscopic findings suggestive of endometritis.
Specific antibiotic treatment according to culture report can be given which may attenuate the effect of chronic endometritis on infertility. Its use has resulted in an improvement of reproductive outcome in women with recurrent miscarriage and repeated implantation failure.
1. Antibiotic therapy – 1st line of action.
2. Hysteroscopy – Hysteroscopy may be a powerful tool for physically removing bacterial biofilms in the endometrium. Hence it improves the reproductive outcome in subsequent IVF-ET cycles in RIF patients.
3. Artificial endometrial injury in ART have reported significant improvement in clinical pregnancy rate.
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