The impact of chronic endometritis on reproductive outcome.
OBJECTIVE
To assess the prevalence of chronic endometritis and the impact on the fertility of asymptomatic patients indicated for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment.


METHODS
In the context of a randomized controlled trial, a hysteroscopy-guided endometrial biopsy was obtained and histologically examined. The live birth rate (including spontaneous pregnancies) after initiation of IVF/ICSI treatment of patients diagnosed with chronic endometritis was compared with the live birth rate of a randomly selected matched control group of patients without endometritis.


METHODS
Two tertiary infertility care units.


METHODS
A total of 678 asymptomatic infertile women with a normal transvaginal ultrasound (TVS) who underwent diagnostic hysteroscopy before a first IVF/ICSI treatment cycle.


METHODS
Hysteroscopy guided endometrial biopsy.


METHODS
The prevalence of chronic endometritis and the live birth rate (including spontaneous pregnancies) within 3 years after initiation of the randomized controlled trial.


RESULTS
The prevalence of chronic endometritis in the 606 patients with an adequate biopsy was 2.8%. The cumulative live birth rate (including spontaneous pregnancies) did not significantly differ between patients with or without endometritis: 76% versus 54%. Also, the clinical pregnancy rate per embryo transfer was not significantly different (hazard ratio 1.456, 95% confidence interval 0.770-2.750).


CONCLUSIONS
Chronic endometritis can be rarely diagnosed in a population of asymptomatic infertile patients with a normal TVS before a first IVF/ICSI treatment. Moreover, the reproductive outcome after initiation of IVF/ICSI was not found to be negatively affected by chronic endometritis. In conclusion, the clinical implication of chronic endometritis seems minimal.
Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, the Netherlands. j.c.kasius@umcutrecht.nl
Jenneke C
JC
Kasius
Human M
HM
Fatemi
Claire
C
Bourgain
Daisy M D S
DM
Sie-Go
René J C
RJ
Eijkemans
Bart C
BC
Fauser
Paul
P
Devroey
Frank J M
FJ
Broekmans
D000465:Algorithms; D000556:Ambulatory Surgical Procedures; D002908:Chronic Disease; D004716:Endometritis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D012098:Reproduction / Q000502:physiology*; D027724:Reproductive Techniques, Assisted; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000150:complications / Q000503:physiopathology* / Q000601:surgery