Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy.
OBJECTIVE
What is the prevalence of chronic endometritis (CE) in women with repeated unexplained implantation failure (RIF) at IVF, and how does antibiotic treatment affect the reproductive outcome?


CONCLUSIONS
Chronic endometritis, associated with infection with common bacteria or mycoplasma, is common in women complaining of RIF and antibiotic treatment significantly improves the reproductive outcome at a subsequent IVF cycle.


BACKGROUND
We have reported that CE is a frequent finding in women with repeated pregnancy loss and a significantly higher rate of successful pregnancies was achieved after adequate antibiotic treatment. Moreover, CE was identified in 30.3% of patients with repeated implantation failure at IVF and women diagnosed with CE had lower implantation rates (11.5%) after IVF cycles. In contrast, other authors reported that the clinical implication of CE should be considered minimal and that the reproductive outcome at IVF/ICSI cycles was not negatively affected by CE.


METHODS
A retrospective study was performed from January 2009 through June 2012 on 106 women with unexplained infertility and a history of RIF.


METHODS
All patients underwent hysteroscopy and endometrial sampling for histology and microbiological investigations. Women diagnosed with CE underwent antibiotic treatment and the effect of treatment was confirmed by hysteroscopy with biopsy. Within 6 months after treatment all women had a further IVF attempt. The IVF outcomes were compared in women without signs of CE (Group 1) and persistent CE (Group 2) after antibiotic treatment. Clinical pregnancy rate (PR), and live birth rate (LBR) were compared at post-treatment IVF attempt.


RESULTS
Seventy (66.0%) women were diagnosed with CE at hysteroscopy. In 61 (57.5%) CE was confirmed by histology and 48 (45.0%) by cultures. Common bacteria and mycoplasma were the most prevalent agents. In 46 (75.4%) out of 61 women, with diagnosis of CE at hysteroscopy and histology, examinations were normal after appropriate antibiotic treatment control (Group 1) while in 15 (24.6%) cases signs of CE were still present (Group 2). At IVF attempt after treatment, a significantly higher PR and LBR was reported in women from Group 1 compared with women from Group 2 (65.2 versus 33.0% P = 0.039; 60.8 versus 13.3%, P = 0.02, respectively).


CONCLUSIONS
Possible biases related to retrospective studies and to preferential referral of patients with CE, and limited number of cases.


CONCLUSIONS
A prospective randomized clinical trial is needed to confirm our findings but in women with RIF a hysteroscopic evaluation of the uterine cavity to exclude CE should be considered and appropriate antibiotic treatment should be given before submitting the patient to a further IVF attempt.
3rd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70124 Bari, Italy ettore.cicinelli@uniba.it.
Ettore
E
Cicinelli
Institute of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy.
Maria
M
Matteo
Department of Obstetrics and Gynecology, San Bastiano Hospital, Bassano del Grappa, Vicenza, 36100 Vicenza, Italy.
Raffaele
R
Tinelli
3rd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70124 Bari, Italy.
Achiropita
A
Lepera
3rd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70124 Bari, Italy.
Raffaello
R
Alfonso
Operative Unit of Obstetric and Gynecology of Civitanova Marche, Marche, Italy.
Ugo
U
Indraccolo
Institute of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy.
Sonia
S
Marrocchella
Institute of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy.
Pantaleo
P
Greco
Department of Pathology, University of Bari, Bari 70124, Italy.
Leonardo
L
Resta
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D004716:Endometritis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D004717:Endometrium / Q000187:drug effects / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000150:complications / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D007558:Italy / Q000453:epidemiology; D050498:Live Birth; D010865:Pilot Projects; D011247:Pregnancy; D018873:Pregnancy Rate; D015995:Prevalence; D060737:Reproductive Tract Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D055815:Young Adult
D000900:Anti-Bacterial Agents
IVF/ICSI outcome; antibiotic treatment; chronic endometritis; hysteroscopy; repeated implantation failure