title: Endometritis in Infertile Couples: The Role of Hysteroscopy and Bacterial Endotoxin.
abstract: OBJECTIVE
  The role of endometritis on infertility is still controversial. The aim of our prospective controlled study was to select infertile couples and to analyze: hysteroscopic findings of endometritis, bacterial endotoxin level in the menstrual blood, histological pattern of endometrial biopsy and to determine the effect of antibiotic therapy on endometritis resolution.
  
  
  METHODS
  100 infertile couples of University Hospital waiting for in vitro fertilization program. We evaluated the incidence of endometritis in infertile population by hysteroscopy, endometrial biopsy and bacterial endotoxin levels in the menstrual samples. Moreover, we verified the effectiveness of antimicrobial treatment on the endometritis resolution by hysteroscopic control.
  
  
  RESULTS
  Out of 100 women enrolled, 15 showed hysteroscopic evidence of endometritis and 12 of these patients presented higher bacterial endotoxin in the menstrual samples. The histological results were positive for endometritis in 9 cases, 1 woman had no adequate samples and 5 patients had negative result. After antibiotic therapy, 9 patients had a complete hysteroscopic endometritis resolution, 4 patients had an improvement and in 2 cases there was no endometrial change. Concerning histological findings after therapy, we had negative results in 12 patients and persistent inflammatory findings in 2 patients.
  
  
  CONCLUSIONS
  Our study demonstrated a high incidence of endometritis in infertile couples (15%). The endometrial biopsy was in agreement with the hysteroscopic findings in 60% of the cases, and the bacterial endotoxin level in the menstrual samples was higher in 12 patients with suspected endometritis, then its measurement can be helpful to confirm an endometrial infection but its influence must be confirmed with further researches. The antibiotic therapy can improve the hysteroscopic endometrial inflammatory aspect in over 80% of cases.
authors.affiliation: University of Pisa, Department Reproductive Medicine and Child Development Division of Obstetrics and Gynecology, Pisa - Italy.
authors.forename: Gérsia A
authors.initials: GA
authors.lastname: Viana
authors.affiliation: University of Pisa, Department Reproductive Medicine and Child Development Division of Obstetrics and Gynecology, Pisa - Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Cela
authors.affiliation: University of Pisa, Department Reproductive Medicine and Child Development Division of Obstetrics and Gynecology, Pisa - Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Ruggiero
authors.affiliation: University of Pisa, Department Reproductive Medicine and Child Development Division of Obstetrics and Gynecology, Pisa - Italy.
authors.forename: Niccola
authors.initials: N
authors.lastname: Pluchino
authors.affiliation: University of Pisa, Department Reproductive Medicine and Child Development Division of Obstetrics and Gynecology, Pisa - Italy.
authors.forename: Andrea Riccardo
authors.initials: AR
authors.lastname: Genazzani
authors.affiliation: University of Siena, Gynecology and Obstetrics Department, Siena - Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tantini
keywords: Infertility; antibiotic therapy.; bacterial endotoxin; endometritis; hysteroscopy