Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis.
OBJECTIVE
To determine the prevalence of chronic endometritis (CE) in patients with recurrent implantation failure (RIF) after IVF and unexplained recurrent pregnancy loss (RPL).


DESIGN
Prospective observational study between November 2012 and March 2015.


SETTING
University-affiliated private IVF clinic.


PATIENT(S)
Women with RIF after IVF (group 1) and unexplained RPL (group 2).


INTERVENTION(S)
Office hysteroscopy followed by an endometrial biopsy was performed as part of the workup for RIF and RPL. The diagnosis of CE was histologically confirmed using immunohistochemistry stains for syndecan-1 (CD138).


MAIN OUTCOME MEASURE(S)
The prevalence of CE in each group and the sensitivity/specificity of office hysteroscopy in the diagnosis of CE.


RESULT(S)
Ninety-nine patients were included (46 in group 1 and 53 in group 2). The mean age was 36.3 ± 4.9 years in group 1 and 34.5 ± 4.9 years in group 2. Five biopsies were uninterpretable (three in group 1 and two in group 2) because of insufficient specimen. The prevalence of CE was 14% (6/43) in group 1 and 27% (14/51) in group 2. The sensitivity and specificity of office hysteroscopy in the diagnosis of CE were 40% (8/20) and 80% (59/74), respectively.


CONCLUSION(S)
We found a high prevalence of immunohistochemically confirmed CE in women with RIF and RPL. Office hysteroscopy is a useful diagnostic tool but should be complemented by an endometrial biopsy for the diagnosis of CE.


CLINICAL TRIAL REGISTRATION NO
NCT01762098.
['Bouet|Pierre-Emmanuel|PE|', 'El Hachem|Hady|H|', 'Monceau|Elise|E|', 'Gariépy|Gilles|G|', 'Kadoch|Isaac-Jacques|IJ|', 'Sylvestre|Camille|C|']
D000026:Abortion, Habitual D000328:Adult D015415:Biomarkers D001706:Biopsy D010064:Embryo Implantation D004715:Endometriosis D005260:Female D005307:Fertilization in Vitro D006801:Humans D015907:Hysteroscopy D007150:Immunohistochemistry D009819:Office Visits D011237:Predictive Value of Tests D011247:Pregnancy D015995:Prevalence D011446:Prospective Studies D011792:Quebec D053668:Syndecan-1 D017211:Treatment Failure
Chronic endometritis recurrent pregnancy loss implantation failure office hysteroscopy plasma cells