Chronic endometritis: a common finding in good prognosis patients with failed implantation following in-vitro fertilization

Abstract

OBJECTIVE: Our objective was to identify the incidence of chronic endometritis (CE) in good prognosis patients with implantation failure by evaluating endometrial samples. DESIGN: Retrospective case series. MATERIALS AND METHODS: Ten consecutive patients were identified who underwent endometrial sampling during the follicular phase following failed in-vitro fertilization (IVF). All patients had unexplained implantation failure, considered to be good prognosis patients who underwent one or more IVF cycles with at least one high quality embryo transferred. CE was defined as the presence of plasma cells in the endometrial stroma, determined by an experienced pathologist. Patients with documented CE were treated with a 21-day course of Levofloxacin and re-biopsied to confirm treatment. The primary outcome was the incidence of CE in patients with implantation failure. Other variables compared between groups included age, history of sexually transmitted diseases, infertility diagnoses, and repeat biopsy results. RESULTS: Six of the ten patients who underwent endometrial sampling tested positive for CE. The mean age of patients with and without CE was 34.2 and 31.8, respectively, which was not significantly different between groups (p = 0.65). Of the patients who tested positive, two couples had a history of Chlamydia treated in one of the partners within a year of presentation, and one patient had a history of bilateral hydrosalpinges removed prior to the IVF cycle. None of the patients who tested negative for CE had a history of a sexually transmitted disease or hyrosalpinx. Of the six patients treated with Levofloxacin, one case of CE persisted on follow-up biopsy requiring further treatment. CONCLUSION: Good prognosis patients with implantation failure after transfer of one or more high quality embryos have a high incidence of CE. CE has been associated with decreased success rates in both spontaneous and IVF cycles, and testing should be considered in appropriate patients with unexplained implantation failure.