ENDOMETRIAL STAINING FOR CD138 AS A MARKER OF CHRONIC ENDOMETRITIS DOES NOT PREDICT FAILED IMPLANTATION

Abstract

Chronic endometritis, diagnosed by endometrial biopsy and analysis for plasma cells, has been implicated as a cause of implantation failure. Staining for CD138, an antigen specific to plasma cells, is the current standard for diagnosis. Previous studies examining chronic endometritis and pregnancy outcomes included patients treated with antibiotics prior to transfer and those who transferred embryos of unknown ploidy status. The aim of this study was to examine the prevalence of plasma cells in patients who underwent endometrial biopsy with no subsequent intervention prior to euploid single embryo transfer (SET) to determine if the presence of plasma cells predicts failed implantation. Case-control study. Endometrial biopsies were obtained from patients undergoing IVF at the time of retrieval. Paraffin embedded endometrial sections were stained using mouse mono-clonal antibody for CD138 (B-A38, Sigma), with tonsil tissue known to contain plasma cells serving as a positive control. Two independent reviewers examined five randomly selected HPFs in each sample, and the results were averaged. Patients underwent euploid SET in a subsequent cycle. Sustained implantation (SI) was defined as fetal heartbeat at discharge. Logistic regression was used to determine if there were significant differences in implantation rates based on presence or absence of CD138. Fifty-six patients were included, n=28 with SI and n=28 with failed implantation (Table 1). Patient age, baseline AMH and FSH, BMI, day of blastulation and embryo morphology were not significantly different between groups. There was no difference in mean number of plasma cells/HPF between those who sustained implantation and those who did not. Only a minority of samples demonstrated ≥ 1 plasma cell per HPF. The majority of patients who underwent CD138 staining for plasma cells exhibited at least one plasma cell in five randomly selected HPFs, indicating that some plasma cells are present in women with normal endometrial receptivity. Further analysis is needed to determine what, if any, threshold of plasma cells is associated with decreased implantation.Table 1Comparison of age, ovarian reserve, embryo quality, and prevalence of plasma cells between patients with and without SI.No implantation (n= 28)Sustained implantation (n=28)p valueAGE (mean, SD)34.1 ± 3.833.9 ± 4.2NSDay 3 FSH (mean, SD)7.2 ± 1.66.7 ± 1.8AMH (mean, SD)3.7 ± 2.14.7 ± 3.5BMI (mean, SD)26.0 ± 4.626.5 ± 4.4Day 5, 6, 7 Blasts36%, 53%, 11%36%, 61%, 3%Mean # of plasma cells/HPF0.5 ± 0.40.4 ± 0.3No plasma cells2/28 (7%)5/28 (18%)0.1-0.9 plasma cells/HPF22/28 (79%)21/28 (75%)≥1 plasma cell/ HPF4/28 (14%)2/28 (7%) Open table in a new tab