Abstract
BackgroundThe diagnostic criteria of chronic endometritis remain controversial in the treatment for infertile patients.MethodsA prospective observational study was conducted in a single university from June 2014 to September 2017. Patients who underwent single frozen-thawed blastocyst transfer with a hormone replacement cycle after histological examination for the presence of chronic endometritis were enrolled. Four criteria were used to define chronic endometritis according to the number of plasma cells in the same group of patients: 1 or more (≥ 1) plasma cells, 2 or more (≥ 2), 3 or more (≥ 3), or 5 or more (≥ 5) in 10 high-power fields. Pregnancy rates, live birth rates, and miscarriage rates of the non-chronic endometritis and the chronic endometritis groups defined with each criterion were calculated. A logistic regression analysis was performed for live births using eight explanatory variables (seven infertility factors and chronic endometritis). A receiver operating characteristic curve was drawn and the optimal cut-off value was calculated.ResultsA total of 69 patients were registered and 53 patients were finally analyzed after exclusion. When the diagnostic criterion was designated as the presence of ≥ 1 plasma cell in the endometrial stroma per 10 high-power fields, the pregnancy rate, live birth rate, and miscarriage rate were 63.0% vs. 30.8%, 51.9% vs. 7.7%, and 17.7% vs. 75% in the non-chronic and chronic endometritis groups, respectively. This criterion resulted in the highest pregnancy and live birth rates among the non-chronic endometritis and the smallest P values for the pregnancy rates, live birth rates, and miscarriage rates between the non-chronic and chronic endometritis groups. In the logistic regression analysis, chronic endometritis was an explanatory variable negatively affecting the objective variable of live birth only when chronic endometritis was diagnosed with ≥ 1 or ≥ 2 plasma cells per 10 high-power fields. The optimal cut-off value was obtained when one or more plasma cells were found in 10 high-power fields (sensitivity 87.5%, specificity 64.9%).ConclusionsChronic endometritis should be diagnosed as the presence of ≥ 1 plasma cells in 10 high-power fields. According to this diagnostic criterion, chronic endometritis adversely affected the pregnancy rate and the live birth rate.
Highlights
The diagnostic criteria of chronic endometritis remain controversial in the treatment for infertile patients
The pregnancy rate and live birth rate were significantly lower in the Chronic endometritis (CE) group, and the miscarriage rate was significantly higher in the CE group
CE chronic endometritis, CI confidential interval, High-power field (HPF) high power field addition, in the evaluation of the receiver operating characteristic (ROC) curve, the optimal cut-off was determined to be ≥ 1 plasma cell per 10 HPFs. These findings suggest that CE should be diagnosed when ≥ 1 plasma cell is found among 10 HPFs, and CE had a detrimental effect on the clinical outcomes of in vitro fertilization when it was diagnosed with this criterion
Summary
The diagnostic criteria of chronic endometritis remain controversial in the treatment for infertile patients. It is difficult to purely evaluate the effect of CE on implantation when the control group is defined as patients with RIF without CE, since the pregnancy rate in patients with RIF will be lower in subsequent treatment cycles due to the presence of causes other than CE for implantation failure. For these reasons, there appear to be no uniform criteria based on clinical outcomes that are accepted worldwide
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