Pregnancy outcomes in women with recurrent pregnancy loss and recurrent implantation failure diagnosed with chronic endometritis

Abstract

To report the obstetrical outcomes in women with recurrent pregnancy loss (RPL) or recurrent implantation failure (RIF) diagnosed with chronic endometritis (CE). Prospective study from 2014-2017 in a university setting. After IRB approval, 88 patients undergoing RPL or RIF workup were enrolled. A hysteroscopy and endometrial biopsy (EMB) were performed on all patients. Diagnosis of CE was confirmed with immunochemistry stains for CD138 (>5 plasma cells per HPF1). Diagnosed patients were treated with a course of antibiotics followed by a repeat EMB to confirm response to treatment. Pregnancy rates (PR), live birth rates (LBR) and mean time to pregnancy (TTP) were observed. The overall incidence of CE was 45.5% (40/88). After a first course of antibiotics, the CE incidence was significantly reduced to 13.6% (P = 0.00000817). In the RIF and RPL groups, CE was present in 45.2% (14/31) and 46.6% (28/60) respectively. In the RIF group, PR were similar in the treated CE group compared to those with normal biopsies (85.7% (12/14) vs 64.7% (11/17); P = 0.1834). However, in the RPL group, there was a statistically significant difference in PR between patients with treated CE and normal biopsies (60.7% (17/28) vs. 84.4% (27/32); P = 0.038). There was also a trend towards higher LBR in the RPL group with normal biopsies compared to those with treated CE (46.9% (15/32) vs 25.5% (7/28), P = 0.0793). Mean TTP overall was 7.33 months in the treated CE group compared to 7.92 months for patients with a normal initial biopsy. Within the RPL group, the mean TTP was higher in women with treated CE compared to women with initial normal biopsies (8.30 vs 7.13, P=0.512). However, within the RIF group, the mean TTP was lower in women with treated CE compared to women with initial normal biopsies (6.57 vs 9.24, P=0.352). This report suggests that CE may influence pregnancy rates in patients with RPL. Furthermore, not only was CE associated with a trend towards lower LBR in RPL patients, it also seems to extend the mean TTP in patients with RPL. Further research with a higher sample size would be necessary to corroborate these findings.