Chronic endometritis in cases with recurrent embryo implantation failure

Samir Mohamed El-Sayed; Tarek Mokhtar Tappozada; Fahd Mohamed Mansour; Eman Sheta Ali

doi:10.18203/2320-1770.ijrcog20223000

Authors

Samir Mohamed El-Sayed Department of Obstetrics and Gynecology, Shatby hospital, Alexandria University, Arab Republic of Egypt http://orcid.org/0000-0001-5074-8306
Tarek Mokhtar Tappozada Department of Obstetrics and Gynecology, Shatby hospital, Alexandria University, Arab Republic of Egypt
Fahd Mohamed Mansour Department of Obstetrics and Gynecology, Shatby hospital, Alexandria University, Arab Republic of Egypt
Eman Sheta Ali Department of Pathology, Faculty of medicine, Alexandria University, Arab Republic of Egypt

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20223000

Keywords:

Chronic endometritis, Hysteroscopy, CD138 antibody

Abstract

Background: Chronic endometritis (CE) is a cause of recurrent implantation failure (RIF) in patients undergoing intracytoplasmic sperm injection (ICSI). CE is diagnosed based on the presence of plasma cell infiltration of the endometrial stroma in endometrial biopsies. Hysteroscopy may be suggestive of CE while the immunohistochemistry with specific cell markers for CD138 cells has been suggested as a more accurate test for the diagnosis of CE.

Methods: This study included 110 patients with recurrent ICSI failure (two or more), despite using good-quality embryos. Hysteroscopy and endometrial biopsy were performed as an outpatient procedure. Immunostaining was then performed using a mouse monoclonal CD138 antibody. The prevalence rate of CE was calculated, and the correlation between hysteroscopic findings and immunohistochemical results was assessed.

Results: In the included patients in this study there was 32 cases (29%) were diagnosed as CE by hysteroscopy, while 27 cases (24.5%) were positive by CD138 immunohistochemistry (IHC), and 18 cases (16.36%) were positive for CD138 IHC with hysteroscopic features of CE. The presence of more than one abnormal hysteroscopic features was considered positive for CE rather than single abnormal feature, the sensitivity, specificity, positive and negative predictive values of hysteroscopy would be 22.2%, 98.8%, 85.7%, and 79.6%, respectively.

Conclusions: The negative diagnostic value of hysteroscopy is high, the combination of the two diagnostic modalities (hysteroscopy and CD138 IHC) will aid in the detection of most cases of CE.

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Author Biography

Samir Mohamed El-Sayed, Department of Obstetrics and Gynecology, Shatby hospital, Alexandria University, Arab Republic of Egypt

Associate professor of obstetrics and gynecology, Alexandria university, ARE

References

World Health Organization (WHO). International Classification of Diseases, 11th Revision (ICD-11) Geneva: WHO. 2018.

Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clin Biochem. 2018;62:2-10.

Kamel RM. Management of the infertile couple: an evidence based protocol. Reprod Biol Endocrinol. 2010;8:21.

Elhussein A, Suliman YA. Epidemiology of infertility and characteristics of infertile couples requesting assisted reproduction in a low-resource setting in Africa, Sudan. Fertility Research and Practice. 2019;5:7.

Centers for Disease Control and Prevention. Infertility FAQs. 2013.

Seppä S, Kuiri-Hänninen T, Holopainen E, Voutilainen R. Management of endocrine disease: diagnosis and management of primary amenorrhea and female delayed puberty. Eur J Endocrinol. 2021;184(6).

ESHRE Capri Workshop Group. Nutrition and reproduction in women. Human Reproduction Update. 2006;12(3):193-207.

Chen J, Zhou Q, Zhang Y, Tan W, Gao H, Zhou L. Discovery of novel serum metabolic biomarkers in patients with polycystic ovarian syndrome and premature ovarian failure. Bioengineered. 2021;12(1):8778-92.

Filip L, Duică F, Prădatu A, Crețoiu D, Suciu N, Crețoiu SM. Endometriosis associated infertility: a critical review and analysis on etiopathogenesis and therapeutic approaches. Medicina. 2020;56(9):460.

Shahi M, Amarosa EJ, Crum CP. The Fallopian Tube and Broad Ligament. Diagnostic Gynecologic Obstetr Pathol. 2018;716-60.

Anwar S, Anwar A. Infertility: A review on causes, treatment and management. Womens Health Gynecol. 2016;5:2-5.

Coughlan C. What to do when good-quality embryos repeatedly fail to implant. Best Practice & Research Clinical Obstetr Gynaecol. 2018;53:48-59.

Sadeghi MR. Unexplained infertility, the controversial matter in management of infertile couples. J Reprod Infertil. 2015;16(1):1-2.

Ray A, Shah A, Gudi A, Homburg R. Unexplained infertility: an update and review of practice. Reproduct Biomed Online. 2012;24(6):591-602.

Hatasaka H. New perspectives for unexplained infertility. Clin Obstet Gynecol. 2011;54(4):727-33.

Szmelskyj I, Aquilina L. Acupuncture for IVF and assisted reproduction: An integrated approach to treatment and management. Elsevier Health Sci. 2014.

Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet. 1978;2(8085):366.

Van Eekelen R, Van Geloven N, Van Wely M, Bhattacharya S, Van der Veen F, Eijkemans MJ. IVF for unexplained subfertility; whom should we treat? Hum Reprod. 2019;34(7):1249-59.

Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology. Recommendations for practices utilizing gestational carriers: a committee opinion. Fertil Steril. 2017;107:3-10.

Casper R, Haas J, Hsieh TB, Bassil R, Mehta C. Recent advances in invitro fertilization. Research. 2017;6.

Chen YQ, Fang RL, Luo YN, Luo CQ. Analysis of the diagnostic value of CD138 for chronic endometritis, the risk factors for the pathogenesis of chronic endometritis and the effect of chronic endometritis on pregnancy: a cohort study. BMC Women’s Health. 2016;16(1):60.

Goyal BK, Gaur I, Sharma S, Saha A, Das NK. Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding. Med J Armed Forces India. 2015;71(2):120-5.

El-Sheikh A, Abou Senna H, Hussein M. Role of hysteroscopic guided endometrial biopsy in diagnosis of endometrial pathology in patients with unexplained recurrent implantation failure. Al-Azhar Med J. 2020;49(2):775-84.

Song D, Li TC, Zhang Y, Feng X, Xia E, Huang X et al. Correlation between hysteroscopy findings and chronic endometritis. Fertil Steril. 2019;111(4):772-9.

Tsonis O, Gkrozou F, Dimitriou E, Paschopoulos M. Hysteroscopic detection of chronic endometritis: evaluating proposed hysteroscopic features suggestive of chronic endometritis. J Gynecol Obstetr Human Reproduct. 2021;50(9):102182.

Yang R, Du X, Wang Y, Song X, Yang Y, Qiao J. The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients. Arch Gynecol Obstetr. 2014;289(6):1363-9.

Cicinelli E, Matteo M, Tinelli R, Lepera A, Alfonso R, Indraccolo U. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Human Reproduct. 2015;30(2):323-30.

Zargar M, Ghafourian M, Nikbakht R, Hosseini VM, Choghakabodi PM. Evaluating chronic endometritis in women with recurrent implantation failure and recurrent pregnancy loss by hysteroscopy and immunohistochemistry. J Minimally Invasive Gynecol. 2020;27(1):116-21.

Polisseni F, Bambirra EA, Camargos AF. Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients. Gynecol Obstetr Investigation. 2003;55(4):205-10.

Zolghadri J, Momtahan M, Aminian K, Ghaffarpasand F, Tavana Z. The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. Eur J Obstetr Gynecol Reproduct Biol. 2011;155(2):217-20.