Role of CD 138 for the diagnosis of chronic endometritis in unexplained infertility and recurrent pregnancy loss

Authors

  • Aprajita Pankaj Department of Reproductive Medicine and Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India https://orcid.org/0000-0002-2626-2442
  • Vikas Swarankar Department of Reproductive Medicine and Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
  • Sangita Sharma Department of Reproductive Medicine and Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
  • Manisha Choudhary Department of Reproductive Medicine and Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
  • V. S. Nahata Department of Advanced Gynecological Endoscopic Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
  • Farendra Bharadwaj Department of Advanced Gynecological Endoscopic Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
  • Himanshu Dodeja Department of Critical Care Medicine, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India https://orcid.org/0009-0006-8508-3192

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20250854

Keywords:

CD 138, Hysteroscopy, Recurrent pregnancy loss, Chronic endometritis, Unexplained infertility

Abstract

Background: Chronic endometritis (CE) is persistent inflammation of the endometrium in response to bacterial infection, which may be mostly asymptomatic. However, patients may present with pain abdomen, abnormal uterine bleeding, pelvic discomfort, leukorrhea and dyspareunia. In this study, we have compared the role of hysteroscopy and CD 138 IHC for the diagnosis of CE in unexplained infertility and RPL. We have also studied the reproductive outcome following cure of CE with antibiotics.

Methods: A prospective study, recruiting 107 participants, was carried out in the department of reproductive medicine and surgery at Mahatma Gandhi hospital, Jaipur, India. The study duration was between September 2022 and April 2024, including 8 months follow up.

Results: The mean age of the patients in unexplained Infertility group was 34.4±4.9 years (range, 25-41 years) and in RPL group was 33.7±3.9 years (range, 20-40 years). Out of the total 107 patients, 75 patients presented with unexplained infertility and 32 presented with RPL.

Conclusions: It was found that both hysteroscopy and immunohistochemical analysis of CD138 cells are equally effective to diagnose CE. While hysteroscopy can be used to obtain a guided biopsy, from the most suspicious areas, it is an invasive procedure and diagnosis is observer dependent. 

Metrics

Metrics Loading ...

References

Li Y, Xu S, Yu S, Huang C, Lin S, Chen W, Mo M, Lian R, Diao L, Ding L, Zeng Y. Diagnosis of chronic endometritis: How many CD138+ cells/HPF in endometrial stroma affect pregnancy outcome of infertile women? Am J Reproduct Immunol. 2021;85(5):e13369. DOI: https://doi.org/10.1111/aji.13369

Sarkar S, Aleyamma TK, Kamath MS. Unraveling chronic endometritis: A review. Int J Infertil Fetal Med. 2022;13(2):80-4. DOI: https://doi.org/10.5005/jp-journals-10016-1279

Osada H, Seto M, Nakase K, Ezoe K, Miyauchi O, Fujita H, et al. Prevalence of chronic endometritis in patients with infertility due to hydrosalpinx or pelvic peritubal adhesions and effect of laparoscopic surgical correction on pregnancy rates post in vitro fertilization. Eur J Obstetr Gynecol Reproduct Biol. 2023;284:143-9. DOI: https://doi.org/10.1016/j.ejogrb.2023.03.021

Park HJ, Kim YS, Yoon TK, Lee WS. Chronic endometritis and infertility. Clin Exp Reproduct Med. 2016;43(4):185. DOI: https://doi.org/10.5653/cerm.2016.43.4.185

Liu Y, Chen X, Huang J, Wang CC, Yu MY, Laird S, et al. Comparison of the prevalence of chronic endometritis as determined by means of different diagnostic methods in women with and without reproductive failure. Fertil Steril. 2018;109(5):832-9. DOI: https://doi.org/10.1016/j.fertnstert.2018.01.022

Buzzaccarini G, Vitagliano A, Andrisani A, Santarsiero CM, Cicinelli R, Nardelli C, et al. Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review. J Assisted Reproduct Genetics. 2020;37:2897-911. DOI: https://doi.org/10.1007/s10815-020-01955-8

Kitaya K. Prevalence of chronic endometritis in recurrent miscarriages. Fertil Steril. 2011;95(3):1156-8. DOI: https://doi.org/10.1016/j.fertnstert.2010.09.061

Espinós JJ, Fabregues F, Fontes J, García-Velasco JA, Llácer J, Requena A, et al. Impact of chronic endometritis in infertility: a SWOT analysis. Reproduct Biomed Online. 2021;42(5):939-51. DOI: https://doi.org/10.1016/j.rbmo.2021.02.003

ESHRE Guideline Group on RPL, Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, et al. ESHRE guideline: recurrent pregnancy loss: an update in 2022. Human Reproduct Open. 2023;2023(1):hoad002. DOI: https://doi.org/10.1093/hropen/hoad002

Bouet PE, El Hachem H, Monceau E, Gariépy G, Kadoch IJ, Sylvestre C. Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil Steril. 2016;105(1):106-10. DOI: https://doi.org/10.1016/j.fertnstert.2015.09.025

Farghali MM, Abdelazim I, El-Ghazaly TE. Relation between chronic endometritis and recurrent miscarriage. Menopause Rev. 2021;20(3):116-21. DOI: https://doi.org/10.5114/pm.2021.109769

Cicinelli E, Matteo M, Trojano G, Mitola PC, Tinelli R, Vitagliano A, et al. Chronic endometritis in patients with unexplained infertility: Prevalence and effects of antibiotic treatment on spontaneous conception. Am J Reproduct Immunol. 2018;79(1):e12782. DOI: https://doi.org/10.1111/aji.12782

Cicinelli E, Matteo M, Tinelli R, Lepera A, Alfonso R, Indraccolo U, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Human Reproduct. 2015;30(2):323-30. DOI: https://doi.org/10.1093/humrep/deu292

Vaduva CC, Sandulescu MS, Tenovici M, Siminel MA, Novac MB. Results of in vitro fertilization after diagnosis and treatment of chronic endometritis. Eur Rev Med Pharmacological Sci. 2023;27(3):1069-76.

Akopians AL, Pisarska MD, Wang ET. The role of inflammatory pathways in implantation failure: chronic endometritis and hydrosalpinges. In Seminars in Reproductive Medicine. 2015;33(04):298-304. DOI: https://doi.org/10.1055/s-0035-1554916

Yasuo T, Kitaya K. Challenges in clinical diagnosis and management of chronic endometritis. Diagnostics. 2022;12(11):2711. DOI: https://doi.org/10.3390/diagnostics12112711

Kuroda K, Yamanaka A, Takamizawa S, Nakao K, Kuribayashi Y, Nakagawa K, et al. Prevalence of and risk factors for chronic endometritis in patients with intrauterine disorders after hysteroscopic surgery. Fertil Steril. 2022;118(3):568-75. DOI: https://doi.org/10.1016/j.fertnstert.2022.05.029

Elnashar AT, Sabry M. Chronic endometritis in in vitro fertilization failure patients. Clin J Obstetr Gynecol. 2020;3(2):175-81. DOI: https://doi.org/10.29328/journal.cjog.1001073

Cicinelli E, McQueen DB, Huepfel B, Vitagliano A, Moreno I, Simon C, et al. Should patients be screened for chronic endometritis before assisted reproductive technology? Fertil Steril. 2022;118(4):639-52. DOI: https://doi.org/10.1016/j.fertnstert.2022.08.846

Pirtea P, Cicinelli E, De Nola R, de Ziegler D, Ayoubi JM. Endometrial causes of recurrent pregnancy losses: endometriosis, adenomyosis, and chronic endometritis. Fertil Steril. 2021;115(3):546-60. DOI: https://doi.org/10.1016/j.fertnstert.2020.12.010

Gu J, Sun Q, Qi Y, Hu F, Cao Y. The effect of chronic endometritis and treatment on patients with unexplained infertility. BMC Women's Health. 2023;23(1):345. DOI: https://doi.org/10.1186/s12905-023-02499-6

Vitagliano A, Laganà AS, De Ziegler D, Cicinelli R, Santarsiero CM, Buzzaccarini G, et al. Chronic endometritis in infertile women: impact of untreated disease, plasma cell count and antibiotic therapy on IVF outcome-a systematic review and meta-analysis. Diagnostics. 2022;12(9):2250. DOI: https://doi.org/10.3390/diagnostics12092250

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. DOI: https://doi.org/10.1016/j.jmig.2019.02.016

Kaku S, Kubo T, Kimura F, Nakamura A, Kitazawa J, Morimune A, et al. Relationship of chronic endometritis with chronic deciduitis in cases of miscarriage. BMC Women's Health. 2020;20:1-6. DOI: https://doi.org/10.1186/s12905-020-00982-y

Cicinelli E, Matteo M, Tinelli R, Pinto V, Marinaccio M, Indraccolo U, et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reproduct Sci. 2014;21(5):640-7. DOI: https://doi.org/10.1177/1933719113508817

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;289:1363-9. DOI: https://doi.org/10.1007/s00404-013-3131-2

Gay C, Hamdaoui N, Pauly V, Habib MC, Djemli A, Carmassi M, et al. Impact of antibiotic treatment for chronic endometritis on unexplained recurrent pregnancy loss. J Gynecol Obstetr Human Reproduct. 2021;50(5):102034. DOI: https://doi.org/10.1016/j.jogoh.2020.102034

Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril. 2010;93(2):437-41. DOI: https://doi.org/10.1016/j.fertnstert.2008.12.131

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;16:1-7. DOI: https://doi.org/10.1186/s12905-016-0341-3

Ticconi C, Inversetti A, Marraffa S, Campagnolo L, Arthur J, Zambella E, et al. Chronic endometritis and recurrent reproductive failure: a systematic review and meta-analysis. Front Immunol. 2024;15:1427454. DOI: https://doi.org/10.3389/fimmu.2024.1427454

McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril. 2015;104(4):927-31. DOI: https://doi.org/10.1016/j.fertnstert.2015.06.044

Sakai K, Takehara I, Kaneko H, Nakamura F, Nakai N, Takahashi K, et al. Impact of Diagnosis and Treatment of Chronic Endometritis on Outcomes Before Starting Assisted Reproductive Technology: A Retrospective Study. Reproduct Sci. 2024;31(10):3086-94. DOI: https://doi.org/10.1007/s43032-024-01633-5

Downloads

Published

2025-03-27

How to Cite

Pankaj, A., Swarankar, V., Sharma, S., Choudhary, M., Nahata, V. S., Bharadwaj, F., & Dodeja, H. (2025). Role of CD 138 for the diagnosis of chronic endometritis in unexplained infertility and recurrent pregnancy loss. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(4), 1155–1161. https://doi.org/10.18203/2320-1770.ijrcog20250854

Issue

Section

Original Research Articles