Chronic endometritis in women with
recurrent pregnancy loss and
recurrent implantation failure:
prevalence and role of office
hysteroscopy and
immunohistochemistry in diagnosis
Pierre-Emmanuel Bouet, M.D., M.Sc.,
a,b
Hady El Hachem, M.D., M.Sc.,
a,b
Elise Monceau, M.D.,
a,b
Gilles Gari epy, M.D.,
c
Isaac-Jacques Kadoch, M.D.,
a,b
and Camille Sylvestre, M.D.
a,b
a
Department of Reproductive Medicine, Ovo Clinic; and
b
Department of Obstetrics and Gynecology and
c
Department of
Pathology, University of Montreal, Montreal, Quebec, Canada
Objective: To determine the prevalence of chronic endometritis (CE) in patients with recurrent implantation failure (RIF) after IVF and
unexplained recurrent pregnancy loss (RPL).
Design: Prospective observational study between November 2012 and March 2015.
Setting: University-affiliated private IVF clinic.
Patient(s): Women with RIF after IVF (group 1) and unexplained RPL (group 2).
Intervention(s): Office hysteroscopy followed by an endometrial biopsy was performed as part of the workup for RIF and RPL. The
diagnosis of CE was histologically confirmed using immunohistochemistry stains for syndecan-1 (CD138).
Main Outcome Measure(s): The prevalence of CE in each group and the sensitivity/specificity of office hysteroscopy in the diagnosis of
CE.
Result(s): Ninety-nine patients were included (46 in group 1 and 53 in group 2). The mean age was 36.3 4.9 years in group 1 and 34.5
4.9 years in group 2. Five biopsies were uninterpretable (three in group 1 and two in group 2) because of insufficient specimen. The
prevalence of CE was 14% (6/43) in group 1 and 27% (14/51) in group 2. The sensitivity and specificity of office hysteroscopy in the
diagnosis of CE were 40% (8/20) and 80% (59/74), respectively.
Conclusion(s): We found a high prevalence of immunohistochemically confirmed CE in women with RIF and RPL. Office hysteroscopy
is a useful diagnostic tool but should be complemented by an endometrial biopsy for the diagnosis of CE.
Clinical Trial Registration No.: NCT01762098. (Fertil Steril
Ò
2016;105:106–10. Ó2016 by
American Society for Reproductive Medicine.)
Key Words: Chronic endometritis, recurrent pregnancy loss, implantation failure, plasma cells,
office hysteroscopy
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T
he endometrial factor in recur-
rent implantation failure (RIF)
after IVF and recurrent preg-
nancy loss (RPL) is under constant
scrutiny. One of the etiologies is
chronic endometritis (CE), which is
defined as a chronic inflammation of
the endometrial lining (1). Patients are
usually asymptomatic but can present
with chronic pelvic pain, dyspareunia,
abnormal uterine bleeding, or persis-
tent vaginal discharge (1). Office hys-
teroscopy can help diagnose CE with
direct visualization of mucosal edema,
focal or diffuse endometrial hyperemia,
and micropolyps (<1 mm) (2). Howev-
er, the gold standard for the diagnosis
of CE is histological identification of
Received July 27, 2015; revised September 2, 2015; accepted September 17, 2015; published online
October 9, 2015.
P.-E.B. has nothing to disclose. H.E.H. has nothing to disclose. E.M. has nothing to disclose. G.G. has
nothing to disclose. I.-J.K. has nothing to disclose. C.S. has nothing to disclose.
Reprint requests: Dr. Pierre-Emmanuel Bouet, M.D., M.Sc., Department of Reproductive Medicine,
Ovo Clinic, 8000 Boulevard Decarie, Montr eal, Quebec H4P 2S4, Canada (E-mail: pebouet@
hotmail.com).
Fertility and Sterility® Vol. 105, No. 1, January 2016 0015-0282/$36.00
Copyright ©2016 American Society for Reproductive Medicine, Published by Elsevier Inc.
http://dx.doi.org/10.1016/j.fertnstert.2015.09.025
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