Current Issue

Volume 13, Number 4, Jan-Mar 2020 Pages: 250-256

Chronic Endometritis: Old Problem, Novel Insights and Future Challenges


Elena Puente, M.D, 1, Luis Alonso, M.D, 2, Antonio Simone Laganà, M.D, 3, *, Fabio Ghezzi, M.D, 3, Jvan Casarin, M.D, 3, Jose Carugno, F.A.C.O.G, 4,
Assisted Reproduction Unit, Fertia Clinic, Fuengirola, Málaga, Spain
Unidad de Endoscopia Ginecológica, Centro Gutenberg, Málaga, Spain
Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
Obstetrics and Gynecology Department, University of Miami, Miller School of Medicine, Miami, Florida, USA
*Corresponding Address: Department of Obstetrics and Gynecology “Filippo Del Ponte” Hospital University of Insubria Piazza Biroldi 1 21100 Varese Italy Email:antoniosimone.lagana@uninsubria.it

Abstract

Chronic endometritis (CE) is a poorly investigated pathology which has been related to adverse reproductive out- comes, such as implantation failure and recurrent miscarriage. In this paper, we aim to provide an overview of diag- nosis, etiology, pathophysiology and treatment of CE, its impact on endometrial microenvironment and its associa- tion with infertility. We present a narrative review of the current literatures, synthesizing the findings retrieved from searches of computerized databases. CE is more prevalent in infertile patients. Effective antibiotic treatment of CE seems to improve the pregnancy and live birth rate in patients with unexplained recurrent pregnancy loss (RPL), and increase ongoing pregnancy rate in patients with recurrent implantation failure. In order to increase the diagnostic ac- curacy, immunohistochemistry is recommended besides the conventional histology. In addition, hysteroscopy could be considered as gold standard tool for diagnosis, considering its high correlation with histological findings. CE, as the chronic inflammation of endometrium, is usually asymptomatic and probably underestimated. Interaction of bac- teria with endometrial microenvironment promotes changes in leukocyte population, cytokine production and growth factors which support its negative impact on endometrial receptivity. Nevertheless, standardization of the criteria for histopathological diagnosis and immunohistochemistry technique needs to be defined.