Analysis of the Predictive Factors for Chronic Endometritis Recurrence in Infertile Women.

PROBLEM: To identify the predictive factors for the recurrence of chronic endometritis (CE) in infertile women.

METHOD OF STUDY: In this case-control study, 1170 infertile women recovered from CE and underwent fertility treatment between December 2018 and August 2021. Among the 146 women (12.5%) who did not conceive or experienced pregnancy loss in 18 months after CE recovery, 105 consecutive women who underwent repeat endometrial biopsy for CD138 immunostaining and endometrial bacterial culturing were recruited. Thereafter, patients with and without CE recurrence were compared.

RESULTS

The total recurrence rate of CE was 29.5% (31 women). Multivariable logistic regression analysis to determine predictive factors for CE recurrence revealed that hysteroscopic surgery (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.02-0.56; p = 0.0009) and pregnancy loss (OR, 4.13; 95% CI, 1.31-13.05; p = 0.016) were significantly associated with decreased and increased CE recurrence rates, respectively. Also, reexamination with CD138 immunostaining after 16-18 months (OR, 9.75; 95% CI, 1.47-64.64; p = 0.024) was significantly associated with increased CE recurrence rates. Among 49 patients without a history of pregnancy loss, the cumulative CE recurrence rates after 6, 12, and 18 months were 5.6%, 13.5%, and 20.4%, respectively.

CONCLUSIONS

We recommend reexamination with endometrial CD138 immunostaining in patients with pregnancy loss or long-term infertility during fertility treatment. Hysteroscopic surgery without antibiotic therapy for CE associated with intrauterine abnormalities is also recommended.