Clinical efficacy and pregnancy outcomes of doxycycline plus medroxyprogesterone acetate therapy for chronic endometritis in women with recurrent reproductive failure: a prospective cohort study.

INTRODUCTION

Chronic endometritis (CE) is associated with recurrent reproductive failure (RRF), but the optimal treatment strategy remains uncertain. This study evaluated the efficacy and safety of doxycycline plus medroxyprogesterone acetate (MPA) in women with RRF and CE.

MATERIAL AND

METHODS

This prospective cohort study included 330 women with RRF and CE diagnosed by CD138 immunohistochemistry. According to the treatment received, patients were classified into the doxycycline group or the doxycycline plus MPA group, with 165 women in each group. The primary outcome was the histological cure rate of CE after one treatment course. Secondary outcomes included pregnancy rate, live birth rate, pregnancy loss rate, ongoing pregnancy rate, and adverse events. Multivariable Poisson regression with robust variance was used to adjust for potential confounders.

RESULTS

In the primary efficacy population, CE cure occurred in 117 of 158 patients (74.1%) receiving doxycycline and 130 of 160 (81.2%) receiving doxycycline plus MPA [adjusted risk difference [aRD], 6.1; 95% CI, -3.2-15.4; adjusted risk ratio [aRR], 1.08; 95% CI, 0.96-1.22; P = 0.202]. Pregnancy occurred in 97 of 158 patients (61.4%) and 126 of 160 (78.8%) (aRD, 16.5 percentage points; 95% CI, 6.5-26.5; aRR, 1.27; 95% CI, 1.09-1.47; P = 0.002). Adverse events occurred in 12 of 165 patients (7.3%) in each group and were all mild.

CONCLUSION

Doxycycline plus MPA did not significantly improve the CE cure rate in women with RRF and CE, but was associated with a higher pregnancy rate without an increase in adverse events.

TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry with the registration number of ChiCTR2400080514 (31/01/2024).