Chronic Endometritis: Old Problem, Novel Insights and Future Challenges

Abstract

Chronic endometritis (CE) is a poorly investigated pathology which has been related to adverse reproductive outcomes, such as implantation failure and recurrent miscarriage. In this paper, we aim to provide an overview of diagnosis, etiology, pathophysiology and treatment of CE, its impact on endometrial microenvironment and its association 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 accuracy, 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 bacteria 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.

Keywords: Endometritis; Hysteroscopy; Immunochemistry; Reproductive Outcomes.

Fig 1

: Immunochemistry of chronic endometritis. A. Fragment of endometrial biopsy specimen showing glandular cell surface syndecan 1 immunoreactivity. Plasma cells are highlighted by syndecan 1 staining in the center of the picture (original magnification: ×400) and B. More detailed picture of plasma cell syndecan 1 immunoreactivity.

Fig 2

Different findings of chronic endometritis at the fluid hysteroscopy. A. Endometrial surface is completely covered by micropolyps, B. Isolated micropolys on the lateral wall of the cavity, C. Endometrial mucosa appears thick, edematous, diffuse hyperemic, with presence of micropolyps, and D. Detailed image of an endometrial micropolyp appearance.