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Meta-Analysis
. 2022 Aug;39(8):1797-1813.
doi: 10.1007/s10815-022-02558-1. Epub 2022 Jul 13.

Does antibiotic therapy for chronic endometritis improve clinical outcomes of patients with recurrent implantation failure in subsequent IVF cycles? A systematic review and meta-analysis

Xinghan Cheng  1   2   3 , Zhongying Huang  4   5 , Zhun Xiao  1   2 , Yu Bai  1   2
Affiliations
Meta-Analysis

Does antibiotic therapy for chronic endometritis improve clinical outcomes of patients with recurrent implantation failure in subsequent IVF cycles? A systematic review and meta-analysis

Xinghan Cheng et al. J Assist Reprod Genet. 2022 Aug.

Abstract

Purpose: This study aims to assess whether antibiotic therapy for chronic endometritis (CE) could improve subsequent IVF outcomes in patients with recurrent implantation failure (RIF).

Methods: Studies that explore CE treatment in patients with RIF were retrieved from PubMed, EMBASE, Wanfang, and Google Scholar up to Jan 31, 2022. All retrieved studies were selected according to the inclusion and exclusion criteria. The main outcome measures include implantation rate (IR), clinical pregnancy rate (CPR), ongoing pregnancy rate/live birth rate (OPR/LBR), and miscarriage rate (MR). Odds ratios (ORs) were analyzed for pregnancy outcomes with a 95% confidence interval (CI).

Results: Nine articles were enrolled in this study. Patients receiving oral antibiotic administration (OAA) did not show any advantage over patients without CE with regard to IR, OPR/LBR, and MR, but they showed a higher CPR. Patients with cured CE after OAA therapy had significantly higher CPR, IR, and OPR/LBR compared with patients without CE. Patients with persistent CE after OAA therapy had significantly lower IR, CPR, and OPR/LBR compared with patients without CE. Patients with cured CE had significantly higher IR, CPR, and OPR/LBR compared with persistent CE patients.

Conclusions: Antibiotic treatment may improve the pregnancy outcomes of RIF patients in subsequent IVF cycles only if the condition of CE is confirmed cured in a control biopsy afterwards. Otherwise, no sufficient evidence has shown improvements in clinical outcomes in RIF patients with persistent CE.

Keywords: Antibiotic therapy; Chronic endometritis; Embryo transfer; Implantation failure; In vitro fertilization.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for the selection of eligible studies. OAA, oral antibiotic administration; IAI, intrauterine antibiotic infusion; CE, chronic endometritis
Fig. 2
Fig. 2
Pregnancy outcomes in RIF patients, CE treated with OAA vs. Non-CE. A Implantation rate; B clinical pregnancy rate; C ongoing pregnancy/live birth rate; D miscarriage rate
Fig. 3
Fig. 3
Pregnancy outcomes in RIF patients, Cured CE vs. Non-CE. A Implantation rate; B clinical pregnancy rate; C ongoing pregnancy/live birth rate; D miscarriage rate
Fig. 4
Fig. 4
Pregnancy outcomes in RIF patients, Persistent CE vs. Non-CE. A Implantation rate; B clinical pregnancy rate; C ongoing pregnancy/live birth rate; D miscarriage rate
Fig. 5
Fig. 5
Pregnancy outcomes in RIF patients, Cured CE vs. Persistent CE. A Implantation rate; B clinical pregnancy rate; C ongoing pregnancy/live birth rate; D miscarriage rate
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