Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Sep 18;12(9):2250.
doi: 10.3390/diagnostics12092250.

Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome-A Systematic Review and Meta-Analysis

Amerigo Vitagliano  1 , Antonio Simone Laganà  2 , Dominique De Ziegler  3 , Rossana Cicinelli  1 , Carla Mariaflavia Santarsiero  1 , Giovanni Buzzaccarini  4 , Vito Chiantera  2 , Ettore Cicinelli  1 , Marco Marinaccio  1
Affiliations
Review

Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome-A Systematic Review and Meta-Analysis

Amerigo Vitagliano et al. Diagnostics (Basel). .

Abstract

This systematic review and meta-analysis aims to evaluate the impact of chronic endometritis (CE) and its therapy on in vitro fertilization (IVF) outcome. Additionally, we aim to investigate whether various degrees of CE severity may exert a different effect on IVF outcome. Ongoing-pregnancy rate/live-birth-rate (OPR/LBR), clinical-pregnancy rate (CPR), and miscarriage rate (MR) were calculated. A total number of 4145 patients (from ten studies) were included. Women with CE had lower OPR/LBR (OR 1.97, p = 0.02) and CPR (OR 2.28, p = 0.002) compared to those without CE. CE cure increased OPR/LBR (OR 5.33, p < 0.0001) and CPR (OR 3.64, p = 0.0001). IVF outcome was comparable between women with cured CE and those without CE (OPR/LBR, CPR and MR: p = ns). Women with severe CE had lower OPR/LBR (OR 0.43, p = 0.003) and CPR (OR 0.40, p = 0.0007) compared to those mild CE. Mild CE showed no influence on the IVF outcome as compared to women without CE (OPR/LBR, CPR and MR: p = ns). Based on this data analysis, CE significantly reduces OPR/LBR and CPR in women undergoing IVF. Importantly, CE resolution after antibiotic therapy may improves IVF outcome, leading to similar OPR/LBR and CPR as compared to unaffected patients. The negative effects of CE on IVF outcome may be restricted to severe disease, whereas mild CE may have no influence on IVF success.

Keywords: CD-138 immunohistochemistry; IVF outcome; antibiotic therapy; chronic endometritis; endometritis severity; hysteroscopy; infertility; plasma cell count; recurrent implantation failure.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow-chart of study screening, selection, and inclusion/exclusion.
Figure 2
Figure 2
Pooled data analysis comparing CE versus non-CE: (a) ongoing pregnancy rate/live birth rate; (b) clinical pregnancy rate; (c) miscarriage rate [6,8,9,10,11,12,32,33,34].
Figure 2
Figure 2
Pooled data analysis comparing CE versus non-CE: (a) ongoing pregnancy rate/live birth rate; (b) clinical pregnancy rate; (c) miscarriage rate [6,8,9,10,11,12,32,33,34].
Figure 3
Figure 3
Pooled data analysis comparing CE versus cured CE: (a) ongoing pregnancy rate/live birth rate; (b) clinical pregnancy rate; (c) miscarriage rate [4,8,12,34].
Figure 3
Figure 3
Pooled data analysis comparing CE versus cured CE: (a) ongoing pregnancy rate/live birth rate; (b) clinical pregnancy rate; (c) miscarriage rate [4,8,12,34].
Figure 4
Figure 4
Pooled data analysis comparing non-CE versus cured CE: (a) ongoing pregnancy rate/live birth rate; (b) clinical pregnancy rate; (c) miscarriage rate [8,12,34].
Figure 4
Figure 4
Pooled data analysis comparing non-CE versus cured CE: (a) ongoing pregnancy rate/live birth rate; (b) clinical pregnancy rate; (c) miscarriage rate [8,12,34].
Figure 5
Figure 5
Pooled data analysis comparing CE versus non-tested for CE: (a) ongoing pregnancy rate/live birth rate; (b) clinical pregnancy rate; (c) miscarriage rate [6,11].
Figure 6
Figure 6
Pooled data analysis comparing severe versus mild CE: (a) ongoing pregnancy rate/live birth rate; (b) clinical pregnancy rate; (c) miscarriage rate [9,10].
Figure 7
Figure 7
Pooled data analysis comparing mild CE versus non-CE: (a) ongoing pregnancy rate/live birth rate; (b) clinical pregnancy rate; (c) miscarriage rate [9,10].
Figure 7
Figure 7
Pooled data analysis comparing mild CE versus non-CE: (a) ongoing pregnancy rate/live birth rate; (b) clinical pregnancy rate; (c) miscarriage rate [9,10].
See this image and copyright information in PMC

References

    1. Moreno I., Cicinelli E., Garcia-Grau I., Gonzalez-Monfort M., Bau D., Vilella F., De Ziegler D., Resta L., Valbuena D., Simon C. The Diagnosis of Chronic Endometritis in Infertile Asymptomatic Women: A Comparative Study of Histology, Microbial Cultures, Hysteroscopy, and Molecular Microbiology. Am. J. Obstet. Gynecol. 2018;218:602.e1–602.e16. doi: 10.1016/j.ajog.2018.02.012. - DOI - PubMed
    1. Kitaya K. Prevalence of Chronic Endometritis in Recurrent Miscarriages. Fertil. Steril. 2011;95:1156–1158. doi: 10.1016/j.fertnstert.2010.09.061. - DOI - PubMed
    1. McQueen D.B., Perfetto C.O., Hazard F.K., Lathi R.B. Pregnancy Outcomes in Women with Chronic Endometritis and Recurrent Pregnancy Loss. Fertil. Steril. 2015;104:927–931. doi: 10.1016/j.fertnstert.2015.06.044. - DOI - PubMed
    1. Cicinelli E., Matteo M., Tinelli R., Lepera A., Alfonso R., Indraccolo U., Marrocchella S., Greco P., Resta L. Prevalence of Chronic Endometritis in Repeated Unexplained Implantation Failure and the IVF Success Rate after Antibiotic Therapy. Hum. Reprod. 2015;30:323–330. doi: 10.1093/humrep/deu292. - DOI - PubMed
    1. Cicinelli E., Matteo M., Trojano G., Mitola P.C., Tinelli R., Vitagliano A., Crupano F.M., Lepera A., Miragliotta G., Resta L. Chronic Endometritis in Patients with Unexplained Infertility: Prevalence and Effects of Antibiotic Treatment on Spontaneous Conception. Am. J. Reprod. Immunol. 2018;79:e12782. doi: 10.1111/aji.12782. - DOI - PubMed

LinkOut - more resources