Successful implantation requires a healthy euploid embryo, a receptive endometrium, and proper timing. Among supported reproductive technologies, IVF offers the highest chance of achieving pregnancy. However, IVF success rates are far from ideal. Diagnosis and treatment of potentially treatable conditions, such as endometritis, can be an important condition for the success of IVF.
Chronic endometritis is a pathological condition caused by a microbial infection. The uterine cavity is not sterile. Its microbial flora is similar to that of the lower genital tract, but is less dominated by lactobacilli (30% versus 99% found in the vagina/cervix). Bacteria (Escherichia coli, Enterococcus, Mycoplasma, Klebsiella, Pseudomonas, Gardnerella, etc.) and yeast may be responsible for chronic endometritis.
Chronic endometritis has been identified as one of the pathologies associated with repeated implantation failure. See estet-portal.com for a recent systematic review evaluating the impact of chronic endometritis on IVF success.
Impact of chronic endometritis on IVF success
Chronic endometritis can cause an inflammatory process responsible for implantation, abnormal histological changes in the endometrium, and can lead to changes in the gene expression profile. Enlargement of the endometrium is usually reduced, resulting in suboptimal endometrial thickness.
Watch the most interesting videos on our Youtube channel
The meta-analysis included the results of five studies (a total of 796 patients) assessing the association between chronic endometritis and re-implantation failure (two or more failed IVF cycles).
All studies obtained follicular phase endometrial biopsy results and hematoxylin-eosin staining showing plasma cells or immunohistochemistry results to confirm chronic endometritis.
Doxycycline, ciprofloxacin, and metronidazole have been suggested to treat this condition.
Conclusions on the study of the impact of chronic endometritis on IVF success
no effect of chronic endometritis on the clinical outcome of IVF has been confirmed under the condition of prior treatment of chronic endometritis;
- IVF clinical results improved significantly after treatment of chronic endometritis compared to chronic untreated endometritis. The live-birth odds ratio was 6.81 (95% CI, 2.08-22.24);
- The clinical results of IVF were similar in the groups after treatment of chronic endometritis and in the group with a history of non-chronic endometritis with successful therapy. Birth rates, clinical pregnancy rates, and implantation rates were not significantly different;
- Oral antibiotics (doxycycline, clindamycin, ciprofloxacin, metronidazole, etc.) are effective in the treatment of chronic endometritis. Repeat biopsy should confirm cure;
- The biopsy itself can also have a positive effect on implantation if performed before IVF. Therefore, if a biopsy is needed as part of the examination, then it should be planned right before IVF to take advantage of its potential positive effect on implantation, even if the histology is negative.
- The review authors concluded that treatment of chronic endometritis results in superior clinical outcomes after IVF compared with persistent disease. Treatment, however, must be confirmed by repeat biopsy. These data are based on data from retrospective and prospective observational studies, not randomized controlled trials; the authors therefore call for future clinical trials on this topic.
Thank you for staying with estet-portal.com. Read other interesting articles in the "Gynecology" section. You may be interested in:
Approaches to the treatment of sexually transmitted infections
Adapted from Medscape
Share:
Add a comment