From the Journals

Treat chronic endometritis to improve implantation rates



In a meta-analysis of five studies of chronic endometritis (CE), women cured of the condition had significantly higher rates of pregnancies, live births, and successful implantations compared with women who had persistent CE.

“These findings potentially suggest that CE is a reversible factor of infertility, whose recognition and therapy may provide better chances at subsequent [in vitro fertilization] attempts,” wrote Amerigo Vitagliano, MD, of the University of Padua (Italy), and his coauthors.

They sought to examine the effect of CE treatment on implantation for women with recurrent implantation failure. While CE is correlated with infertility, prior studies have not resolved the question of whether curing CE would restore fertility. The condition is cured in as many of 80% of cases with a single cycle of antibiotics.

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The systematic review found five studies with a total of 796 patients with recurrent implantation failure in Argentina, China, Italy, Japan, and the United States. Two studies compared cured CE with persistent CE, and three studies compared cured CE with patients not affected by CE.

Only one of the studies evaluated CE patients receiving antibiotics with CE patients not receiving antibiotics. The study showed that there was no difference between those two groups in clinical pregnancy rate, ongoing (12 or more weeks’ gestation) pregnancy rate/live birth rate, or implantation rate.

The significant result was the difference between cured and persistent CE. Those numbers worked out to a higher ongoing pregnancy rate/live birth rate (odds ratio, 6.81; 95% confidence interval, 2.08-22.24; P = .001), clinical pregnancy rate (OR, 4.98; 95% CI, 1.72-14.43; P = .003), and implantation rate (OR, 3.24; 95% CI, 1.33-7.88; P = .01), with no difference in the miscarriage rate (P = .30).

The authors recommend further research in the form of randomized controlled trials to confirm whether completed CE treatment will improve in vitro fertilization success, and whether routine CE screening is advisable for all patients with recurrent implantation failure. At present, they recommend that diagnosed cases of CE be resolved before continuing with fertility treatment.

“If our results are confirmed, CE may represent a new therapeutic target for women suffering from [recurrent implantation failure], with affordable access (diagnosed through a simple endometrial biopsy and treated by oral antibiotics),” they wrote.

The authors reported having no financial disclosures.

SOURCE: Vitagliano A et al. Fertil Steril. 2018 Jun. doi: 10.1016/j.fertnstert.2018.03.017.

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