The impact of chronic endometritis on infertility: prevalence, reproductive outcomes, and the role of hysteroscopy as a screening tool.

OBJECTIVES: To study the prevalence of chronic endometritis (CE) in infertile women, its impact on reproductive outcomes, and the accuracy of hysteroscopy as a screening tool for CE.

DESIGN: Prospective observational study.

PARTICIPANTS: 514 asymptomatic patients with infertility.

SETTING: Tertiary care center.

METHODS: The participants underwent a hysteroscopy and endometrial biopsy (EMB). Antibiotics were given for cases of CE. We investigated the prevalence of CE in patients starting assisted reproductive technologies (ART) as a primary outcome. Secondary outcomes were the clinical pregnancy rate (CPR) in the ART cycle after hysteroscopy, EMB, and antibiotic treatment in cases of CE; the cumulative CPR in the subsequent 2 years after hysteroscopy and EMB; the sensitivity and specificity of hysteroscopy as a screening tool compared to EMB as the "gold standard" for diagnosing CE.

RESULTS: CE was identified in 2.8% of patients starting ART (11/393). CPRs did not differ significantly between patients with CE and the entire cohort of patients without CE in the subsequent ART cycle (OR 0.43; 95% CI 0.09-2.02) or in the 2 years after EMB (OR 0.56; 95% CI 0.16-1.97). In a matched control comparison (with matching for age, basal FSH, and cause of infertility) CPR in patients with CE did not differ in the subsequent ART cycle (OR 0.39; 95% CI 0.09-1.61); however, their CPR in the 2 years after EMB was significantly lower (OR 0.22; 95% CI 0.13-0.38). The sensitivity and specificity of hysteroscopy as a screening tool for diagnosing CE were 8.3% and 90.1%, respectively.

LIMITATIONS: Due to our cohort's low CE prevalence, we could not detect significant differences in CPRs.

CONCLUSION: CE is rare in our studied population of asymptomatic patients starting ART. Hysteroscopy cannot replace EMB for diagnosing CE.