International Journal of Infertility & Fetal Medicine

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VOLUME 14 , ISSUE 3 ( September-December, 2023 ) > List of Articles

RESEARCH ARTICLE

Does Oral Antibiotic Therapy for Chronic Endometritis Improve Reproductive Outcomes in Assisted Reproductive Technology? A Prospective Cohort Study

Amulya Nagulapalli, Hiya Agrawal, Monna Pandurangi, Radha Vembu, Sanjeeva R Nellepalli

Keywords : Assisted reproductive technology, Cluster of differentiation 138 immunohistochemistry, Chronic endometritis, Oral antibiotic therapy, Reproductive outcomes

Citation Information : Nagulapalli A, Agrawal H, Pandurangi M, Vembu R, Nellepalli SR. Does Oral Antibiotic Therapy for Chronic Endometritis Improve Reproductive Outcomes in Assisted Reproductive Technology? A Prospective Cohort Study. Int J Infertil Fetal Med 2023; 14 (3):123-128.

DOI: 10.5005/jp-journals-10016-1324

License: CC BY-NC 4.0

Published Online: 28-11-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: Chronic endometritis (CE) is a continuous and subtle inflammation of the endometrium caused by bacterial pathogens. It is associated with infertility and poor reproductive outcomes and presents with nonspecific symptoms, making the diagnosis difficult. The gold standard diagnostic criterion is histopathological examination (HPE) and cluster of differentiation (CD) 138 immunohistochemistry (IHC) of endometrial tissue, which is a marker of plasma cells. The effect of antibiotic treatment on reproductive outcomes in Indian infertile women with CE undergoing assisted reproductive technology (ART) has not been extensively studied. Aim: To investigate the influence of oral antibiotic treatment on reproductive outcomes in women with CE undergoing ART. Settings and design: Prospective cohort study at a tertiary care teaching hospital. Materials and methods: A total of 234 infertile women planned for ART underwent endometrial biopsy in the proliferative phase. They were divided into CE-negative (group I) and CE-positive group (group II) based on endometrial biopsy HPE and CD138 IHC. Women in group II received oral antibiotic therapy, and a repeat biopsy was done to assess the cure rate. If CE persisted, they received a second course of antibiotic therapy. They had undergone intracytoplasmic sperm injection (ICSI), and embryo transfer was done where at least one good-grade embryo was transferred. The baseline characteristics and ART outcomes were compared among the two groups. Statistical analysis: Statistical Package for the Social Sciences (SPSS) 29.0 version, Chi-squared test, one-way analysis of variance (ANOVA), and independent sample t-test. Results: The baseline characteristics, controlled ovarian stimulation cycle characteristics, and cycle outcomes were comparable among the two groups. No significant difference in cumulative pregnancy rate (p = 0.95), cumulative miscarriage rate (p = 0.21), ongoing pregnancy rate (p = 0.52), and cumulative live birth rate (p = 0.69) was noted between the two groups. Conclusion: Evaluation and treatment of infertile women undergoing ART for CE is an effective option to improve reproductive outcomes. Clinical significance: To improve reproductive outcomes in ART, routine screening and timely oral antibiotic treatment for CE is a feasible choice.


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  1. Moreno I, Cicinelli E, Garcia-Grau I, et al. The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology. American J Obstet Gynecol 2018;218(6):602.e1–602.e16. DOI: 10.1016/j.ajog.2018.02.012
  2. Michels TC. Chronic endometritis. Am Fam Physician 1995;52(1):217–222. PMID: 7604765.
  3. Park HJ, Kim YS, Yoon TK, et al. Chronic endometritis and infertility. Clin Exp Reprod Med 2016;43(4):185–192. DOI: 10.5653/cerm.2016.43.4.185
  4. Kitaya K, Yamaguchi T, Yasuo T, et al. Post-ovulatory rise of endometrial CD16(-) natural killer cells: in situ proliferation of residual cells or selective recruitment from circulating peripheral blood? J Reprod Immunol 2007;76(1-2):45–53. DOI: 10.1016/j.jri.2007.03.010
  5. Buzzaccarini G, Vitagliano A, Andrisani A, et al. Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review. J Assist Reprod Genet 2020;37(12):2897–2911. DOI: 10.1007/s10815-020-01955-8
  6. Puente E, Alonso L, Laganà AS, et al. Chronic Endometritis: Old Problem, Novel Insights and Future Challenges. Int J Fertil Steril. 2020;13(4):250–256. DOI: 10.22074/ijfs.2020.5779
  7. Cicinelli E, Matteo M, Trojano G, et al. Chronic endometritis in patients with unexplained infertility: Prevalence and effects of antibiotic treatment on spontaneous conception. Am J Reprod Immunol 2018;79(1). DOI: 10.1111/aji.12782
  8. Kitaya K, Matsubayashi H, Takaya Y, et al. Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure. Am J Reprod Immunol 2017;78(5). DOI: 10.1111/aji.12719
  9. McQueen DB, Bernardi LA, Stephenson MD. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril. 2014;101(4):1026–1030. DOI: 10.1016/j.fertnstert.2013.12.031
  10. Kitaya K, Matsubayashi H, Yamaguchi K, et al. Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications. Am J Reprod Immunol 2016;75(1):13–22. DOI: 10.1111/aji.12438
  11. Kitaya K, Takeuchi T, Mizuta S, et al. Endometritis: new time, new concepts. Fertil Steril 2018;110(3):344–350. DOI: 10.1016/j.fertnstert.2018.04.012
  12. Johnston-MacAnanny EB, Hartnett J, Engmann LL, et al. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril 2010;93(2):437–441. DOI: 10.1016/j.fertnstert.2008.12.131
  13. Liu WJ, Huang J, Sun L, et al. New biopsy after antibiotic treatment: effect on outcomes of assisted reproduction in patients with infertility and chronic endometritis. Reprod Biomed Online 2022;45(6):1167–1175. DOI: 10.1016/j.rbmo.2022.07.020
  14. Song D, Feng X, Zhang Q, et al. Prevalence and confounders of chronic endometritis in premenopausal women with abnormal bleeding or reproductive failure. Reprod Biomed Online 2018;36(1):78–83. DOI: 10.1016/j.rbmo.2017.09.008
  15. Greenwood SM, Moran JJ. Chronic endometritis: morphologic and clinical observations. Obstet Gynecol 1981;58(2):176–184. PMID: 7604765.
  16. Bayer-Garner IB, Nickell JA, Korourian S. Routine syndecan-1 immunohistochemistry aids in the diagnosis of chronic endometritis. Arch Pathol Lab Med 2004;128(9):1000–1003. DOI: 10.5858/2004-128-1000-RSIAIT
  17. Kitaya K, Tanaka SE, Sakuraba Y, et al. Multi-drug-resistant chronic endometritis in infertile women with repeated implantation failure: trend over the decade and pilot study for third-line oral antibiotic treatment. J Assist Reprod Genet 2022;39(8):1839–1848. DOI: 10.1007/s10815-022-02528-7
  18. Xiong Y, Chen Q, Chen C, et al. Impact of oral antibiotic treatment for chronic endometritis on pregnancy outcomes in the following frozen-thawed embryo transfer cycles of infertile women: a cohort study of 640 embryo transfer cycles. Fertil Steril 2021;116(2):413–421. DOI: 10.1016/j.fertnstert.2021.03.036
  19. Cicinelli E, Vitagliano A, Kumar A, et al. Unified diagnostic criteria for chronic endometritis at fluid hysteroscopy: proposal and reliability evaluation through an international randomized-controlled observer study. Fertil Steril 2019;112(1):162–173. DOI: 10.1016/j.fertnstert.2019.03.004
  20. Liu H, Song J, Zhang F, et al. A New hysteroscopic scoring system for diagnosing chronic endometritis. J Minim Invasive Gynecol 2020;27(5):1127–1132. DOI: 10.1016/j.jmig.2019.08.035
  21. Moreno I, Simon C. Relevance of assessing the uterine microbiota in infertility. Fertil Steril 2018;110(3):337–343. DOI: 10.1016/j.fertnstert.2018.04.041
  22. Chen YQ, Fang RL, Luo YN, et al. Analysis of the diagnostic value of CD138 for chronic endometritis, the risk factors for the pathogenesis of chronic endometritis and the effect of chronic endometritis on pregnancy: a cohort study. BMC Womens Health 2016;16(1):60. DOI: 10.1186/s12905-016-0341-3
  23. Kasius JC, Fatemi HM, Bourgain C, et al. The impact of chronic endometritis onreproductive outcome. Fertil Steril 2011;96(6):1451–1456. DOI: 10.1016/j.fertnstert.2011.09.039
  24. Song D, He Y, Wang Y, et al. Impact of antibiotic therapy on the rate of negative test results for chronic endometritis: a prospective randomized control trial. Fertil Steril 2021;115(6):1549–1556. DOI: 10.1016/j.fertnstert.2020.12.019
  25. Luncan M, Huniadi A, Bimbo-Szuhai E, et al. The effectiveness of intrauterine antibiotic infusion versus oral antibiotic therapy in the treatment of chronic endometritis in patients during IVF (in vitro fertilization) procedures. BMC Womens Health 2022;22(1):529. DOI: 10.1186/s12905-022-02128-8
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