Chronic endometritis (CE) is a pathology associated with persistent inflammation of the endometrial lining. The symptomatology of CE is usually mild or absent. CE is emerging as one of the main causative factors for altering the endometrial receptivity, which negatively impacts the process of implantation. It is mainly associated with unexplained infertility, recurrent miscarriages, and recurrent implantation failures. While immunohistochemical CD 138 staining is the gold standard for the diagnosis of CE, conventional tissue staining, hysteroscopy, transvaginal color Doppler, and culture sensitivity are other useful diagnostic modalities. Targeted or empirical antimicrobial therapy is effective for treatment in women with CE. Reproductive outcomes may improve following treatment with antimicrobial agents.
Michels TC. Chronic endometritis. Am Fam Physician. 1995;52(1):217–222. PMID: 7604765.
McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril 2015;104(4):927–931. DOI: 10.1016/j.fertnstert.2015.06.044
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
Kasius JC, Fatemi HM, Bourgain C, et al. The impact of chronic endometritis on reproductive outcome. Fertil Steril 2011;96(6):1451–1456. DOI: 10.1016/j.fertnstert.2011.09.039
Cicinelli E, Matteo M, Tinelli R, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod 2015;30(2):323–330. DOI: 10.1093/humrep/deu292
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
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
Wu D, Kimura F, Zheng L, et al. Chronic endometritis modifies decidualization in human endometrial stromal cells. Reprod Biol Endocrinol 2017;15(1):16. DOI: 10.1186/s12958-017-0233-x
Kitaya K, Yasuo T. Aberrant expression of selectin E, CXCL1, and CXCL13 in chronic endometritis. Mod Pathol 2010;23(8):1136–1146. DOI: 10.1038/modpathol.2010.98
Pinto V, Matteo M, Tinelli R, et al. Altered uterine contractility in women with chronic endometritis. Fertil Steril. 2015;103(4):1049–1052. DOI: 10.1016/j.fertnstert.2015.01.007
Coughlan C, Ledger W, Wang Q, et al. Recurrent implantation failure: definition and management. Reprod Biomed Online 2014;28(1):14–38. DOI: 10.1016/j.rbmo.2013.08.011
Kitaya K, Yasuo T. Immunohistochemistrical and Clinicopathological Characterization of Chronic Endometritis. Am J Reprod Immunol 2011;66(5):410–415. DOI: 10.1111/j.1600-0897.2011.01051.x
Hirata K, Kimura F, Nakamura A, et al. Histological diagnostic criterion for chronic endometritis based on the clinical outcome. BMC Womens Health 2021;21(1):94. DOI: 10.1186/s12905-021-01239-y
Inki P. Expression of syndecan-1 in female reproductive tract tissues and cultured keratinocytes. Mol Hum Reprod. 1997;3(4):299–305. DOI: 10.1093/molehr/3.4.299
Lee SK, Kim CJ, Kim DJ, et al. Immune Cells in the Female Reproductive Tract. Immune Netw 2015;15(1):16–26. DOI: 10.13039/501100003625
Tortorella C, Piazzolla G, Matteo M, et al. Interleukin-6, interleukin-1β, and tumor necrosis factor α in menstrual effluents as biomarkers of chronic endometritis. Fertil Steril 2014;101(1):242–247. DOI: 10.1016/j.fertnstert.2013.09.041. PMID: 24314919.
Crum CP, Egawa K, Fenoglio CM, et al. Chronic endometritis: The role of immunohistochemistry in the detection of plasma cells. Am J Obstet Gynecol 1983;147(7):812–815. DOI: 10.1016/0002-9378(83)90045-5
Kitaya K, Yasuo T. Inter-observer and intra-observer variability in immunohistochemical detection of endometrial stromal plasmacytes in chronic endometritis. Exp Ther Med 2013;5(2):485–488. DOI: 10.3892/etm.2012.824
Bayer-Garner IB, Nickell JA, Korourian S. Routine Syndecan-1 Immunohistochemistry Aids in the Diagnosis of Chronic Endometritis. Arch Pathol Lab Med 2004;128:4. DOI: 10.5858/2004-128-1000-RSIAIT
Elnashar AT, Sabry M. Chronic endometritis in in vitro fertilization failure patients. Clin J Obstet Gynecol 2020;3:175–181. DOI: 10.17352/gjfr.000018
Mishra K, Wadhwa N, Guleria K, et al. ER, PR and Ki-67 expression status in granulomatous and chronic non-specific endometritis. J Obstetrics and Gynaecology Research 2008;34(3):371–378. DOI: 10.1111/j.1447-0756.2007.00700.x
Zolghadri J, Momtahan M, Aminian K, et al. The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. Eur J Obstet Gynecol Reprod Biol 2011;155(2):217–220. DOI: 10.1016/j.ejogrb.2010.12.010
Panchal S, Nagori C. Ultrasound in Infertility and Gynecology: Text and Atlas. New Delhi: Jaypee Brothers Medical Publishers; 2019. p. 386. ISBN 9789389129984
Said TH. Prediction of chronic endometritis using 2D and 3D transvaginal ultrasound examination in infertile women. Int J Reprod Contracept Obstet Gynecol. 2021;10(3):865–870. DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20210701
Cicinelli E, De Ziegler D, Nicoletti R, et al. Poor Reliability of Vaginal and Endocervical Cultures for Evaluating Microbiology of Endometrial Cavity in Women with Chronic Endometritis. Gynecol Obstet Invest 2009;68(2):108–115. DOI: 10.1159/000223819
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):e12719. DOI: 10.1111/aji.12719
Haggerty CL, Hillier SL, Bass DC, et al. The PID Evaluation and Clinical Health (PEACH) Study Investigators. Bacterial Vaginosis and Anaerobic Bacteria Are Associated with Endometritis. Clin Infect Dis 2004;39(7):990–995. DOI: 10.1086/423963
Chen C, Song X, Wei W, et al. The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases. Nat Commun 2017;8(1):875. DOI: 10.1038/s41467-017-00901-0. PMID: 29042534; PMCID: PMC5645390.
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. Am J Obstet Gynecol 2018;218(6):602.e1–602.e16. DOI: 10.1038/s41467-017-00901-0
Adegboyega PA, Pei Y, McLarty J. Relationship between eosinophils and chronic endometritis. Hum Pathol 2010;41(1):33–37. DOI: 10.1016/j.humpath.2009.07.008
Cicinelli E, Matteo M, Tinelli R, et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014;21(5):640–647. DOI: 10.1177/1933719113508817
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):e12782. DOI: 10.1111/aji.12782
Vitagliano A, Saccardi C, Noventa M, et al. Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis. Fertil Steril 2018;110(1):103–112. DOI: 10.1016/j.fertnstert.2018.03.017
Sharma JB, Roy KK, Pushparaj M, et al. Genital tuberculosis: An important cause of Asherman's syndrome in India. Arch Gynecol Obstet 2008; 277:37–41. DOI: 10.1007/s00404-007-0419-0
Jindal UN, Verma S, Bala Y. Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Hum Reprod 2012;27(5):1368–1374. DOI: 10.1093/humrep/des076
Kumar P, Shah NP, Singhal A, et al. Association of tuberculous endometritis with infertility and other gynecological complaints of women in India. J Clin Microbiol 2008;46(12):4068-4070. DOI: 10.1128/JCM.01162-08
Bahadur A, Malhotra N, Mittal S, et al. Second-look hysteroscopy after antitubercular treatment in infertile women with genital tuberculosis undergoing in vitro fertilization. Int J Gynaecol Obstet 2010;108(2):128–131. DOI: 10.1016/j.ijgo.2009.08.031
Sharma JB, Sneha J, Singh UB, et al. Effect of antitubercular therapy on endometrial function in infertile women with female genital tuberculosis. Infect Disord Drug Targets 2016;16:101–108. DOI: 10.2174/1871526516666151223103534
Parikh FR, Nadkarni SG, Kamat SA, et al. Genital tuberculosis - A major pelvic factor causing infertility in Indian women. Fertil Steril 1997;67:497–500. DOI: 10.1016/s0015-0282(97)80076-3