#95 : Analysis of the Incidence of and Risk Factors for Chronic Endometritis Recurrence in Infertile Women

Abstract

Background and Aims: Chronic endometritis (CE) is an inflammatory condition of the endometrium which is related to repeated implantation failure. Recovery from CE can increase opportunities for successful pregnancy; however, some of them remain incapable of conceiving or have a miscarriage and concern CE recurrence. The aim of this study is to identify the incidence rates of and risk factors for the recurrence of CE in infertile women. Method: The study population consisted of 1,897 infertile women from a hospital specializing in reproductive medicine who recovered from CE between December 2018 and August 2021. Among the 152 women (13.0%) who did not conceive or experienced pregnancy loss, 105 consecutive women who underwent repeat endometrial biopsy for CD138 immunostaining and endometrial bacterial culturing within 18 months from CE recovery were recruited. Thereafter, patients with and without CE recurrence were compared. Results: The total recurrence rate of CE was 29.5% (31 women). Multivariable logistic regression analysis to determine risk factors for CE recurrence revealed that hysteroscopic surgery (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.02–0.56) and pregnancy loss (OR, 4.13; 95% CI, 1.31–13.05) were significantly associated with decreased and increased CE recurrence rates, respectively. Also, re-examination with CD138 immunostaining after 16–18 months (OR, 9.75; 95% CI, 1.47–64.64) was significantly associated with increased CE recurrence rates. Among 40 patients without a history of hysteroscopic surgery and pregnancy loss, the cumulative CE recurrence rates after 6, 12, and 18 months were 12.5%, 23.3%, and 30.0%, respectively (Graph 1). Conclusion: We recommend re-examination with endometrial CD138 immunostaining in patients with pregnancy loss or long-term infertility during fertility treatment. Hysteroscopic surgery without antibiotic therapy for CE associated with intrauterine abnormalities is also recommended.