Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy.

نویسندگان

  • Ettore Cicinelli
  • Maria Matteo
  • Raffaele Tinelli
  • Achiropita Lepera
  • Raffaello Alfonso
  • Ugo Indraccolo
  • Sonia Marrocchella
  • Pantaleo Greco
  • Leonardo Resta
چکیده

STUDY QUESTION What is the prevalence of chronic endometritis (CE) in women with repeated unexplained implantation failure (RIF) at IVF, and how does antibiotic treatment affect the reproductive outcome? SUMMARY ANSWER Chronic endometritis, associated with infection with common bacteria or mycoplasma, is common in women complaining of RIF and antibiotic treatment significantly improves the reproductive outcome at a subsequent IVF cycle. WHAT IS KNOWN ALREADY We have reported that CE is a frequent finding in women with repeated pregnancy loss and a significantly higher rate of successful pregnancies was achieved after adequate antibiotic treatment. Moreover, CE was identified in 30.3% of patients with repeated implantation failure at IVF and women diagnosed with CE had lower implantation rates (11.5%) after IVF cycles. In contrast, other authors reported that the clinical implication of CE should be considered minimal and that the reproductive outcome at IVF/ICSI cycles was not negatively affected by CE. STUDY DESIGN, SIZE, DURATION A retrospective study was performed from January 2009 through June 2012 on 106 women with unexplained infertility and a history of RIF. PARTICIPANTS/MATERIALS, SETTING, METHODS All patients underwent hysteroscopy and endometrial sampling for histology and microbiological investigations. Women diagnosed with CE underwent antibiotic treatment and the effect of treatment was confirmed by hysteroscopy with biopsy. Within 6 months after treatment all women had a further IVF attempt. The IVF outcomes were compared in women without signs of CE (Group 1) and persistent CE (Group 2) after antibiotic treatment. Clinical pregnancy rate (PR), and live birth rate (LBR) were compared at post-treatment IVF attempt. MAIN RESULTS AND THE ROLE OF CHANCE Seventy (66.0%) women were diagnosed with CE at hysteroscopy. In 61 (57.5%) CE was confirmed by histology and 48 (45.0%) by cultures. Common bacteria and mycoplasma were the most prevalent agents. In 46 (75.4%) out of 61 women, with diagnosis of CE at hysteroscopy and histology, examinations were normal after appropriate antibiotic treatment control (Group 1) while in 15 (24.6%) cases signs of CE were still present (Group 2). At IVF attempt after treatment, a significantly higher PR and LBR was reported in women from Group 1 compared with women from Group 2 (65.2 versus 33.0% P = 0.039; 60.8 versus 13.3%, P = 0.02, respectively). LIMITATIONS, REASONS FOR CAUTION Possible biases related to retrospective studies and to preferential referral of patients with CE, and limited number of cases. WIDER IMPLICATIONS OF THE FINDINGS A prospective randomized clinical trial is needed to confirm our findings but in women with RIF a hysteroscopic evaluation of the uterine cavity to exclude CE should be considered and appropriate antibiotic treatment should be given before submitting the patient to a further IVF attempt.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Chronic Endometritis: Old Problem, Novel Insights and Future Challenges

Background/Aims: Chronic endometritis (CE) is a poorly investigated pathology that has been related to adverse reproductive outcomes, such as implantation failure and recurrent miscarriage. In this paper we aim to provide an overview about diagnosis, etiology, pathophysiology and treatment of CE, its impact on endometrial microenvironment and how it may be associated with infertility. Methods: ...

متن کامل

I-23: The Role of Hysteroscopy in Patients with Repeated IVF Failure

The success of reproduction, although gradually increasing over the years, many couples also had been left frustrated following repeated failed attempts. Implantation of the embryo, can only take place in a receptive uterus and inadequate uterine receptivity is responsible for approximately two-thirds of implantation failures. Endometrial receptivity can be reduced by morphological and/or molec...

متن کامل

Onm-18: Infertility and Pregnancy Outcome in Female Genital Tuberculosis

Background: Tuberculosis of the genital tract is one of the major causes of gynecological morbidity. Genital TB affects about 12% of patients with pulmonary tuberculosis and represents 15-20% of extrapulmonary tuberculosis. Genital TB may be asymptomatic but involves genital organs such as fallopian tubes, endometrium, ovaries, cervix, vulva/ vagina and myometrium. The major presenting symptom ...

متن کامل

Hysteroscopy before the first in vitro fertilization: a 7-year experience from a single center

Objective. This study aims to evaluate the importance of performing hysteroscopy prior to the first attempt of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) by specifying the incidence of intrauterine pathologies and the success of IVF/ICSI cycle. Methods. This is a retrospective review of 357 women who underwent their first cycle of IVF/ICSI treatment during a 7year p...

متن کامل

O-26: The Value of Hysteroscopy in Diagnosis of Chronic Endometritis in Patients with Unexplained Recurrent Spontaneous Abortion

Background: We performed this study in order to investigate the role of chronic endometritis (CE) in unexplained recurrent spontaneous abortion (RSA) and to determine the correlation between hysteroscopic and histologic findings of CE in patients with unexplained RSA. We also tried to find out the relation between CE and primary vs. secondary RSA. Materials and Methods: One hundred and forty-two ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Human reproduction

دوره 30 2  شماره 

صفحات  -

تاریخ انتشار 2015