Although assisted reproductive techniques have made considerable progress in recent years, some questions still remain unanswered. The culture media, the embryo selection criteria, the culture process extended to the blastocyst, among others, have improved significantly. However, in patients with a good prognosis and in the best conditions, successful child birth rates are reached around 66%. We do not know many of the factors involved in embryo implantation, and it is quite possible that the uterus plays a more relevant role than it has been considered to up to now.
What is chronic endometritis?
Chronic endometritis is defined as a localised inflammatory condition of the endometrial mucosa, the inner lining of the uterine cavity, it is present in 10-11% of the general population, with a higher frequency in infertile women.
The Cicinelli group in their recent research of 2,190 hysteroscopies, a diagnostic procedure that allows direct visualisation of the cervical canal and the uterine cavity, found that 37% of patients with a hysteroscopic diagnosis of endometritis corresponded to infertile women.
Causes and symptoms of chronic endometritis.
The most common cause of chronic endometritis are common bacteria (streptococcus, coli, enterococcus). It often appears asymptomatic or is present with non-specific symptoms such as pelvic pain, abnormal uterine bleeding, dyspareunia (painful intercourse), leukorrhea (increased vaginal discharge), cystitis, recurrent vaginitis or mild intestinal discomfort to name just a few.
The presence of these bacteria in the uterine cavity produce a series of alterations at different levels:
- Alteration of the population of immune cells involved in embryo implantation, with a greater presence of B lymphocytes.
- Reduction of the presence of Nk cells in the implantation area.
- Increase in the number of antibodies.
- It modifies a series of genes involved in embryo implantation.
- It induces changes in the secretion of various cytokines and other factors involved in endometrial receptivity.
- Causes resistance to progesterone at the endometrial level.
- It modifies the normal pattern of endometrial development.
- Uterine contractility increases in the peri-implantation period.
All these alterations caused by chronic endometritis have a negative impact on the implantation of the embryo, in fact, it is usually associated with implantation failure and repeated miscarriages.
How can chronic endometritis be detected?
Its diagnosis is done by an endometrial biopsy and immunohistochemical study that detects the presence of pathognomonic plasma cells or by hysteroscopy, as we have already mentioned before.
Can a woman with endometritis get pregnant?
Yes, a woman with endometritis can get pregnant!
The treatment is as follows:
To treat chronic endometritis antibiotics are prescribed, the treatment lasts between 10-14 days. Once the course of antibiotics is finished a new biopsy/ hysteroscopy is done to confirm that the inflammation has disappeared. A good response to the antibiotic treatment, according to various studies can lead to a significant improvement in fertility and successful pregnancies in patients.
At Clínica Fertia, we always carry out a medical examination to rule out chronic endometritis in all patients with repeated miscarriages or implantation failure and in those who, due to some symptoms they present, make us think that they may have this pathology and we need to study it further before performing their IVF cycle.
Our extensive experience has shown us that a good medical history is essential to determine what will be the best fertility treatment. Our medical team will study your case personally and create a personalised and tailored treatment plan for you.
Closely reviewing your case and your medical history, together with the latest advances in assisted reproduction that we use in our reproduction clinic in Malaga will be the best tools to help you achieve your dream of becoming a mother.