Evaluating Chronic Endometritis in Women with Recurrent Implantation Failure and Recurrent Pregnancy Loss by Hysteroscopy and Immunohistochemistry |
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| Affiliation: | 1. Fertility, Infertilty and Perinatology Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Drs. Zargar, Ghafourian, Nikbakht, and Hosseini);2. Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Dr. Zargar);3. Research Center for Thalassemia and Hemoglobinopathy, Ahvaz, Iran (Dr. Choghakabodi);1. Department of Obstetrics and Gynecology, School of Medicine, Cheeloo College of Medicine, Shandong University (Drs. Liu, Kong, Lv, and Yan);2. Center for Reproductive Medicine, Reproductive Hospital affliated to Shandong University, Cheeloo College of Medicine, Shandong University (Drs. Liu, Song, F. Zhang, Kong, Lv, and Yan);3. Department of Pathology, Shandong Provincial Hospital (Dr. Li), Shandong University, Jinan;4. National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Drs. Liu, Song, F. Zhang, Kong, Lv, and Yan);5. The Key Laboratory for Reproductive Endocrinology Ministry of Education, Jinan (Drs. Liu, Song, F. Zhang, Kong, Lv, and Yan);6. Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, (Drs. Liu, Song, F. Zhang, Kong, Lv, and Yan);7. Department of Reproductive Medicine, People''s Hospital of Rizhao, Rizhao, (Dr. Liu);8. Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Maternal and Child Health Care Hospital of Shandong Province, Shandong University, Jinan (Dr. L. Zhang), Shandong, China.;1. Clinical Division of Gynecologic Endocrinology and Reproductive Medicine (Drs. Holzer, Ott, Kurz, Hager, and Kuessel);2. Clinical Department of Pathology (Dr. Hofstetter), Medical University of Vienna, Vienna, Austria;3. Parryscope and Positive Steps Fertility, Madison (Dr. Parry);4. Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson (Dr. Parry), Mississippi |
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| Abstract: | Study ObjectiveThe identification of less invasive methods with acceptable diagnostic value for evaluating intrauterine abnormalities can improve the satisfaction of patients and physicians. Although hysteroscopy plus biopsy has favorable predictive and diagnostic values, limited studies have evaluated its value, and the exact value of this method is not completely understood. The aim of this study was to evaluate the prevalence of chronic endometritis in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) by hysteroscopy and immunohistochemistry.DesignA cross-sectional study.SettingAn infertility clinic at Jundishapur University Hospital, Ahvaz, Iran.PatientsWomen with RIF after IVF and RPL.InterventionsHysteroscopy on the third to fifth day after finishing the menstruation cycle and then a biopsy for immunohistochemistry by a specific monoclonal antibody against the CD138 marker.Measurements and Main ResultsIn total, 85 patients with a mean age of 36.08 ± 5.76 years underwent hysteroscopy on the third to fifth day after finishing the menstruation cycle. At the end of hysteroscopy, a biopsy was taken and assessed using immunohistochemistry by a specific monoclonal antibody against the CD138 marker. Immunohistochemical staining findings of >5 plasma cells per 20 high-power fields were considered the gold standard. The prevalence of chronic endometritis (CE) in both groups and the diagnostic value of hysteroscopy were evaluated. All data were analyzed using the Fisher exact test and analysis of variance. The prevalence of RIF-related CE was 23.4% (11); 21.3% (10) of the cases were diagnosed by hysteroscopy. The prevalence of RPL-related CE was 36.8% (14) and 31.6% (12) based on hysteroscopy and immunohistochemistry staining, respectively. Subsequently, 10 patients (RIF/RPL-related CE with a positive hysteroscopic outcome) were selected randomly for in vitro fertilization therapy, and 3 (30%) of them eventually became pregnant. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy in diagnosing CE were 86.36%, 87.30%, 70.37%, and 94.82%, respectively.ConclusionHysteroscopy is a reliable diagnostic technique in patients with RIF after in vitro fertilization and RPL that can reliably diagnose chronic endometritis. |
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