Transcription
Hi, I'm Dr. Sara, scientific director with Zea Fertility Centers.
Chronic endometritis, or CE, is persistent inflammation of the endometrium, which is the inner lining of the uterus. Unlike acute endometritis, which is typically associated with more severe symptoms and often linked to recent pregnancy or pelvic inflammatory disease, chronic endometritis is usually asymptomatic or presents with subtle symptoms, making it very challenging to diagnose. It is characterized by the presence of plasma cells in the endometrial stroma, which are not normally found in the endometrial tissue.
Let's look at the causes of chronic endometritis. The exact etiology of chronic endometritis is not always clear, but several potential causes have been identified.
Like infection, chronic endometritis can result from low-grade infections caused by bacteria, including E. coli, Enterococcus, Mycoplasma, Ureaplasma, and Chlamydia trachomatis. These infections may be subclinical, without causing noticeable symptoms.
Use of IUD (intrauterine device) also can cause chronic endometritis. The use of an IUD can sometimes lead to chronic endometritis due to irritation or infection.
Previous pelvic inflammatory disease. A history of PID can predispose women to developing chronic endometritis.
Endometrial procedures also can be a cause. Surgical intervention, such as hysteroscopy, dilation and curettage, or endometrial biopsy, can introduce bacteria into the uterus, potentially leading to chronic endometritis.
Recurrent miscarriage or implantation failure. Women with a history of unexplained recurrent pregnancy loss or implantation failure may have undiagnosed chronic endometritis.
So, what are the symptoms? Often, chronic endometritis is asymptomatic or presents with non-specific symptoms, which may include abnormal uterine bleeding, such as intermenstrual spotting or postcoital bleeding; mild and chronic pelvic pain; unusual or persistent vaginal discharge. Many women with chronic endometritis may also not experience noticeable symptoms, and the condition is often discovered during investigations for infertility or recurrent pregnancy loss.
So, how do we do the diagnosis for chronic endometritis? The gold standard for diagnosing chronic endometritis is identifying plasma cells in the endometrial biopsy sample. Immunohistochemical staining for CD138, a plasma cell marker, can improve diagnostic accuracy. Culturing endometrial samples may identify bacterial pathogens, although this is not routinely done due to the complexity and potential contamination issues. Hysteroscopy also allows direct visualization of the endometrium and may reveal signs of inflammation, such as micro-polyps, stromal edema, or hyperemia.
The role of CE in implantation failure should also be discussed. It can have a significant impact on fertility, particularly regarding implantation failure.
Let's look at the mechanisms. Endometrial receptivity to embryo implantation can be compromised by the inflammatory environment caused by chronic endometritis. Inflammatory cytokines and other immune factors may affect the endometrial lining and its normal function, making it less receptive to implantation.
Immune balances. Chronic endometritis may disrupt the delicate immune balance required for successful implantation and early pregnancy maintenance. An abnormal immune response can lead to rejection or expulsion of the embryo. The presence of inflammatory mediators and possibly pathogens can create an embryotoxic environment, reducing the likelihood of successful embryo implantation and growth.
So, what are the treatment options? The primary treatment for chronic endometritis is antibiotics, which looks at eradicating the underlying infections. Broad-spectrum antibiotics, such as doxycycline, metronidazole, or combination therapy, depending on the suspected or confirmed pathogens, are usually given. Follow-up testing is very important and recommended to ensure the infection and inflammation have resolved. And in cases where chronic endometritis is associated with infertility or recurrent implantation failure, treating the condition has been shown to improve reproductive outcomes, including pregnancy rates.
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