Associations of hysteroscopic features of chronic endometritis with pregnancy outcomes of in vitro fertilization: A retrospective study

Abstract

The impact of the hysteroscopic features of chronic endometritis (CE) on pregnancy outcomes is unclear. This study explored whether the morphological features of CE on hysteroscopy were associated with in vitro fertilization (IVF) pregnancy outcomes. This retrospective study was conducted at Yantai Yuhuangding Hospital from 01/2017 to 09/2018. Infertile women who underwent hysteroscopy before IVF were grouped according to CE. To decrease confounding, a group of standardized patients was selected from the women enrolled in this study to compare pregnancy outcomes between the CE and non-CE groups. The outcomes were clinical pregnancy rate (CPR), live birth rate (LBR), miscarriage rate, and premature birth rate. In this study, 3280 women underwent IVF, and 3179 of these patients underwent hysteroscopy. In standardized patients, significant differences were found between the CE and non-CE groups in CPR (54.3% vs. 65.6%, P=0.02) and LBR (45.7% vs. 58.3%, P=0.012). In patients who underwent fresh embryo transfer, CPR differed among groups (P=0.002) and was highest in the hemorrhagic spots group (61.7%). In patients who underwent frozen embryo transfer (FET), CPR was higher in the CE group than in the non-CE group (54.7% vs. 43.0%, P<0.001), highest in the hemorrhagic spots group (70.6%, P=0.002) and lowest in the hyperemia combined with micropolyps group (39.4%, P=0.022). The only factor independently associated with CPR was hysteroscopic features of CE (odds ratio: 1.47, 95% confidence interval: 1.21–1.80, P<0.001). Hysteroscopic features of CE are associated with adverse pregnancy outcomes after IVF.