Evaluating Chronic Endometritis in Women with Recurrent Implantation Failure and Recurrent Pregnancy Loss by Hysteroscopy and Immunohistochemistry

Abstract

The 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. Design: A cross-sectional study.

In women with chronic or subclinical endometritis is hysteroscopy suitable for setting the diagnosis? A systematic review

“…Sixteen studies were selected in full text as potentially suitable for inclusion. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] One study was subsequently excluded:…”

“…In one study of Cicinelli et al, 12 details of confirmation are not available. In some studies where histologic confirmations were used, immunohistochemistry (IHC) staining was applied and the pathologists set the diagnosis of CE in the presence of five or more plasma cells in endometrium stroma in high power fields, 10,14,20 while in others traditional hematoxylin and eosin (H&E) staining was performed. 9,15,16,22 In one case, double-blind pathologist assessment was used in order to minimize the risk of bias 18 ( Table 2).…”

“…7,18 In women suffering from infertility, common hysteroscopic findings suggestive of CE are micropolyps, usually located near endocervix and strawberry effect, meaning hyperemia with a white central point, localized or scattered throughout the cavity. 9,[13][14][15]19 In terms of histologic confirmation of CE, Cicinelli et al, 6 using CD-138 immunoreactivity, specific for inflammation, suggested the positive for CD-138 Endometrial polyps were not always correlated with CE, meaning that the common pattern of inflammation in both CE and endometrial polyps potentially links the presence of endometrial polyps with CE, but implies. 6 A number of studies found histology with CD-138 to be superior of conventional histology, meaning plain identification of plasma cells in an endometrial biopsy.…”

“…More specifically, seven studies 6,8,9,[16][17][18][19] had a low risk of selection criteria, because they had used appropriate method of random sequence generation. There were four studies of unclear risk of bias, [11][12][13][14] since the method was not reported and four with high risk of selection criteria, as retrospective studies. 7,11,20 Three studies 6,7,11 were judged to be at low risk of selection bias for the use of an adequate method of allocation concealment.…”

Recurrent Pregnancy Loss: Investigations and Interventions

“…A diagnostic video hysteroscopy can help identify CE, with direct visualization of the endometrial cavity, which usually presents with mucosal edema, focal or diffuse endometrial hyperemia, or micropolyps. 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 [61].…”