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Can Chronic Endometritis Be the Missing Link in IVF Failure Cases

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by

Vishnu
in

Introduction

Chronic endometritis (CE), an often overlooked uterine condition, may hold the key to unlocking fertility challenges for women experiencing repeated IVF failures. This condition, characterized by subtle inflammatory changes in the endometrial lining, can go undetected in routine fertility assessments. A recent clinical study conducted at Sohag University in Egypt offers new insight into the diagnostic value of CD138 staining for detecting CE in patients with failed IVF attempts.

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Understanding the Study Key Takeaways

  • Research Focus: The study aimed to evaluate CD138 (Syndecan-1) as a sensitive marker for identifying plasma cells in endometrial biopsies of women with prior IVF failures.
  • Sample: 55 women aged 18–45 with previous IVF failure were examined using hysteroscopy and biopsies.
  • Findings:
    • CE was diagnosed in 52.7% of cases using H&E staining and in 10.9% using CD138 immunostaining.
    • CD138 proved more sensitive but less specific than H&E.
    • A significant correlation was observed between CE and abnormal uterine bleeding, abortion history, and tubal infertility (p < 0.05).

Why CD138 Matters in Diagnosis

CD138 is a transmembrane protein highly expressed in plasma cells. Detecting its presence helps pathologists distinguish chronic inflammation in the endometrium, especially in asymptomatic cases. Plasma cells often elude detection via standard H&E staining due to phase-related changes in the endometrium, making CD138 a valuable immunohistochemical marker.

The Broader Implications: Fertility and Diagnosis

The American Society for Reproductive Medicine (ASRM) recognizes the role of chronic endometritis in reproductive failure, particularly in patients with unexplained infertility or recurrent implantation failure. Routine screening for CE could enhance IVF outcomes by enabling targeted antibiotic therapy and uterine preparation.

Microbial Links and Treatment Potential

CE is associated with microbial infiltration involving common bacteria Streptococcus, E. coli), and sometimes fungal and viral agents. Treatment with appropriate antibiotics has shown promising results in improving IVF success rates. This aligns with findings in the study where CE resolution improved outcomes in follow-up IVF attempts.

Diagnostic Advancements:

Further Reading and Resources

Read the full study at: https://doi.org/10.29328/journal.cjog.1001073

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