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Antibiotic treatment of chronic endometritis seems to preserve pregnancy in women with recurrent miscarriages or recurrent implantation failure
20 September 2018 (online)
Investigation and treatment options for women with recurrent miscarriages (RM ≥3 consecutive miscarriages) and recurrent implantation failures (RIF ≥6 top quality embryos transferred) are limited. It has been shown that 27 – 56% of women with RM and 14 – 66% of women with RIF suffer from chronic endometritis (CE). The aim of this study was to analyze incidence, diagnosis and treatment of CE and to improve thereby the chances for successful pregnancy.
Women in therapy for RM or RIF at the Bern University Hospital from 2016 – 2017 were examined by diagnostic hysteroscopy. In case of plasma cells in the endometrial biopsy and a positive immunohistochemical analysis of CD 138, women were treated with doxycyclin 100 mg twice daily for two weeks. Afterwards time to implantation and on-going pregnancy were analyzed.
A total of 47 women were identified; 14 (60.8%) of 23 with RM and 12 (50%) of 24 with RIF were diagnosed positive for chronic endometritis without other risk factors for implantation failure. After antibiotic treatment 38.5% (10/26) of all women with CE achieved a clinical and 27% (7/26) an on-going (> 24 weeks) pregnancy up to now.
Treatment possibilities in women suffering from RM or RIF are poor. This minimal invasive investigation by diagnostic hysteroscopy with endometrial biopsy and subsequent antibiotic treatment in suspected CE would be easy to implement in daily practice. The positive reproductive effect shown in this small study seems promising.