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New Study on Treatment of Chronic Endometritis after Repeated Pregnancy Loss or Fetal Death

Wednesday, April 9, 2014

Fertility specialists treating women who've had repeated pregnancy loss or a fetal death should consider screening and treating them for chronic endometritis, new research shows. "The endometrial biopsy should be part of a standard diagnostic evaluation for recurrent pregnancy loss or fetal demise" in these women who have a "devastating reproductive history," said principal investigator Dr. Mary D. Stephenson, from the University of Illinois Hospital & Health Sciences System and UIC College of Medicine, in an email to Reuters Health. In what Dr. Stephenson called the first published investigation to determine the prevalence of chronic endometritis as well as the improvement in live birth rates after a course of antibiotics in these women, she and her colleagues conducted an observational cohort study using prospectively collected data. They looked at 395 women with a history of two or more pregnancy losses of under 10 weeks' size or a fetal death of 10 or more weeks' size who were in a program to treat recurrent pregnancy loss.

All women underwent an endometrial biopsy. Those with chronic endometritis - defined by the presence of plasma cells on biopsy - were treated with antibiotics and offered a second endometrial biopsy for a test of cure. Those with persistent chronic endometritis were offered a second course of antibiotics. After treatment with antibiotics, the endometritis cure rate was 100%, the researchers reported online January 24 in Fertility and Sterility. The subsequent cumulative live-birth rate was 88% (21 of 24 women) for those treated for chronic endometritis compared with 74% (180 of 244 women) for those without chronic endometritis.