Endometritis in infertile couples: The role of hysteroscopy and bacterial endotoxin

Abstract

Objective: The role of endometritis on infertility is still controversial. The aim of our prospective controlled study was to select infertile couples and to analyze: hysteroscop-ic fndings of endometritis, bacterial endotoxin level in the menstrual blood, histological pattern of endometrial biopsy and to determine the effect of antibiotic therapy on endo-metritis resolution. Methods: 100 infertile couples of University Hospital waiting for in vitro fertilization program. We evaluated the incidence of endometritis in infertile population by hysteros-copy, endometrial biopsy and bacterial endotoxin levels in the menstrual samples. Moreover, we verifed the effectiveness of antimicrobial treatment on the endometritis resolution by hysteroscopic control. Results: Out of 100 women enrolled, 15 showed hystero-scopic evidence of endometritis and 12 of these patients presented higher bacterial endotoxin in the menstrual samples. The histological results were positive for endo-metritis in 9 cases, 1 woman had no adequate samples and 5 patients had negative result. After antibiotic therapy, 9 patients had a complete hysteroscopic endometritis resolution, 4 patients had an improvement and in 2 cases there was no endometrial change. Concerning histological fndings after therapy, we had negative results in 12 patients and persistent infammatory fndings in 2 patients. Conclusion: Our study demonstrated a high incidence of endometritis in infertile couples (15%). The endometrial biopsy was in agreement with the hysteroscopic fndings in 60% of the cases, and the bacterial endotoxin level in the menstrual samples was higher in 12 patients with suspected endometritis, then its measurement can be helpful to confrm an endometrial infection but its infuence must be confrmed with further researches. The antibiotic therapy can improve the hysteroscopic endometrial infammatory aspect in over 80% of cases.