Chronic endometritis as a risk factor of infertility: An up-to-date review

Chronic endometritis (CE) is an inflammatory disorder of the endometrium, whose pathogenesis has not been fully elucidated. Although CE may be asymptomatic or it may present with subtle symptoms, it may cause significant adverse outcomes on human reproduction including an increased risk of recurrent miscarriages (RM) and recurrent implantation failure (RIF). The diagnostic procedure includes hysteroscopy with a targeted biopsy from areas suspected of having abnormalities. Histopathological assessment involves the identification of immunohistochemical markers for plasma cells, such as CD138 and MUM-1. The treatment of CE in women with a history of RIF may increase clinical pregnancy rates, implantation rates and ongoing pregnancy rates/live birth rates. It mainly concerns antibiotic therapy, with doxycycline as the first-line treatment. Surgical removal is necessary in cases of lesions such as fibroids, polyps or severe intrauterine adhesions. We aimed to summarize current knowledge in the field of the effective diagnosis and treatment of CE.