New biopsy after antibiotic treatment: effect on outcomes of assisted reproduction in patients with infertility and chronic endometritis

• Published in: Reproductive biomedicine online 2022-12, Vol.45 (6), p.1167-1175
• Main Authors: Liu, Wen-juan, Huang, Ju, Sun, Li, Huang, Li, Zhang, Qian-yu, Nong, Ying-qi, Wei, Jia-hui, Wu, Kun-he, Liu, Feng-hua
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotic therapy; Biopsy; Chronic endometritis; Doxycycline - therapeutic use; Endometrial biopsy; Endometritis - complications; Endometritis - drug therapy; Female; Humans; Infertility; Male; Pregnancy; Pregnancy outcome; Reproduction; Semen
• ISSN: 1472-6483; 1472-6491
• DOI: 10.1016/j.rbmo.2022.07.020

•Doxycycline-treated women with CE and infertility were re-examined•The endometrial re-examination did not affect pregnancy outcomes•The 1st doxycycline treatment cycle improved outcomes in women with CD138+/HPF≥5•Multiple endometrial biopsies are not required for some CE patients What is the effect of chronic endometritis on patients with infertility, the necessity of endometrial re-examination and the effect of improving chronic endometritis after one cycle of antibiotic treatment on pregnancy outcomes? Infertile patients (n = 4003) who underwent IVF and intracytoplasmic sperm injection treatment were included. Pregnancy outcomes of groups positive for chronic endometritis were compared with groups that were negative (group 1). Patients that were positive were divided into the chronic endometritis new biopsy group (group 2) and chronic endometritis non-re-examination group (group 3). After doxycycline treatment and re-examination, the chronic endometritis new biopsy group was divided into improved chronic endometritis group (ICE) and not-improved chronic endometritis group (NICE), and their general indicators and reproductive outcomes were compared. No significant difference was observed in embryo implantation, early or late pregnancy loss, ectopic pregnancy, clinical pregnancy and live birth rates between groups 2 and 3. The clinical pregnancy and live birth rates in the NICE group were significantly lower than those in the ICE group (P = 0.008 and P = 0.001, respectively). After controlling for potential confounding factors, age, average number of high-quality embryos, endometrial thickness on the day of embryo transfer and number and type of embryo transfer were factors associated with live birth rates. Endometrial re-examination of women with chronic endometritis treated with doxycycline had no effect on pregnancy outcomes. The first cycle of doxycycline treatment could effectively improve reproductive outcomes of women with five or more CD138+ cells/high-power field.