Research Article

Chronic endometritis in in vitro fertilization failure patients

Afaf T Elnashar* and Mohamed Sabry

Published: 01 December, 2020 | Volume 3 - Issue 2 | Pages: 175-181

Introduction: Chronic endometritis (CE) is a common cause of infertility in asymptomatic patients and its diagnosis and treatments improved assisted reproduction technique outcome in most of the specialized centers. Diagnosis of CE in endometrial biopsy by Hematoxylin and Eosin (H&E) stain is hard to identify chronic inflammatory cells from the stroma and the use of plasma cells-specific stains is helpful.

Aim of the work: Evaluation of the use of CD138 in the identification of plasma cells in endometrial biopsy of patients with previous IVF trial failure.

Material and methods: Hysteroscopic and curettage endometrial biopsies from fifty-five females with previous IVF trial failure were stained with H&E and CD138 immunostaining for detection of plasma cells.

Results: Plasma cells were identified in 52.7% of cases by H&E and in 6/55 by CD138 immunostaining. CD138 is more sensitive in detecting plasma cells in endometrial biopsy than H&E stain. There was a significant statistical correlation between CE and abnormal uterine bleeding, abortion and primary infertility (p > 0.5).

Conclusion: Diagnosis of CE is helpful in infertility patients with IVF trial failure to improve the outcome of the maneuver. CD138 is more sensitive for plasma cells specially in endometrial biopsies than H&E.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001073 Cite this Article Read Full Article PDF


CD138; Syndecan-1; Chronic endometritis; IVF


  1. Fatemi HM, Kasius JC, Timmermans A, van Disseldorp J, Fauser BC, et al. Prevalence of unsuspected uterine cavity abnormalities diagnosed by office hysteroscopy prior to in vitro fertilization. Hum Reprod. 2010; 25: 1959-1965. PubMed: https://pubmed.ncbi.nlm.nih.gov/20570971/
  2. Kasius JC, Fatemi HM, Bourgain C, Sie-Go DMD, Eijkemans RJC, et al. The impact of chronic endometritis on reproductive outcome. Fertil Steril. 2011; 96: 1451-1456. PubMed: https://pubmed.ncbi.nlm.nih.gov/22019126/
  3. Matteo M, Cicinelli E, Greco P, Massenzio F, Baldini D, et al. Abnormal pattern of lymphocyte subpopulations in the endometrium of infertile women with chronic endometritis. Am J Reprod Immunol. 2009; 61: 322-329. PubMed: https://pubmed.ncbi.nlm.nih.gov/19341383/
  4. Cicinelli E, Matteo M, Tinelli R, Pinto V, Marinaccio M, et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014; 21: 640-647. PubMed: https://pubmed.ncbi.nlm.nih.gov/24177713/
  5. Quaas A, Dokras A. Diagnosis and treatment of unexplained infertility. Rev Obstet Gynecol. 2008; 1: 69-76. PubMed: https://pubmed.ncbi.nlm.nih.gov/18769664/
  6. Kasius JC, Broekmans FJM, Sie-Go DM, Bourgain C, Eijkemans MJC, et al. The reliability of the histological diagnosis of endometritis in asymptomatic IVF cases: a multicenter observer study. Hum Reprod. 2012; 27: 153-158. PubMed: https://pubmed.ncbi.nlm.nih.gov/22025228/
  7. O’Connell FP, Pinkus JL, Pinkus GS. CD138 (Syndecan-1) A plasma cell marker, immunohistochemical profile in hematopoietic and non- hematopoietic neoplasms. Am J Clin Pathol. 2004; 121: 254-263. https://pubmed.ncbi.nlm.nih.gov/14983940/
  8. Kitaya K, Yamada H. Pathophysiological roles of chemokines in human reproduction: an overview. Am J Reprod Immunol. 2011; 65: 449–459. PubMed: https://pubmed.ncbi.nlm.nih.gov/21087337/
  9. Kitaya K and Yasuo T. Aberrant expression of Selectin E, CXCL1, and CXCL13 in chronic endometritis. Mod Pathol. 2010; 23:1136–1146. PubMed: https://pubmed.ncbi.nlm.nih.gov/20495539/
  10. Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, et al. Chronic endometritis: Potential cause of infertility and obstetric and neonatal complications. A J Reproductive Immunol. 2016; 75: 13-22. PubMed: https://pubmed.ncbi.nlm.nih.gov/26478517/
  11. Cicinelli E, Resta L, Nicoletti R, Zappimbulso V, Tartagni M, et al. Endometrial micro polyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod. 2005; 20: 1386– 1389. PubMed: https://pubmed.ncbi.nlm.nih.gov/15734762/
  12. Chen YQ, Fang RL, Luo YN, Luo CQ. Analysis of the diagnostic value of CD138 for chronic endometritis, the risk factors for the pathogenesis of chronic endometritis and the effects of chronic endometritis in pregnancy: A cohort study. BMC Women’s Health. 2016; 16: 60. PubMed: https://pubmed.ncbi.nlm.nih.gov/27596852/
  13. Al-Quran SZ, Yang L, Magill JM, Braylan RC, Douglas-Nikitin VK. Assessment of bone marrow plasma cell infiltrates in multiple myeloma: the added value of CD138 immunohistochemistry. Human Pathol. 2007; 38: 1779–1787. PubMed: https://pubmed.ncbi.nlm.nih.gov/17714757/
  14. Florkowski CM. Sensitivity, specificity, receiver-operating characteristic (ROC) curves and likelihood ratios: communicating the performance of diagnostic tests. Clin Biochem Rev. 2008; 29: S83-S87. PubMed: https://pubmed.ncbi.nlm.nih.gov/18852864/
  15. Carvalho FM, Aguiar FN, Tomioka R, de Oliveira RM, Frantz N, et al. Functional endometrial polyps in infertile asymptomatic patients: a possible evolution of vascular changes secondary to endometritis. Eur J Obstet Gynecol Reprod Biol. 2013; 170: 152–156. PubMed: https://pubmed.ncbi.nlm.nih.gov/23773528/
  16. Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, et al. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril. 2010; 93: 437-441. PubMed: https://pubmed.ncbi.nlm.nih.gov/19217098/
  17. Kitaya K. Prevalence of chronic endometritis in recurrent miscarriages. Fertil Steril. 2011; 95: 1156-1158. PubMed: https://pubmed.ncbi.nlm.nih.gov/21030015/
  18. McQueen DB, Benardi LA, Stephenson MD. Chronic endometritis in women with recurrent early pregnancy lose and/ or fetal demise. Fertil Steril. 2014; 101: 1026-1030. PubMed: https://pubmed.ncbi.nlm.nih.gov/24462055/
  19. Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, et al. Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. Fertil Steril. 2008; 89: 677–684. PubMed: https://pubmed.ncbi.nlm.nih.gov/17531993/
  20. Cicinelli F, Matteo M, Tinelli R, Lepera A, Alfonso R, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Human Reprodu. 2015; 30: 323-330. PubMed: https://pubmed.ncbi.nlm.nih.gov/25385744/
  21. Bouet PE, El-Hachem H, Monceau E, Gariepy G, Kadoch IJ, et al. Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: Prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil Steril. 2016; 105: 106-110. PubMed: https://pubmed.ncbi.nlm.nih.gov/26456229/
  22. McQueen DB, Perfello CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril. 2015; 104: 927-931. PubMed: https://pubmed.ncbi.nlm.nih.gov/26207958/
  23. Lewis EI, Brower M, Shamonki M. Treatment of chronic endometritis in women with implantation failure improves implantation in subsequent embryo transfers. Fertil Steril. 2013; 100: S390.
  24. Bayer-Garner IB, Korourian S. Plasma cells in chronic endometritis are easily identified when stained with syndecan-1. Modern Pathol. 2001; 14: 877-879. PubMed: https://pubmed.ncbi.nlm.nih.gov/11557783/
  25. Kannar V, Lingaiah HKM, Sunita V. Evaluation of endometrium for chronic endometritis by using syndecan-1 in abnormal uterine bleeding. J Laboratory Physician. 2012; 4: 69-73. PubMed: https://pubmed.ncbi.nlm.nih.gov/23440678/
  26. Hartman SK, Symons WA, Yeh T. Chronic endometritis: How many plasma cells does it take to make the diagnosis? FASEB. 2011; 25: 1002-1013


Figure 1

Figure 1

Figure 1

Figure 2

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?