We spoke with Dr Shanujeet Kaur, Associate Director, Department of Fertility, Cloudnine Group of Hospitals, Chandigarh, to understand the connection between chronic endometritis and infertility, its possible causes and symptoms, how it may affect conception, and available treatment options.
What Is Chronic Endometritis?
Chronic endometritis is persistent inflammation of the endometrium, the inner lining of your uterus. It is different from endometriosis, a separate condition in which tissue similar to the uterine lining grows outside the uterus.Can Chronic Endometritis Affect Fertility?
There may be a connection between chronic endometritis and fertility problems. Ongoing inflammation can change the environment inside your uterus and may affect how receptive the endometrium is to an embryo.For pregnancy to occur, an embryo needs to attach successfully to the uterine lining. Inflammation may interfere with this process in some patients. This is why chronic endometritis has been investigated as a possible factor in implantation failure, recurrent miscarriage and unexplained infertility.
What Causes Chronic Endometritis?
Several factors may be associated with chronic endometritis.These can include:
- Bacterial infections involving the uterus or reproductive tract
- Previous pelvic infections or sexually transmitted infections
- Recent childbirth, miscarriage or abortion
- Procedures involving the uterus, such as an intrauterine device insertion or uterine instrumentation
- Conditions that allow bacteria to remain within the uterine cavity
- Structural problems inside the uterus, such as polyps, which may sometimes coexist with inflammation
What Are the Symptoms of Chronic Endometritis?
Chronic endometritis can occur without obvious symptoms.When symptoms are present, they may include:
- Irregular or unusual vaginal bleeding
- Spotting between periods
- Bleeding after sexual intercourse
- Unusual vaginal discharge
- Pelvic discomfort or mild lower abdominal pain
- Pain during intercourse
- Difficulty becoming pregnant
- Repeated pregnancy loss in some cases
Who May Be More Likely to Develop Chronic Endometritis?
Certain situations may increase your risk of chronic endometritis, including:- Previous pelvic or reproductive tract infections.
- Recent miscarriage, childbirth or abortion.
- Procedures involving the uterus.
- Previous uterine inflammation.
- Uterine conditions such as polyps.
How Is Chronic Endometritis Diagnosed?
Your doctor may use a combination of your medical history, symptoms and specific tests to check for chronic endometritis.Diagnosis may include:
- Endometrial biopsy: A small sample of your uterine lining is collected and examined for signs of inflammation.
- CD138 testing: This laboratory marker can help identify plasma cells, which may support a diagnosis of chronic endometritis.
- Hysteroscopy: A thin camera is used to look inside your uterus and check for abnormalities.
- Microbial testing: In selected cases, testing may be used to look for microorganisms that could be contributing to inflammation.
How Is Chronic Endometritis Treated?
Treatment depends on what may be causing the inflammation and your individual fertility history.Your doctor may recommend:
- Antibiotics: These may be prescribed when a bacterial infection is suspected or identified.
- Treatment of uterine problems: Polyps or other abnormalities found inside the uterus may need to be treated separately.
- Follow-up testing: In some cases, your doctor may recommend repeat testing to check whether the inflammation has resolved.
- Fertility treatment planning: If you are undergoing IVF or other fertility treatment, your doctor may decide when it is appropriate to proceed after treatment.
Can Treating Chronic Endometritis Improve Fertility?
Treating chronic endometritis may improve fertility outcomes in some patients, particularly when infection or inflammation is successfully treated.Research continues to examine whether identifying and treating CE consistently improves pregnancy and live-birth outcomes. Therefore, while there may be a connection between chronic endometritis and reproductive difficulties, it should be viewed as one possible factor rather than a universal explanation for infertility.
When Should You See a Doctor?
You may want to speak with your doctor if you have:- Difficulty becoming pregnant despite regular attempts
- Repeated miscarriages or implantation failure
- Unusual bleeding or spotting between periods
- Persistent pelvic discomfort or pain
- Unusual vaginal discharge
- A history of miscarriage, childbirth or procedures involving your uterus
- Previous treatment for a uterine or pelvic infection
FAQs on Chronic Endometritis and Infertility: Is There a Connection?
- Can chronic endometritis come back after treatment?
It can recur in some patients, particularly if an underlying cause remains. If you continue to have symptoms or fertility difficulties after treatment, your doctor may reassess you and decide whether additional testing or treatment is needed. - Can chronic endometritis affect your uterine lining thickness?
Chronic endometritis does not always change your endometrial thickness. Your uterine lining may appear normal on an ultrasound even when inflammation is present. Therefore, lining thickness alone cannot confirm or rule out chronic endometritis. - Can chronic endometritis affect embryo transfer timing?
If chronic endometritis is diagnosed before IVF, your fertility specialist may recommend completing treatment before proceeding with embryo transfer. The timing depends on your test results, treatment response and overall fertility plan.