Chronic Endometritis: A Silent Cause of Infertility and Miscarriage

Monday, November 18, 2019
Chronic Endometritis: A Silent Cause of Infertility and Miscarriage

What is Endometritis?

Endometritis essentially means an inflammation of the uterine lining. It is a completely different condition from endometriosis and is usually caused by certain pathogen bacteria climbing up a woman’s reproductive tract and infecting the uterine endometrium, which should otherwise be a sterile environment. 

Bacterial pathogens that are frequently associated with endometritis are Gonorrhea, Chlamydia, Enterococcus, Streptococcus, Staphylococcus, Mycoplasma, Ureaplasma and Enterobacteriaceae. They may be introduced into the uterus during vaginal birth, C-section surgery, transcervical procedures like hysteroscopy, HSG, IUI and IVF or when the immune system cannot contain a vaginal infection and it ends up infecting the cervix and uterus. Very rarely, even a fungal infection like Candida may end up reaching and colonizing the uterine lining.

Endometritis can present as either acute (when the symptoms develop rapidly and are quite obvious) or chronic (the symptoms develop gradually over a longer period of time and may even be missing entirely).

What are the symptoms of chronic endometritis?

Although both acute and chronic endometritis can cause infertility and recurrent miscarriage, chronic endometritis is particularly elusive and easily overlooked, since its symptoms can be extremely subtle. Chronic endometritis causes a persistent low-grade inflammatory response which is largely asymptomatic but generates an unfriendly environment for a pregnancy to implant and thrive in.

When the infection does show signs, they typically consist of pelvic discomfort, abnormal vaginal bleeding and/or an unusual vaginal discharge. In the vast majority of cases through, chronic endometritis is a silent condition. In fact, up until recently, the medical community used to largely ignore chronic endometritis altogether believing it was a benign and inconsequential condition. Latest research however shows it can have a strong negative impact on fertility outcomes.

According to recent medical studies, the prevalence of chronic endometritis in women who suffer from infertility and recurrent pregnancy loss ranges from 14% to 58%. This is a shockingly high percentage, given that most infertile women do not routinely undergo any diagnostic tests to check for this disease.

How do I know if I have chronic endometritis?

The most reliable diagnostic procedure for chronic endometritis is having an endometrial biopsy with histologic analysis, which when positive will show plasma cells in the endometrial stroma. Plasma cells in the stroma are the diagnostic marker of chronic endometritis. An endometrial culture is usually performed alongside the biopsy, to help identify the exact bacteria which is causing the infection.

Occasionally, endometritis can also be noticed with the naked eye when undergoing a hysteroscopy. 

Can I become pregnant after treating endometritis?

The good news is that targeted antibiotic treatment is highly effective in curing this condition, with quick resolution of the inflammation and subsequent pregnancy success in many women treated. When dealing with a stubborn infection, the antibiotic treatment can be repeated up to 3 times or a different antibiotic may be used that is more effective. More recently, intrauterine antibiotic infusions have been showing promise in curing the more relentless of cases.

Are you suffering from infertility or repeated miscarriage, but no cause has yet been discovered despite extensive testing? Ask your doctor about having an endometrial biopsy with histological analysis and an endometrial culture. You may be surprised to find an antibiotic course could restore your fertility.