Chronic endometritis is a chronic inflammation in the uterus that is usually asymptomatic and of polymicrobial etiology. It is a clinical situation that has been ignored and almost missing for many years by the scientific literature, since its scientific documentation and diagnosis has to be based on specific findings of characteristic histopathological markers or microbiological detection of the responsible infectious agent. (Puente et al, Int J Fert Steril 2020 Jan;13(4):250-256). But based on other literature data (Moreno et al. 2018 Jun;218(6):602.e1-602.e16), finding these markers or microbes responsible for chronic endometritis is almost impossible, since the endometrial tissue cultures are able to identify only one infectious agent, whereas in fact many more infectious agents are responsible and conventional biopsies can detect an infectious agent in only 10% of cases.
The diagnosis of chronic endometritis is currently based on clinical criteria, with the hysteroscopic imaging of the endometrium or through electron microscopy. Through the electronic microscopic imaging, a detailed observation of all the layers of the endometrium is made at a particularly high magnification and the visualization of the “pinopodes” is achieved with the “NIKA” examination. Any other attempt to diagnose endometritis, such as cultures or conventional biopsies, run the risk of giving false results and “overlooking” a condition that can unfairly affect the outcome of your IVF attempt, no matter how good the conditions are (Moreno et al. 2018) Jun;218(6):602.e1-602.e16).
Even though it seems really hard to diagnose chronic endometritis, it is even more difficult to treat it, because due to the chronicity of the disease, microbes tend to form “caves” within the endometrial cavity, and therefore they that can’t be easily eliminated by oral antibiotics since they only have very limited access.
After many years of clinical observation and research, our medical group has come to the conclusion that the ideal treatment of chronic endometritis includes oral treatment that targets all possible pathogenic microbes for a long period of at least 2 months and the simultaneous intrauterine administration of an antibiotic that acts locally (Sfakianoudis K, et al. BMC Womens Health. 2018). The latter is an innovative treatment that includes periodic intrauterine injections of antibiotics in the uterus for the same period under painless and aseptic conditions.
Based on our clinical data, the combination of these two antibiotic administration methods is able to reduce the inflammation in 85% of cases of chronic endometritis and thus create the appropriate window of ifection remission in which we aim to have fertility success either naturally, if the conditions are naturally met, or by In Vitro Fertilization.
Finally, it must be highlighted that even after the termination of this treatment there is a risk of a revival of the chronic endometritis and for this reason you will be administered with maintenance treatment until conception is achieved and possibly even during early pregnancy stages.
