Role of CD 138 for the diagnosis of chronic endometritis in unexplained infertility and recurrent pregnancy loss

Background: Chronic endometritis (CE) is persistent inflammation of the endometrium in response to bacterial infection, which may be mostly asymptomatic. However, patients may present with pain abdomen, abnormal uterine bleeding, pelvic discomfort, leukorrhea and dyspareunia. In this study, we have compared the role of hysteroscopy and CD 138 IHC for the diagnosis of CE in unexplained infertility and RPL. We have also studied the reproductive outcome following cure of CE with antibiotics. Methods: A prospective study, recruiting 107 participants, was carried out in the department of reproductive medicine and surgery at Mahatma Gandhi hospital, Jaipur, India. The study duration was between September 2022 and April 2024, including 8 months follow up. Results: The mean age of the patients in unexplained Infertility group was 34.4±4.9 years (range, 25-41 years) and in RPL group was 33.7±3.9 years (range, 20-40 years). Out of the total 107 patients, 75 patients presented with unexplained infertility and 32 presented with RPL. Conclusions: It was found that both hysteroscopy and immunohistochemical analysis of CD138 cells are equally effective to diagnose CE. While hysteroscopy can be used to obtain a guided biopsy, from the most suspicious areas, it is an invasive procedure and diagnosis is observer dependent.