Efficacy of Hysteroscopy in the Diagnosis if Chronic Endometritis in Infertile Females

Background: Chronic endometritis (CE) is a chronic inflammatory condition characterized by the presence of plasma cells in endometrial stroma. CE is a subtle disease, often overlooked by clinicians due to poor symptomatology, such as uterine bleeding, pelvic discomfort, dyspareunia, and leucorrhoea.

Methods: This cohort prospective study was conducted at Tanta University hospitals aiming to evaluate the efficacy of hysteroscopy in the diagnosis of chronic endometritis in infertile females. We included a total of 80 infertile females who were subjected to complete history taking, general examination, and complete gynaecological investigations. Routine laboratory parameters were also performed. In addition, hysteroscopic examination was performed for all cases with endometrial biopsy.

Results: Our results showed that the mean age of the included cases was 26.6 years (range, 20 – 36), the mean BMI of the included cases was 30.51 kg/m2, Hysteroscopic examination revealed endometrial hyperemia (85.4%), stromal edema (52.1%), and endometrial polyps (43.75%), Hysteroscopic diagnosis of chronic endometritis was established in 48 cases (60%). Nevertheless, pathological examination confirmed the diagnosis only in 33 cases (41.25%), Hysteroscopy had sensitivity and specificity of 81.89 and 55.3% respectively, with an accuracy of 66.25% in detecting chronic endometritis, Agreement between hysteroscopic and pathological had kappa factor of 0.325 (p = 0.004), On immunohistochemical analysis of chronic endometritis specimens, CD138 was positive in 31out of 33 cases (93.93%).

Conclusions: Office hysteroscopy is a reliable examination for investigating chronic endometritis. It could be useful for screening asymptomatic infertile patients. The chronic endometritis is a hidden condition that is difficult to detect with non-invasive examination, we suggest that hysteroscopy should be always performed in the diagnostic work-up of women with unexplained infertility, especially before starting assisted reproduction procedures. Also, endoscopic samples should be obtained during hysteroscopy to increase the diagnostic accuracy.