Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review

Giovanni Buzzaccarini, Amerigo Vitagliano, Alessandra Andrisani, Carla Mariaflavia Santarsiero, Rossana Cicinelli, Claudia Nardelli, Guido Ambrosini, Ettore Cicinelli
In: Journal of Assisted Reproduction and Genetics · 2020 · vol. 37(12) , pp. 2897–2911 · doi:10.1007/s10815-020-01955-8 · W3091999973
review OA: hybrid CC0 ⤵ 17 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This systematic review proposes that chronic endometritis, driven by infection and an inflammatory response, impairs embryo implantation by disrupting decidualization, vascularization, and uterine contractility.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper is a systematic review that synthesized evidence from 15 original human studies on the pathophysiology linking chronic endometritis (CE)—diagnosed histologically by stromal plasma cells—to impaired embryo implantation and infertility in IVF/ICSI contexts. Across included studies using hysteroscopy and endometrial biopsy (often in the follicular phase), the authors report that CE is associated with an infectious etiology leading to characteristic cytokine/leukocyte patterns, altered immune balance, impaired decidualization, and disrupted endometrial vascularization (including irregular vessel density and luminal thickening/thrombosis) as well as possible changes in uterine wave propagation affecting embryo–decidua contact. A stated limitation is that the review aggregates heterogeneous original studies and mechanisms, and it identifies that noninvasive sampling (e.g., vaginal/endocervical cultures) shows low concordance with endometrial findings. Relevance to endometriosis: while the paper is primarily about chronic endometritis and embryo implantation, it is included in this corpus because pelvic inflammation and reproductive failure pathways are often examined alongside endometriosis/adenomyosis-related implantation impairment.

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Abstract

Abstract Purpose Chronic endometritis (CE) is a frequent hysteroscopic and histological finding which affects embryo transfer implantation during IVF-ICSI cycles. In particular, CE impairs proper decidualization and, subsequently, implantation. Although this correlation has been clearly clarified, a pathophysiological explanation assembling all the studies performed has not been elucidated yet. For this reason, we have structured a systematic review considering all the original articles that evaluated a pathological element involved in CE and implantation impairment. Methods The authors searched electronic databases and, after screening, collected 15 original articles. These were fully scanned and used to create a summary pathway. Results CE is primarily caused by infections, which lead to a specific cytokine and leukocyte pattern in order to prepare the uterus to fight the noxa. In particular, the immunosuppression requested for a proper semi-allogenic embryo transfer implantation is converted into an immunoreaction, which hampers correct embryo implantation. Moreover, endometrial vascularization is affected and both irregular vessel density and luminal thickening and thrombosis reduce what we have first identified as endometrial flow reserve. Finally, incorrect uterine wave propagation could affect embryo contact with decidua. Conclusion This is the first summary of evidence on CE pathophysiology and its relationship with infertility. Understanding the CE pathophysiology could improve our knowledge in embryo transfer success.

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Condition tags

infertilitydisambig:endometritis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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