Pathophysiology of Chronic Endometritis

Jacqueline Chung Pui Wah, Judy Zhang Tao, Tin Chiu Li
In: Early Pregnancy · 2025 · pp. 13–21 · doi:10.1017/9781009532549.004 · W4409452465
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This chapter reviews chronic endometritis, a condition linked to implantation failure and pregnancy loss, discussing diagnostic challenges, the role of plasma cells, and potential improvements through hysteroscopy, culture, and immunohistology, alongside antibiotic treatment's impact on pregnancy outcomes.

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This book chapter reviews chronic endometritis (CE), focusing on its proposed association with recurrent implantation failure, recurrent miscarriage, and fetal demise, and describing the major challenges in diagnosing CE. It highlights that the endometrium contains multiple stromal cell types, so identifying plasma cells (often via immunohistochemistry) is essential, while the optimal timing of endometrial biopsy and the best diagnostic evaluation approach remain uncertain; it also notes that hysteroscopy and endometrial culture can support diagnosis and antibiotic selection, and that antibiotic therapy has been associated with improved pregnancy outcomes despite no established ideal regimen. A major limitation explicitly emphasized is the lack of consensus on diagnostic timing and the absence of a standardized, optimal treatment regimen. This paper is centrally about endometriosis — it is focused on chronic endometritis, an inflammatory endometrial condition discussed in the broader early-pregnancy and reproductive-failure context relevant to endometriosis-related infertility and pregnancy complications.

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- Early Pregnancy - Early Pregnancy - Copyright page - Contents - Preface to Third Edition - Contributors - Chapter 1 Novel 3-D Imaging Techniques in Early Pregnancy - Chapter 2 What Is Endometrial Receptivity? - Chapter 3 Pathophysiology of Chronic Endometritis - Chapter 4 Clinical Management of Chronic Endometritis in Recurrent Pregnancy Loss - Chapter 5 Implantation - Chapter 6 Early Placental Development and Disorders - Chapter 7 The Uncertain Science of Preimplantation Genetic Testing for Reproduction - Chapter 8 Thyroid Physiology and Early Pregnancy - Chapter 9 Early Pregnancy Core Outcomes - Chapter 10 Thyroid Treatment Trials - Chapter 11 Müllerian Duct Development, Diagnosis and Management of Anomalies - Chapter 12 Candidate Genes in Pregnancy Loss - Chapter 13 Inherited Thrombophilia - Chapter 14 Guidelines on the Diagnosis and Management of Sporadic Miscarriage - Chapter 15 Investigation of Recurrent Pregnancy Loss - Chapter 16 Talking with Patients about Pregnancy Loss - Chapter 17 Psychological Support after Pregnancy Loss - Chapter 18 Tubal Ectopic Pregnancy and Pregnancy of Unknown Location - Chapter 19 Medical Management of Tubal Pregnancy - Chapter 20 Candidate Biomarkers for Prediction of Pregnancy Location and Viability - Chapter 21 Diagnosis and Management of Extrauterine Pregnancies - Chapter 22 Ultrasound to Diagnose and Predict Early Pregnancy Outcome - Chapter 23 Molar Pregnancy - Chapter 24 COVID and Early Pregnancy - Chapter 25 Obstetric and Perinatal Outcome after Assisted Reproductive Technology Pregnancy Events and Complications - Chapter 26 Obesity and Early Pregnancy - Chapter 27 Dynamic Prediction Models for Recurrent Pregnancy Loss - Chapter 28 Pregnancy Loss: From Cytogenetics to Genomics - Chapter 29 Progesterone Use in Early Pregnancy - Index - Plate Section (PDF Only) - References Published online by Cambridge University Press: 16 April 2025 Book contents - Early Pregnancy - Early Pregnancy - Copyright page - Contents - Preface to Third Edition - Contributors - Chapter 1 Novel 3-D Imaging Techniques in Early Pregnancy - Chapter 2 What Is Endometrial Receptivity? - Chapter 3 Pathophysiology of Chronic Endometritis - Chapter 4 Clinical Management of Chronic Endometritis in Recurrent Pregnancy Loss - Chapter 5 Implantation - Chapter 6 Early Placental Development and Disorders - Chapter 7 The Uncertain Science of Preimplantation Genetic Testing for Reproduction - Chapter 8 Thyroid Physiology and Early Pregnancy - Chapter 9 Early Pregnancy Core Outcomes - Chapter 10 Thyroid Treatment Trials - Chapter 11 Müllerian Duct Development, Diagnosis and Management of Anomalies - Chapter 12 Candidate Genes in Pregnancy Loss - Chapter 13 Inherited Thrombophilia - Chapter 14 Guidelines on the Diagnosis and Management of Sporadic Miscarriage - Chapter 15 Investigation of Recurrent Pregnancy Loss - Chapter 16 Talking with Patients about Pregnancy Loss - Chapter 17 Psychological Support after Pregnancy Loss - Chapter 18 Tubal Ectopic Pregnancy and Pregnancy of Unknown Location - Chapter 19 Medical Management of Tubal Pregnancy - Chapter 20 Candidate Biomarkers for Prediction of Pregnancy Location and Viability - Chapter 21 Diagnosis and Management of Extrauterine Pregnancies - Chapter 22 Ultrasound to Diagnose and Predict Early Pregnancy Outcome - Chapter 23 Molar Pregnancy - Chapter 24 COVID and Early Pregnancy - Chapter 25 Obstetric and Perinatal Outcome after Assisted Reproductive Technology Pregnancy Events and Complications - Chapter 26 Obesity and Early Pregnancy - Chapter 27 Dynamic Prediction Models for Recurrent Pregnancy Loss - Chapter 28 Pregnancy Loss: From Cytogenetics to Genomics - Chapter 29 Progesterone Use in Early Pregnancy - Index - Plate Section (PDF Only) - References This book chapter provides an overview of chronic endometritis (CE), a condition which is increasingly recognized as being associated with recurrent implantation failure, recurrent miscarriage, and fetal demise. The diagnosis of CE is challenging due to the presence of various cell types in the endometrial stroma, making the identification of plasma cells essential. The optimal timing and diagnostic evaluation of endometrial biopsy are still being researched, while immunohistological staining may improve the identification of plasma cells. Hysteroscopy and endometrial culture may also aid in diagnosis and guide antibiotic selection. Although antibiotic treatment has shown improved pregnancy outcomes in cases of CE, there is no established ideal regimen. Overall, this chapter provides valuable information on CE and highlights the need for continued research to improve diagnosis and treatment. - Type - Chapter - Information - Early Pregnancy , pp. 13 - 21Publisher: Cambridge University PressPrint publication year: 2025 Greenwood, S. M., Moran, J. J.. Chronic endometritis: morphologic and clinical observations. 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Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis. Fertil Steril. 2018;110(1):103–12e1.CrossRefGoogle Scholar Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. 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