The Use of Endometrial Culture For Targeted Treatment of Endometritis in Patients Experiencing Infertility and Recurrent Pregnancy Loss

Aims: To evaluate whether endometrial culture in addition to endometrial biopsy reduces time to clear chronic endometritis (CE) and fewer endometrial biopsies in patients experiencing infertility and recurrent pregnancy loss (RPL). Methods: This retrospective cohort study was performed at an academic tertiary care facility. We included patients (N=92) with endometritis (defined as either endometritis on pathologic evaluation or 5 plasma cells per high power field) who were evaluated in the reproductive infertility and endocrinology clinic for infertility or RPL from March 2018 to January 2022. In March 2021, the clinic implemented routine use of endometrial culture in addition to endometrial biopsy as part of the evaluation of infertility or RPL. We hypothesized that treatment of specific endometrial pathogens with reported sensitivities to antibiotics would result in a reduction in length of treatment to clear CE and fewer number of biopsies per patient. Patients evaluated prior to March 2021 with only endometrial biopsy (n=46) were compared to patients evaluated after March 2021 with endometrial culture in addition to endometrial biopsy (n=46). Patients who did not follow up to evaluate for clearance of endometritis were excluded from the study. Mean time to clearance and average number of biopsies were compared via student’s t-test. Results: The mean time needed to clear chronic endometritis in the endometrial biopsy only cohort was 73.1 days, while the average time needed in the endometrial culture plus endometrial biopsy cohort was 51.4 days (p=0.018). The average number of biopsies per patient in the endometrial biopsy only cohort was 2.89, while the average number of biopsies in the endometrial culture plus endometrial biopsy cohort was 1.98 (p=0.00001). Conclusion: Endometrial culture in addition to endometrial biopsy leads to a statistically significant decreased time to treat patients with CE and significantly fewer endometrial biopsies required per patient. Endometrial culture is a diagnostic tool that could reduce time needed to treat CE by targeting specific pat