Does chronic endometritis affect pregnancy outcomes in patients with endometriosis associated infertility? A retrospective cohort study

Shunhe Lin, Xi Xie, Yi-Shan Chen, Penghui Huang, Jinna Zhang, Chaobin Liu, Guan Ning Lin, Yi Wang, Yuyan Guo
In: Research Square · 2024 · doi:10.21203/rs.3.rs-3866949/v1 · W4391215343
preprint OA: green CC0
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

Endometriosis patients with chronic endometritis had a higher risk of placenta previa, gestational hypertension, and cesarean delivery, but combined surgery improved pregnancy rates.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This retrospective cohort study examined clinical characteristics and subsequent pregnancy outcomes in 1574 infertile patients (2018–2020) undergoing combined laparoscopic and hysteroscopic surgery, comparing women with endometriosis (n=685) who had chronic endometritis diagnosed by CD138/CD38-positive plasma cells versus those without. The chronic endometritis prevalence among women with endometriosis was 46.42%, and within those with CE, the authors reported higher cumulative clinical pregnancy rates in EFI score strata (7–8 and 9–10) than in scores below 7. Women with both endometriosis and CE experienced higher rates of pregnancy and delivery complications, including placenta previa, gestational hypertension, and cesarean delivery. The study explicitly notes it is a preprint and, based on its design, relies on postoperative care selection and telephone/hospital follow-up data rather than randomized allocation. This paper is centrally about endometriosis — it evaluates how chronic endometritis coexisting with endometriosis-associated infertility affects pregnancy and perinatal complication outcomes after surgery.

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Abstract

Abstract Background: Endometriosis (EMS) and chronic endometritis (CE) often coexist. Laparoscopic and hysteroscopic surgery surgery is one of the main methods for diagnosing and treating these conditions. The objectives of this study were to examine the clinical characteristics and prognosis of surgically diagnosed EMS complicated by CE and to assess the reproductive outcomes during subsequent pregnancies. Methods:A total of 1574 infertile patients were included in this study between January 2018 and December 2020. 685 patients were diagnosed with endometriosis who were further divided into two groups: a CE group consisting of 318 patients and a non-CE group consisting of 367 patients. Within the cohort who suffered from CE, a subset of postoperative care clinical pregnant women (n=123) was selected to form the study group. The control group consisted of women undergoing singleton pregnancy (n=369) who underwent delivery during the same period. Data on clinical statuses and complications during pregnancy and delivery were collected from hospitals and through telephone interviews. Results: The CE prevalence rate in women with EMS was 46.42%. Among the 318 women who were diagnosed with posterior CE, 135 achieved pregnancy. The cumulative clinical pregnancy rate was found to be significantly higher in groups with endometriosis fertility index (EFI) scores ranging from 7 to 8 and from 9 to 10 compared to groups with EFI scores below 7. Furthermore, women with both EMS and CE had a higher risk of experiencing complications during pregnancy, including placenta previa (13.01%), gestational hypertension (5.69%), and cesarean section delivery (59.34%). Conclusions:Patients diagnosed with endometriosis exhibited a heightened prevalence of chronic endometritis. Our investigation revealed that combined hysteroscopic and laparoscopic surgery proved to be a successful approach in augmenting the overall pregnancy rate. Furthermore, women afflicted by both EMS and CE face an independently escalated susceptibility to placenta previa, gestational hypertension, and cesarean delivery.

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endometriosisinfertility

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