How Chronic Endometritis Can Affect Fertility

Chronic endometritis is an endometrial disease and also a cause of infertility, most commonly found among fertility patients experiencing recurring implantation failure, recurring miscarriages and unexplained infertility.

In this article, we share explanations provided by Cape Fertility’s Dr Lizle Oosthuizen through a number of videos, covering what chronic endometritis is; what symptoms it causes – including infertility; how it is diagnosed; and how it can be treated, which will also improve the chances of falling pregnant.

Endometrial health is vital when it comes to getting pregnant. This is because a pregnancy can only occur if an embryo (an egg fertilised with sperm) can successfully implant in the endometrium, which is the lining that grows inside the uterus. This lining is the part that builds up throughout a monthly cycle, and is shed with a period every month, unless an embryo has implanted successfully.

For an embryo to implant successfully, a healthy lining is required – this refers to a thick, receptive and nourishing lining that creates the best possible environment for the embryo. A healthy lining is often described as at least 8mm thick, evenly distributed throughout the uterus, and with good blood flow.

Chronic endometritis is a persistent inflammation of the endometrial lining, and it is not possible for an embryo to implant successfully in an inflamed lining. As such, chronic endometritis is an increasingly common reason why many women cannot conceive naturally, or experience recurring implantation failure and miscarriages.

What is chronic endometritis?

Firstly, it is important to clarify that endometritis is not the same as endometriosis. More people are familiar with endometriosis, a condition in which the lining of the uterus grows outside of the womb, and which is also a known cause of infertility.

Endometritis happens inside the lining of the womb, and is a different disease with different causes, symptoms and treatments. It is also increasingly recognised as a factor in infertility.

Endometritis can be acute, which means there is usually a likely known cause, such as bacterial infection. Endometritis can also be chronic, which means it can cause ongoing, prolonged inflammation with noticeable symptoms.

Chronic endometritis is a mild and prolonged, continuous endometrial inflammation, which is characterised by plasma cell infiltration of the lining inside of the uterus. When even just a few inflammatory cells – or abnormal plasma cells – have settled inside of the lining, the natural processes are disturbed.

The cause of chronic endometritis is not 100% established, but scientists know that it is related to an imbalance of the bacteria found inside of the uterus. There are certain bacteria, specifically the lactobacillus, that need to be in the uterus in abundance, and there are other bacteria that should not be in the uterus at all, and these bacteria cause the cells in the lining to respond with chronic inflammation.

What are the symptoms of chronic endometritis?

There are several symptoms that could indicate a woman is suffering from this disease, such as malaise, fever, pelvic or abdominal pain, distended abdomen, vaginal bleeding or discharge. However, many women who have chronic endometritis are asymptomatic or have no clear symptoms.

It has also not been determined how common chronic endometritis is among women in the general population, but it is very prevalent in very specific groups, such as women experiencing recurrent implantation failure, those who have recurrent pregnancy loss and those with unexplained fertility. This strongly suggests chronic endometritis is one of multiple factors that could affect the chances of implantation or pregnancy loss.

You can find out more about how common endometritis is in this video by Dr Oosthuizen.

How is it diagnosed?

To determine the exact cause of any condition, it is necessary to eliminate the many different possible causes thereof through various investigations and tests.

Fortunately, there are very specific signs related to chronic endometritis, such as wet patches called strawberry lesions or little finger-like protrusions called micro polyps. These can be detected in various ways.

The gold standard for a chronic endometritis diagnosis is looking inside of the uterus through a hysteroscopy to visually assess the lining. This involves inserting a tiny camera into the inside of the uterus, through the mouth of the womb (where a Pap smear is done) or filling the uterus with fluid to see what the lining looks like.

Another option is to do what is called an endometrial biopsy, by placing a little catheter inside of the uterus and, through a gentle scratch, collecting some of the lining for immunohistochemistry with specific cell markers for CD138 cells, which is considered an accurate test for the diagnosis of chronic endometritis.

There’s a third line of testing, which is the genomics side of testing. This is a study of an organism’s genome, and is used to map the genomes of the various bacteria in the uterus. However, this testing is not done in South Africa, and the samples are sent overseas for testing. It’s an expensive test to do to and your fertility specialist will use clinical judgment to determine if it is necessary for your individual circumstances.

If you would like to know more about the diagnostic process, watch this video in which Dr Oosthuizen sheds light on the clinical assessments, tests, and procedures used in identifying this condition and the difficulties in diagnosis due to the fact that there is no clear cut definition yet of chronic endometritis.

Treating chronic endometritis

So can chronic endometritis be treated?

The first line of therapy is usually two weeks of two different antibiotics, which at Cape Fertility is supplemented with a probiotic with lactobacillus to replace the good bacteria and to manage the side effects of the treatment.

The studies show that, most of the time, such a course of antibiotic treatment is sufficient to clear up the chronic endometritis. Still, at Cape Fertility, our team will recheck to make sure that all the inflammation is gone, because often our IVF patients only have one or two precious embryos and cannot risk a failed implantation due to inflammation in the lining that could be easily treated beforehand.

There is also a second line course of antibiotics that can be prescribed, as well as genomic tests can also be used for patients for whom the routine antibiotics haven’t worked. The genomic testing can detect unusual bacteria that can be treated with a different antibiotic to resolve the inflammation.

Where to get treatment

The good news is that clinical experience indicates that women who do have chronic endometritis and receive treatment have better outcomes when it comes to achieving a pregnancy.

However, it is important to remember that when treating infertility, there is rarely just one single cause. More often, there are several contributing causes of symptoms such as recurring implantation failure and recurring miscarriages, and these contributing causes can only be determined accurately with the right tests and accurate diagnoses.

If you are concerned about your fertility or if you are having difficulty falling pregnant, we invite you to reach out to us at Cape Fertility – it is as simple as clicking here…

At Cape Fertility, we value each individual patient and we look forward to providing you with individualised and personalised care, affordable quality fertility treatment, and higher success rates at our purpose-built premises in the beautiful city of Cape Town.