Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis

Amerigo Vitagliano; Carlo Saccardi; Marco Noventa; Attilio Di Spiezio Sardo; Gabriele Saccone; Ettore Cicinelli; Sara Pizzi; Alessandra Andrisani; Pietro Salvatore Litta

doi:10.1016/j.fertnstert.2018.03.017

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 Jul 1;110(1):103-112.e1. doi: 10.1016/j.fertnstert.2018.03.017. Epub 2018 Jun 13.

Authors

Amerigo Vitagliano¹, Carlo Saccardi², Marco Noventa², Attilio Di Spiezio Sardo³, Gabriele Saccone⁴, Ettore Cicinelli⁵, Sara Pizzi⁶, Alessandra Andrisani², Pietro Salvatore Litta²

Affiliations

¹ Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy. Electronic address: [email protected].
² Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy.
³ Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy.
⁴ Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
⁵ 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science, University of Bari, Bari, Italy.
⁶ Department of Medicine, Surgical Pathology, and Cytopathology, University of Padova, Padova, Italy.

PMID: 29908776
DOI: 10.1016/j.fertnstert.2018.03.017

Abstract

Objective: To evaluate the impact of antibiotic therapy for chronic endometritis (CE) on IVF outcome.

Design: Systematic review and meta-analysis.

Setting: Not applicable.

Patient(s): Infertile women with history of recurrent implantation failure, defined as two or more failed ETs, undergoing one or more IVF cycle(s).

Intervention(s): The review was registered in PROSPERO (CRD42017062494) before the start of the literature search. Observational studies were identified by searching electronic databases. The following comparators were included: women with CE receiving antibiotics vs. untreated controls; women with cured CE vs. women with persistent CE; and women with cured CE vs. women with normal endometrial histology (negative for CE). The summary measures were reported as odds ratio (OR) with 95% confidence interval (CI).

Main outcome measure(s): Clinical pregnancy rate (CPR), ongoing pregnancy rate/live birth rate (OPR/LBR), implantation rate (IR), miscarriage rate.

Result(s): A total of 796 patients (from five studies) were included. Women receiving antibiotic therapy (without the histologic confirmation of CE cure) did not show any advantage in comparison with untreated controls (OPR/LBR, CPR, and IR). Patients with cured CE showed higher OPR/LBR (OR 6.81), CPR (OR 4.02), and IR (OR 3.24) in comparison with patients with persistent CE. In vitro fertilization outcome was comparable between women with cured CE and those without CE (OPR/LBR, CPR, and IR). Miscarriage rate was not significantly different between groups.

Conclusion(s): Chronic endometritis therapy may improve IVF outcome in patients suffering from recurrent implantation failure. A control biopsy should always confirm CE resolution before proceeding with IVF.

Keywords: Antibiotic therapy; chronic endometritis; infertility; live birth rate; pregnancy rate.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Abortion, Habitual / epidemiology*
Abortion, Habitual / etiology
Abortion, Habitual / therapy*
Chronic Disease
Embryo Implantation / physiology
Endometritis / complications
Endometritis / epidemiology*
Endometritis / therapy*
Female
Fertilization in Vitro* / methods
Fertilization in Vitro* / statistics & numerical data
Humans
Infertility, Female* / epidemiology
Infertility, Female* / etiology
Infertility, Female* / therapy
Pregnancy
Pregnancy Outcome* / epidemiology
Pregnancy Rate
Recurrence
Treatment Outcome