**Chronic Endometritis**

Attilio Di Spiezio Sardo, Federica Palma, Gloria Calagna, Brunella Zizolfi and Giuseppe Bifulco

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/63023

#### **Abstract**

Chronic endometritis is a persistent inflammation of the inner lining of the uterine cavity. Several studies have demonstrated that it is a condition frequently associated with repeat‐ ed unexplained implantation failure at in vitro fertilization, recurrent miscarriage, as well as poor obstetric outcomes such as preterm labor.

The aim of this paper is to provide information about diagnosis and treatment of this condi‐ tion to improve reproductive outcome. In fact, significantly higher rate of successful preg‐ nancies was achieved in those patients in whom antibiotic treatment was able to normalize both hysteroscopic and histologic endometrial pattern compared with women who were not treated or with persistent disease. Hysteroscopy with endometrial biopsy is assumed to be the best method for the detection of chronic endometritis. So, we support the impor‐ tance of hysteroscopy as a part of the diagnostic workup of infertile women.

**Keywords:** Infections, chronic endometritis, infertility, hysteroscopy, antibiotic therapy

### **1. Introduction**

#### **1.1. Definition and etiology**

Endometritis is defined as inflammation of the endometrium, grouped in various typologies, depending on the underlying causality.

It may present in acute or chronic forms.

The acute form is principally a transitional phase of short duration generally arising due to the persistence of placental or abortive residues, or in combination with pelvic inflammatory disease, or with inflammatory conditions of bacterial/viral etiology elsewhere in the urogenital tract [1–4].

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Chronic inflammation may follow the acute stage—which is the most frequently seen—or it may occur more subtly, as chronic inflammation 'ab initio', without passing through an acute stage.

Chronic endometritis can reveal a microbiological origin or a mechanical–chemical origin [5].

In the latter case, the most frequent causative agents are common pyogenic pathogens (streptococci, staphylococci, enterococci, *Escherichia coli*), as well as bacteria such as *Chlamydia trachomatis*, *Neisseria gonorrhoeae*, *Mycoplasma*, and *Ureaplasma urealyticum*. It has also been described in cases of postpartum endometritis secondary to herpes simplex virus (HSV) and cytomegalovirus (CMV) infections, particularly in patients with HIV [6–8].

However, although the etiology in most cases is polymicrobial, the results obtained by traditional culture tests are laboratory dependent, and often, given the use of endometrial sampling devices, vaginal and endocervical contamination cannot be excluded.

Also worth mentioning is tubercular endometritis, because in recent years there has been an increased incidence of tuberculosis in Western countries, owing to migration from countries with a high incidence of endemic tuberculosis.

Endometritis of chemical–mechanical origin, on the other hand, is generally caused by the presence of pessaries or intrauterine devices.
