A New Hysteroscopic Risk Scoring System For Diagnosing Chronic Endometritis And The Effect On IVF/ICSI Pregnancy Outcomes

Study ObjectiveTo develop a new hysteroscopic morphologic scoring system that helps physicians,especially those who have less experience,to make a differential on diagnosis chronic endometritis.MethodsA total of 320 endometrial biopsies were included in the study:164 patients with chronic endometritis(CE),and 156 patients without chronic endometritis(NCE).All patients who were planning to undergo assisted reproduction technology treatments due to infertility or recurrent abortion were enrolled from February 2017 to June 2018.All women underwent hysteroscopy and endometrial biopsy for histological examination,gold standard for the diagnosis of chronic endometritis is hematoxylin-eosin staining(HE)and CD 138 immunohistochemical staining.A new hysteroscopic risk scoring system for diagnosing chronic endometritis was made according endometrial morphologic parameters under hysteroscopy before endometrial biopsie,principal significant variables were selected by means of the chi-square test(p<0.05)and integrated into an binary logistic analysis.Through the estimate of the beta coefficient,a score was obtained to be appointed to each of the selected variables,and characteristic intervals of each of the endometrial lesions were created,then the sensitivity and specificity of the grading system were evaluated and the reproductive prognosis was followed up.Measurements and ResultsThe scoring system showed a sensitivity and specificity of 83.5%and 69.2%,The positive predictive values and negative predictive values,respectively,were 74.1%and 80%.Hysteroscopic and histologic grading showed moderate agreement(kappa index = 0.497).the pregnancy rate of CD138-positive patients was lower than the pregnancy rate of CD138 negative patients(42.4%vs.56.9%,p = 0.116>0.05).The pregnancy rate of hysteroscopy positive patients was lower than the pregnancy rate of hysteroscopy negative patients(47.17%vs.51.56%,P=0.636>0.05).The failure rate of repeated artificial insemination(AID/AIH)in the chronic endometritis group was significantly higher than that in the non-chronic endometritis group(66.7%vs.1.3%,P<0.05).ConclusionThe hysteroscopic scoring system showed general diagnostic performance in chronic endometritis,diffuse hyperemia,focal hyperemia,diffuse punctual hemorrhage,visible endometrial interstitial vessels and microscopic polyps are independent risk factors of chronic endometritis.In this study,chronic endometritis was associated with repeated artificial insemination failure,suggesting that chronic endometritis may lead to infertility or adverse pregnancy outcomes.