Study On The Correlation Between Embryo Implantation Failure And Chronic Endometritis

Objective:Exploring the correlation between embryo implantation failure and chronic endometritis（CE）,comparing the pregnancy outcomes after CE treatment,and analyzing the high-risk factors related to CE.Methods:A total of 350 female patients who received in vitro fertilization or intracytoplasmic sperm injection-embryo transfer（IVF/ICSI-ET）in the Department of Reproductive Medicine,the First People’s Hospital of Yunnan Province from June 2020 to August 2021 were included in this study.All these350 female patients has performed hysteroscopy,endometrial pathology and CD138 / CD38 immunohistochemical staining.The experiment group including 270 patients and at least happened one time of implantation failure,according to the frequency of embryo implantation failure,experiment patients were divided into four groups: one time failure group（100 cases）,two times failure group（85 cases）,three-times group（57 cases）and above four-times group（28 cases）.The control group contains 80 female patients with previous natural pregnancy and delivery history,IVF/ICSI assisted pregnancy due to tubal factors or male factors,hysteroscopy and no abnormality of CD138 / CD38.Spss 25.0 was used to compare the detection rate of CE,the difference of endometrial ultrasound abnormality and CE rate in each group were compared.The pregnancy outcomes of frozen embryo transfer after CE treatment between each group was analyzed.Logistic regression was performed to analysis the high-risk factors related to CE.Results:1.There was a positive correlation between the frequency of embryo implantation failures and the detection rate of CE（r = 0.232,P < 0.001）.The detection rates of CE in patients with one-time,two-times,three-times and above four-times were 25%,37.6%,45.6%and 60.7% respectively（P < 0.05）.The proportion of abnormal endometrial ultrasound in patients with one-time embryo transfer failure was significantly lower than that in patients with failure twice（25% vs 56.5%,P < 0.001）.There was no significant difference in the proportion of abnormal intimal ultrasound among the groups compared with the patients who failed one-time,two-times,three-times and ≥four-times（56.5% vs 63.5% vs 75%,P > 0.05）.2.Compared with the control group,there was no significant difference in h CG positive rate,clinical pregnancy rate,ectopic pregnancy rate and multiple pregnancy rate among patients with one-time,two-times,three-times and ≥ four-times embryo transfer failures（P > 0.05）.3.Chlamydia / gonococcus infection,endometrial polyps,spontaneous abortion and fallopian tube obstruction are the high-risk factors of CE occurance.Conclusions:1.The detection rate of CE increased significantly with the increase of the number of embryo transfer failures.Hysteroscopy and immunohistochemistry are recommended to determine CE for those who have failed embryo implantation once with abnormal endometrial ultrasound,or those who have failed embryo implantation more than twice.2.The pregnancy outcome of patients with CE after oral antibiotic treatment was consistent with that of patients without CE.CE should be actively treated to improve the pregnancy rate.3.The history of Chlamydia / Neisseria gonorrhoeae infection,endometrial polyps,spontaneous abortion and fallopian tube obstruction are high-risk factors of CE.Hysteroscopy and endometrial immunohistochemical is suggested to detect CE in those women with high-risk factors before assisted reproductive technology.