Chronic Endometritis and Its Link to Recurrent IVF Failures & Miscarriages

What is Chronic Endometritis?

Chronic endometritis happens when the inner lining of the uterus stays inflamed for a long time due to an infection. This infection is usually caused by bacteria entering the uterus from the vagina. It often doesn’t show clear symptoms, but it can make it harder for a woman to get pregnant or stay pregnant.

Chronic endometritis is a very common yet often undiagnosed issue, especially in a country like India. It is one of the leading causes of recurrent IVF failures and repeated miscarriages. In my practice as a reproductive immunologist in Mumbai, I see many patients for whom this silent condition is the root cause of their fertility challenges.

When we decide to test for chronic endometritis, the luteal phase (starting after ovulation and lasting until the start of the next period, usually about 12–14 days), the second half of the menstrual cycle, is the ideal time. This is when the endometrial immune response is at its peak, allowing us to detect abnormalities that might otherwise go unnoticed.

We’ve shared this across various educational platforms before, but it bears repeating—uterine NK (natural killer) cells play a pivotal role in implantation and the formation of spiral arterioles, which are crucial for embryo development and successful pregnancy.

Chronic endometritis involves inflammation of the endometrial cavity.

• This inflammation is usually due to ascending infections from the vagina or external genitalia.

• The infection triggers the recruitment of peripheral NK cells, increasing their activity in the uterus.

Normally, uterine NK cells make up about 10-30% of the local immune population. In cases of chronic infection, this number skyrockets, disrupting implantation and increasing the risk of miscarriage.

There are a few key reasons why this condition often goes undiagnosed:

• It is frequently asymptomatic.

• Empirical use of broad-spectrum antibiotics during IVF cycles can mask the symptoms temporarily.

To accurately diagnose chronic endometritis, we prefer performing a hysteroscopy.

• We’re looking for strawberry spots or micro polyps inside the uterine cavity.
• A biopsy is then taken for confirmation.

Once the tissue sample is collected, it must be transported in a specialized buffer solution to maintain integrity. In our lab, we test the sample using MUM-1 staining, a highly specific marker for identifying plasma cells in the endometrium.

Many labs across India lack the automation needed for precise results, which often leads to false reports. We use automated platforms for both preparation and staining, ensuring accuracy.

If we find more than 5 to 10 plasma cells per high-power field (HPF), we proceed to culture and sensitivity testing to tailor the antibiotic treatment.

📞 Ready to Get Clarity on Your Fertility Struggles?

If you’ve had recurrent IVF failures or unexplained miscarriages, don’t wait. Book a consultation with Dr. Jay Mehta, Mumbai’s leading expert in reproductive immunology, and take the first step toward successful pregnancy today, and let’s explore if chronic endometritis could be the missing link.

Call  1800-268-4000 to schedule your appointment.

We don’t believe in giving blanket antibiotics. That’s outdated and contributes to antibiotic resistance. Based on culture reports, we typically prescribe:

• Clindamycin
• Doxycycline
• Cyanomycin

Treatment usually lasts 21 days, and it’s equally important to include oral probiotics to restore the vaginal and endometrial microbiome.

After completing the antibiotic course:

• No need for repeat biopsy
• Wait approximately 2 months before attempting embryo transfer or natural pregnancy

If you’re preparing for IVF, we strongly recommend doing genetic testing of embryos to ensure you are transferring a euploid (chromosomally normal) embryo.

Testing is highly recommended if you meet any of the following:

1. Blocked fallopian tubes with failed IVF cycles
2. Unexplained infertility after two or more failed IVF cycles
3. Chronic thin endometrium
4. Failed IVF with a euploid embryo
5. Recurrent miscarriages without any known cause

At our IMMUREPRO Division, we’ve accepted and tested thousands of specimens from across India. Our pathologists specialize in chronic endometritis diagnostics, ensuring accurate and timely results.

The response we’ve seen from patients who’ve been correctly diagnosed and treated has been life-changing. Many have gone on to have successful pregnancies after years of heartbreak.

If you’ve had:

• More than two IVF failures
• Repeated abortions without explanation

You owe it to yourself to get tested for chronic endometritis. This silent condition could be the missing piece in your fertility journey.