Endometritis and Fertility

Written by the specialized Obstetrician Gynecologist Dr. Evangelos Sakkas.

Endometritis and Fertility
Unfortunately, little has been written and even less is known to patients about the silent enemy of fertility, endometritis. A gynecological condition that can lurk and hide well behind unexplained infertility, miscarriages and failed IVF attempts.

What is endometritis?

Endometritis is an acute or chronic inflammation of the lining of the endometrium due to the entry of a germ. The environment of the endometrium, the inner cavity of the uterus, is particularly important for the achievement and development of a pregnancy, since the fertilized egg is implanted in it and the fetus develops during the nine months of pregnancy.

However, many women of reproductive age, without knowing it and without any symptoms, suffer from endometritis. As a result, they face difficulties in fertility, conception or inability to achieve pregnancy.

Endometritis is usually the result of a bacterial infection, from pathogenic germs that enter the uterine cavity, settle in it and cause inflammation in its tissue.

Endometritis & Fertility

The most common germs we encounter are:

  • mycoplasma
  • ureaplasma
  • chlamydia
  • gonococcus
  • escherichia coli and enterococcus. (more rarely)

Acute form of endometritis

The acute form of endometritis usually occurs after:

  • medical endometrial surgeries (e.g. scrape)
  • placental retention after childbirth

The clinical picture is typical and includes:

  • high fever
  • foul-smelling vaginal secretions
  • severe pain in the abdomen

The diagnosis is clinical and laboratory with culture and isolation of the microbial agent.

Acute endometritis is treated with intravenous antibiotics.

Chronic Endometritis

Χρόνια ενδομητρίτιδα αποκαλούμε μια χρόνια κατάσταση λοίμωξης που έχει ριζώσει στο ενδομήτριο για τα καλά.
Chronic endometritis is called a chronic state of infection that has rooted in the endometrium for good.
The clinical picture is almost always absent, while few patients have any particular symptom. Interestingly, several women with chronic endometritis had undergone a scraping in the past for various reasons such as e.g. polyps or termination of pregnancy.
In addition, the simple culture of vaginal and cervical fluid and the menstrual blood pcr is uncertain whether they will reveal the germ to us.

It depends on the gynecologist’s experience to suspect the presence of chronic endometritis, based on the patient’s history.

Methods of Diagnosis:

1. Diagnostic Hysteroscopy.
The gold standard of diagnosis is diagnostic hysteroscopy.
That is why the Gyn Care team chooses to always perform a hysteroscopy on all infertile women in order to rule out unpleasant surprises.
An experienced gynecologist who specializes in infertility can identify those clinical microscopic signs associated with chronic endometritis.

2. Staining CD138
The endometrial biopsy should be a regular practice. Doctors use it to look for plasma cells, commonly known as cd138 staining,. The method is simple and objective, but it can often be negative and still the woman can suffer from endometritis. That is why the interpretation and guidance of each incident must be separate.

3. Intrauterine tissue culture
The cultivation of endometrial tissue unfortunately does not help, because usually it gives us false positive results, due to the infection.

4. Test Alice, Emma
Quite debatable are some new tests such as the alice test or the emma test. They detect the pathogens DNA.

In any case, any information is useful but the main weapon in the medical quiver is Hysteroscopy.


Antibiotics are the solution to the problem.
The type of antibiotic, its duration and method of administration remain a matter of medical controversy.
My many years of experience in both Belgium and Italy have led me to the conclusion that a long period of double oral antibiotics is required, in combination with topical antibiotics, the well-known intrauterine infusions.

Extracorporeal and Endometritis

I had such good fetuses, but I did not get pregnant.
They gave me two perfect blastocysts but again I got a negative result, how is that possible?
Although I had a pre-implantation diagnosis, the chorionic is still negative.

These are unfortunately some of the phrases we hear more and more often from women who come to our specialized center for ivf and endoscopic procedures.

It is impressive and at the same time sad to realize how much mental and physical effort but also how much money is spent on IVF cycles. And all this in vain, because some patients have not been tested for something so simple, yet so important, endometritis.

Before you decide on the assisted reproduction method, you have to purposefully investigate the causes of infertility. The appropriate treatment plan is determined after the investigation of the causes and is crucial for the positive result of any effort.

I am sure that if endometritis is diagnosed immediately and properly, then we often even have natural conceptions without even in vitro fertilization.

Detailed relevant video, you can also see on our Youtube channel.

Read more about another topic that may interest you, that of Endometriosis.

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