High prevalence of chronic endometritis in women diagnosed with hydrosalpinx before in vitro fertilization treatment.

Abstract

Objective: To compare the prevalence of chronic endometritis (CE) in women with hydrosalpinx undergoing in vitro fertilization (IVF), to a control group without hydrosalpinx.

Design: A bicentric historical prospective case-control study, between June 2017 and December 2021.

Setting: Angers and Montreal university hospitals.

Patient(s): In the Hydrosalpinx (H) group, we included all women undergoing IVF for various indications, and who were diagnosed with a hydrosalpinx before or during the cycle. In the control (C) group, we included women without hydrosalpinx, undergoing IVF for male factor infertility, or following bilateral tubal ligation.

Intervention(s): A laparoscopy was scheduled for the removal of the hydrosalpinx, and an endometrial biopsy was performed concomitantly to rule out CE. In the C group, an endometrial biopsy was performed in the clinic. CE diagnosis was confirmed using immunohistochemistry.

Measurements and main results: Our primary endpoint was the rate of positive biopsies for CE. Ninety-four patients were included, 62 in the H group and 32 in the C group. Mean age was 32.1 ± 5.1 years. The prevalence of CE was significantly higher in the H group compared to the C group (41.9% (26/62) vs 15.6% (5/32) (p=0.01)). Multivariate analysis showed that the presence of hydrosalpinx was an independent risk factor of CE (aOR = 3.93 (1.31-11.81)), whether the hydrosalpinx was unilateral (aOR = 4.39 (1.32-14.61)) or bilateral (aOR = 3.52 (1.01-11.99)).

Conclusions: There is a significant increase in the prevalence of CE in women with hydrosalpinx undergoing IVF, whether the hydrosalpinx was unilateral or bilateral.