Prevalence of Chronic Endometritis in Infertile Women Candidates for In-vitro Fertilization and Diagnostic Value of Hysteroscopy in its Diagnosis

Background: Chronic endometritis (CE) can contribute to infertility and reproductive outcome. Currently there is a lack of information about the prevalence of CE and diagnostic value of hysteroscopy in the CE in infertile women in Iran. Objectives: To determine the CE prevalence in female candidates for in-vitro fertilization (IVF) and evaluate hysteroscopy’s sensitivity, specificity, and accuracy in diagnosing CE. Methods: This cross-sectional study enrolled 90 women candidates for IVF undergoing hysteroscopy by consecutive sampling in the infertility clinic of Vali-e-Asr Hospital, Tehran, Iran from October 2019 to February 2020. Hysteroscopic features of CE were recorded, and endometrial specimens were taken for histological study. Data analysis was done using descriptive and chi-square tests and specificity, sensitivity, negative and positive predictive value were calculated. Results: Chronic endometritis prevalence was identified in 19 (21.1%) women by histology. A significant relationship was found between CE and vaginal discharge (P = 0.03), pelvic inflammatory disease (PID) (P = 0.01), and abnormal uterine bleeding (AUB) (P = 0.001). Sensitivity, specificity, negative and positive predictive value (NPV and PPV), and accuracy of hysteroscopy for diagnosis of CE were 68.4%, 87.3%, 91.17%, 59.1%, and 83.3%, respectively. Conclusions: Considering the good specificity, NPV, and accuracy of hysteroscopy in diagnosing CE, an endometrial biopsy can be avoided in infertile women without risk factors for CE and with normal hysteroscopy. However, it should be considered for CE diagnosis in patients with vaginal discharge, dyspareunia, PID, and positive hysteroscopy findings.