REVIEW   

Minerva Obstetrics and Gynecology 2021 December;73(6):790-805

DOI: 10.23736/S2724-606X.21.04970-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Hysteroscopic findings in chronic endometritis

Antonio LA MARCA ^{1, 2} ✉, Giorgia GAIA ¹, Mario MIGNINI RENZINI ^{2, 3}, Carlo ALBONI ¹, Elisa MASTELLARI ¹

¹ Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy; ² Clinica Eugin Modena, Modena, Italy; ³ Biogenesi Reproductive Medicine Center, Istituti Clinici Zucchi, Monza, Monza e Brianza, Italy

Chronic endometritis (CE) is a subtle pathology. Despite being difficult to detect and probably underdiagnosed, it has great clinical relevance, representing as it does a reversible cause of infertility. Nowadays, histological examination with identification of endometrial stromal plasma cells is considered the gold standard for diagnosis. Diagnostic difficulties persist, however, as a result of the technical limitations of this method and the lack of standardized histological diagnostic criteria. Hysteroscopy has been proposed as an aid for CE diagnosis. The method works by detecting signs of inflammation (focal or diffuse hyperemia, stromal edema, presence of micropolyps and the typical strawberry aspect) on the endometrial surface. Yet, the jury is still out on how reliable this technique is. Hysteroscopy displays a high sensitivity (over 86% and up to 100%) and high negative predictive value (over 92% and up to 100%) in the diagnosis of CE, and it should probably be performed routinely in the assessment of patients with unexplained infertility, repeated implantation failure and repeated pregnancy loss; however, since values in the literature regarding specificity are conflicting, in cases of suspected CE, hysteroscopy may be combined with histological examination, which remains the gold standard to confirm CE. Considering that histopathological evaluation probably underdiagnoses CE, and that hysteroscopy tends to overdiagnose, further studies are needed to determine which technique (or combination of techniques) has greater value for patients.

KEY WORDS: Chronic endometritis, diagnosis, fluid hysteroscopy, micropolyps, stromal edema