Endometritis is an inflammation of the inner lining of the uterus, known as the endometrium. This condition can affect a person’s ability to conceive and carry a pregnancy to term. This article explores endometritis, its impact on fertility, and strategies for managing it during conception and pregnancy.
Understanding Endometritis
Endometritis is distinct from endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus. It is categorized into two main types: acute and chronic. Acute endometritis typically presents with clear symptoms such as fever, lower abdominal pain, and unusual vaginal discharge, often appearing suddenly after events like childbirth, miscarriage, or medical procedures.
Chronic endometritis (CE), by contrast, often remains asymptomatic or presents with subtle, non-specific symptoms like abnormal uterine bleeding or mild pelvic pain. This makes chronic endometritis particularly challenging to diagnose.
The condition commonly results from bacterial infections that ascend from the cervix and vagina into the uterine cavity. These infections can occur after childbirth, miscarriages, or procedures like intrauterine device (IUD) insertion, dilation and curettage (D&C), or hysteroscopy. Sexually transmitted infections (STIs) such as chlamydia and gonorrhea can also lead to endometritis.
Diagnosis typically involves an endometrial biopsy, which identifies specific inflammatory cells, particularly plasma cells, in the uterine lining. Hysteroscopy, a procedure that visualizes the uterine cavity, can also reveal signs of inflammation like swelling, redness, or small polyps.
How Endometritis Affects Fertility
Inflammation of the endometrium can significantly hinder embryo implantation, a necessary step for pregnancy. Endometritis creates an environment within the uterus that is less receptive to an embryo, disrupting the delicate communication required for implantation.
Chronic endometritis can also affect the balance of immune cells within the uterine lining, such as an increased presence of plasma cells and lymphocytes, which can create a hostile environment for an implanting embryo. This disruption in immune tolerance can lead to repeated implantation failure and recurrent miscarriages. Individuals undergoing assisted reproductive technologies (ART) like in vitro fertilization (IVF) may experience lower success rates if they have undiagnosed or untreated chronic endometritis. Studies indicate that successful treatment of chronic endometritis with antibiotics can significantly improve pregnancy rates and live birth rates in women undergoing IVF.
Navigating Pregnancy with Endometritis
Pregnancy can occur even when endometritis is present, particularly if the condition is mild or undiagnosed. However, active endometritis carries potential risks for both the mother and the developing fetus. The severity and type of endometritis often influence the course of the pregnancy.
When pregnancy occurs with active endometritis, there is an increased risk of complications. These can include a higher chance of miscarriage, especially recurrent pregnancy loss. Endometritis has also been associated with an increased risk of preterm birth. The ongoing inflammation or infection within the uterus can create an unfavorable environment, potentially impacting the health and development of the pregnancy. Diagnosing and treating endometritis before or early in pregnancy is important for managing these risks and improving pregnancy outcomes.
Strategies for Conception and Pregnancy Management
Treating chronic endometritis often involves a course of antibiotics to eliminate the underlying infection. Common antibiotic regimens, such as doxycycline for 14 days, have shown high cure rates, often exceeding 70% in diagnosed cases. Successful eradication of the infection can significantly improve the chances of conception and positive pregnancy outcomes.
Ideally, diagnosis and treatment of endometritis should occur before attempting conception, especially for individuals with a history of infertility or recurrent pregnancy loss. For those who become pregnant with a history of or active endometritis, close medical monitoring is advisable. This monitoring can help identify and manage any potential complications early in the pregnancy. Healthcare providers may recommend specific interventions to mitigate risks associated with the condition. General health practices, including maintaining good hygiene and addressing any underlying infections, also support overall reproductive well-being.