Chronic endometritis diagnosed using a cut-off of ≥5 CD138 plasma cells significantly affects the reproductive outcomes of frozen embryo transfer: a case-control study

Hasan Bulut; Tamer Yeğinaltay; Mustafa Tunç; Murat Berkkanoğlu; Hande Töre; Kevin Coetzee; Kemal Özgür

doi:10.4274/jtgga.galenos.2023.2022-9-20

Chronic endometritis diagnosed using a cut-off of ≥5 CD138 plasma cells significantly affects the reproductive outcomes of frozen embryo transfer: a case-control study

J Turk Ger Gynecol Assoc. 2023 Sep 7;24(3):165-171. doi: 10.4274/jtgga.galenos.2023.2022-9-20.

Authors

Hasan Bulut^{1

2}, Tamer Yeğinaltay³, Mustafa Tunç³, Murat Berkkanoğlu¹, Hande Töre¹, Kevin Coetzee¹, Kemal Özgür¹

Affiliations

¹ Antalya In Vitro Fertilization Centre, Antalya, Turkey.
² Antalya Bilim University Faculty of Health Sciences, Antalya, Turkey.
³ Antalya Pathology Centre, Antalya, Turkey.

PMID: 37675502
PMCID: PMC10493815
DOI: 10.4274/jtgga.galenos.2023.2022-9-20

Abstract

Objective: To investigate the clinical significance of a diagnosis of chronic endometritis (CE) made using a diagnostic cut-off of ≥1 or ≥5 CD138 plasma cells per high power field (HPF) in asymptomatic patients undergoing in vitro fertilization (IVF) with frozen embryo transfer (FET).

Material and methods: In this retrospective case-control study, 1,865 patients underwent freeze-all-IVF treatment between January and December 2019, with 419 undergoing endometrial biopsies at oocyte retrieval. Of the 419 biopsy-patients, 301 have since undergone first FET. The processed endometrial biopsies of the 301 patients underwent immunohistochemical (IHC) examination with anti-CD138 to count CD138+ plasma cells per HPF. CE diagnosis was defined as 0 CD138 plasma cells (control-group), ≥1 CD138 plasma cells (CE^control-group) or ≥5 CD138 plasma cells (CE^disease-group) per HPF.

Results: Twenty-six (8.6%) patients were retrospectively diagnosed having ≥1 CD138 plasma cells, and five patients (1.7%) having ≥5 CD138 plasma cells (CE^disease-group) per HPF. The live birth and pregnancy loss rates of the three groups were 52.7% and 27.9%, 53.8% and 26.3% and 20.0% and 66.7%, respectively. The antral follicle count (AFC) of the three groups were 15.0 (9.0-22.0), 10.5 (7.75-15.25), and 6.0 (5.0-14.0), respectively.

Conclusion: Asymptomatic patients diagnosed with CE with ≥5 CD138 plasma cells per HPF, had the lowest live birth and highest pregnancy loss rates, with these patients also having significantly reduced AFC.

Keywords: CD138; Chronic endometritis; asymptomatic; frozen embryo transfer; live birth.