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Does antibiotic therapy for chronic endometritis improve clinical outcomes of patients with recurrent implantation failure in subsequent IVF cycles? A systematic review and meta-analysis

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Abstract

Purpose

This study aims to assess whether antibiotic therapy for chronic endometritis (CE) could improve subsequent IVF outcomes in patients with recurrent implantation failure (RIF).

Methods

Studies that explore CE treatment in patients with RIF were retrieved from PubMed, EMBASE, Wanfang, and Google Scholar up to Jan 31, 2022. All retrieved studies were selected according to the inclusion and exclusion criteria. The main outcome measures include implantation rate (IR), clinical pregnancy rate (CPR), ongoing pregnancy rate/live birth rate (OPR/LBR), and miscarriage rate (MR). Odds ratios (ORs) were analyzed for pregnancy outcomes with a 95% confidence interval (CI).

Results

Nine articles were enrolled in this study. Patients receiving oral antibiotic administration (OAA) did not show any advantage over patients without CE with regard to IR, OPR/LBR, and MR, but they showed a higher CPR. Patients with cured CE after OAA therapy had significantly higher CPR, IR, and OPR/LBR compared with patients without CE. Patients with persistent CE after OAA therapy had significantly lower IR, CPR, and OPR/LBR compared with patients without CE. Patients with cured CE had significantly higher IR, CPR, and OPR/LBR compared with persistent CE patients.

Conclusions

Antibiotic treatment may improve the pregnancy outcomes of RIF patients in subsequent IVF cycles only if the condition of CE is confirmed cured in a control biopsy afterwards. Otherwise, no sufficient evidence has shown improvements in clinical outcomes in RIF patients with persistent CE.

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Acknowledgements

We would like to thank Dr. Demirdag for kindly providing us the data.

Funding

This study was supported by grants from the National Natural Science Foundation of China (81200453), and Chengdu Science and Technology Bureau (2019-YF09-00210-SN).

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Authors and Affiliations

  1. The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China

    Xinghan Cheng, Zhongying Huang, Zhun Xiao & Yu Bai

  2. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China

    Xinghan Cheng, Zhongying Huang, Zhun Xiao & Yu Bai

  3. West China School of Medicine, Sichuan University, Chengdu, China

    Xinghan Cheng

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  1. Xinghan Cheng
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  2. Zhongying Huang
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Correspondence to Zhongying Huang.

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Cheng, X., Huang, Z., Xiao, Z. et al. Does antibiotic therapy for chronic endometritis improve clinical outcomes of patients with recurrent implantation failure in subsequent IVF cycles? A systematic review and meta-analysis. J Assist Reprod Genet 39, 1797–1813 (2022). https://doi.org/10.1007/s10815-022-02558-1

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