Chronic endometritis is a condition affecting up to 40% of infertile women, with a prevalence as high as 57% in those suffering from recurrent miscarriage and 66% in those with recurrent implantation failure.
Recent research confirms the importance of the microbial flora of the endometrium for reproduction.
The accuracy of this single molecular test is comparable to the combination of traditional hysteroscopy, histology and microbiology, enabling a more accessible, rapid and cost-effective diagnosis.
Chronic endometritis is a persistent inflammation of the endometrial tissue caused by bacterial pathogens. Although often asymptomatic, it is present in up to 40% of infertile women and in as many as 66% of women with repeated implantation failure, and 57% with unexplained recurrent miscarriage.
ALICE (Analysis of Infectious Chronic Endometritis) detects the nine pathogens responsible for chronic endometritis, including Enterobacteriaceae, Enterococcus, Streptococcus, Staphylococcus, Mycoplasma and Ureaplasma.
“Until now, the diagnosis of this condition was generally carried out through histology (microscopic analysis of the endometrial biopsy), which could be combined with microbial culture. However, not all the micro-organisms involved can be cultured. Specifically, between 20% and 60% cannot be grown in standard laboratory conditions and, as a result, information is lost. A third option was to undertake a hysteroscopy of the uterine cavity, but this method required surgery and didn’t allow the specific pathogens in question to be identified,” said Dr Inmaculada Moreno, researcher at Igenomix and first author of the study- The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology, published in the American Journal of Obstetrics & Gynaecology, describes the first molecular diagnostic tool for chronic endometritis, which is equivalent in terms of sensitivity and accuracy to the three classical diagnostic methods combined.
“Our aim was to develop a molecular diagnostic tool, comparable, in terms of sensitivity and accuracy, to using the three classical methods combined, overcoming any of their individual or collective shortcomings,” she added.
The study was conducted in 65 patients who had been assessed for chronic endometritis using all three classical diagnostic methods.
The importance of the microbiome for reproductive success
Recently published studies have demonstrated the importance of the microbiome for reproductive success.
Humans have ten times more bacteria than human cells. Therefore, a person weighing 70 kg contains between 30 and 50 trillion bacteria. Until recently, it was thought that the endometrium was free from bacteria. However, it is now known that bacteria are present in the endometrium, and their type and abundance are related to infertility.
Knowledge about the endometrial microbiome has allowed us to take another step towards improving treatment. In addition to diagnosing conditions that are linked to infertility, such as chronic endometritis, study of the endometrial microbiome helps determine whether or not the endometrium is receptive for pregnancy.
Another Igenomix study, using next generation sequencing on a sample of healthy women, found two types of microbial profiles: “Dominated by Lactobacillus (DL)” and “Not Dominated by Lactobacillus (NDL)”. The latter had a lower implantation rate and a higher miscarriage rate (60%). “Today, this research, which led to the EMMA (Endometrial Microbiome Metagenomic Analysis) test, also allows us to determine the complete profile of bacteria in the patient’s endometrium – the endometrial microbiome. After treating the patient (in the case of NDL bacteria) with probiotics prior to embryo transfer, there is an increase in the pregnancy rate,” said Dr Moreno.
IGENOMIX is a pioneering biotechnology company in the field of reproductive genetics. Its combined experience and advanced research abilities make it one of the world leaders in this field of reproductive genetics and guarantee the provision of effective solutions personalized to different infertility problems. It is present in Valencia (Spain), Miami, Los Angeles, New York, Mexico City, UK, Japan, Sao Paulo, Dubai, Delhi, Turkey and Argentina with a workforce of over 250 professionals. It has a robust global presence with 14 laboratories worldwide.