Comparison of treatment strategies on pregnancy outcomes in women with persistent chronic endometritis: a retrospective study

Abstract

Objective This study aims to evaluate the associations between different treatment regimens and pregnancy outcomes, histological cure rates of chronic endometritis (CE), adverse reactions, and adverse events in patients with persistent CE and pregnancy failure. Methods This retrospective study included 125 patients diagnosed with CE, of whom 90 were diagnosed with persistent CE. Based on the treatment regimen, the patients were divided into three groups: Group A (antibiotic therapy only), Group B (antibiotic therapy + intrauterine infusion of recombinant human granulocyte colony-stimulating factor (rhG-CSF)), and Group C (antibiotic therapy + intrauterine infusion and subcutaneous injection of rhG-CSF).The primary outcome measures were pregnancy outcomes (total pregnancy rate, clinical pregnancy rate, spontaneous abortion rate, live birth rate, and preterm birth rate), while secondary outcome measures included histological cure rate of CE, adverse reactions, and adverse events. Overall, biochemical and clinical pregnancy rates were calculated based on all patients in each group; spontaneous abortion and live birth rates were calculated based on clinical pregnancies; and the preterm birth rate was calculated based on live births. Results (1) Pregnancy outcomes: The total pregnancy rate in Group C was higher than in Group A, with no difference between Groups B and C. Biochemical pregnancy rate was higher in Group B than Group C, with no significant differences between other comparisons. Clinical pregnancy rate was higher in Group C than Group A, with no differences between other groups. Group C had the lowest spontaneous abortion rate and highest live birth rate. Preterm birth rates in Groups B and C were lower than in Group A, with no difference between B and C. Group C had the lowest spontaneous abortion rate and the highest live birth rate. Preterm birth rates in Groups B and C were lower than in Group A, with no difference between Groups B and C. (2) Factors associated with spontaneous abortion: Multivariate analysis showed Groups A and B were associated with higher odds of spontaneous abortion than Group C, and increasing age was also associated with higher odds of spontaneous abortion. (3) Histological cure rate of CE: Post-treatment, Groups B and C had higher cure rates of CE than Group A, with no difference between B and C. (4) Adverse reactions and adverse events: Subchorionic hematoma and placental adhesion were higher in Group A than Group C, no differences between other groups. No ectopic pregnancies or neonatal malformations occurred. Conclusion rhG-CSF combination therapy was associated with better pregnancy outcomes in persistent CE patients,including higher pregnancy, clinical pregnancy, and live birth rates, and a lower spontaneous abortion rate. Continuous use of rhG-CSF may be associated with better outcomes, but its potential clinical benefit and safety require validation through larger studies.