Chronic endometritis

O-town gal

1 Posts
Reply Posted on: Dec 15, 2012 at 11:42am
Dr. Braverman-

I have heard mention of you many times on various forums and boards dealing with trying to conceive, all with high praises. I am curious to know what your thoughts are on my situation. I have one daughter who is almost 18 months old. It took us 14 months to conceive her. I believe I had a mild luteal phase defect, as my luteal phases varied but averaged at 10 days. Since it took some time the first time, we decided to try for our second as soon as my period returned at 6 months post-partum (I am 34, almost 35 and not getting any younger). We had a chemical pregnancy the second cycle, followed immediately by another pregnancy. This one ended in a missed MC. The ultrasound at 7w2d showed the baby measuring only 6 weeks with a heartrate of 45, and the next ultrasound at 8w4d confirmed the baby stopped growing at 6 weeks with no heartbeat. I ended up requiring a D&C, as medical induction failed. The baby was chromosomally normal.

My OB referred me to an RE for repeat loss testing, which came back essentially normal, except for a heterozygous MTHFR A mutation. Incidentally, my husband has the homozygous MTHFR A mutation. On the HSG, the RE saw what he described as "abnormal lining" and suggested a hysteroscopy if I didn't get pregnant again after a couple cycles. When I had the hysteroscopy, he saw what I have seen in the medical literature descibed as micropolyps. An endometrial biopsy done at that time confirmed chronic endometritis. I had taken Augmentin a month prior to this for strep throat, so obviously that particular antibiotic was not an effective treatment. He prescribed ciprofloxacin, which I proved to be allergic to. After trying to prescribe Augmentin again, it was switched to Azithromycin, and I completed the course. Although it is not protocol to repeat endometrial biopsies after treatment, I insisted on another, since I had already been inadvertently unsuccesfully treated. I had another biopsy the beginning of the next cycle, which again showed chronic endometritis. The RE then gave me the choice of either Augmentin or Azithromycin AGAIN. The plan was to then ignore the condition and proceed with Femara to boost ovulation (I ovulate on my own and have regular cycles).

Well, instead, I got pregnant! I am 4w4d currently. My concern is that the inflammation is still present and could be interfering with normal implantation and development, putting me at risk for yet another miscarriage. I had already started on an anti-inflammatory diet with no dairy or wheat. I was taking CoQ10, royal jelly/propolis/bee pollen, fish oil, baby aspirin, and vitamin E. I stopped the CoQ10 and vitamin E; I have cut back on the royal jelly mix and baby aspirin; and have increased the fish oil. But I am feeling quite helpless as to what else I can do to quell the inflammation now that I am already pregnant. As far as I know, I've never had any inflammation/ autoimmune issues, although both my mother and grandmother were diagnosed with hypothyroidism. Any guidance from you would be so greatly appreciated!

Dr. Braverman

2026 Posts
RE: Chronic endometritis Posted on: Dec 15, 2012 at 3:19pm
Ok so you have not had significant immune testing and these diagnosis of chronic endometritis could be "red herring" . First if you truley have an ifection you dont want antiinflammatories because then you are reducing the immune systems ability to fight the infection. did they ever try to culture the biopsies? I use a mix of clindamycin and doxycycline for these cases. At this point you cant use doxy but you can use clindamycin. I would want to have all of your other immune parameters tested though before agreeing that any treatment is correct for you , and now that you are pregnant its a perfect time to see the immune systems response to your embryo. I do not beleive the MTFHR is a sigificant issue for you.

at this point as time is critical I would choose between infection or immune and treat.. If you choose immune I would stay on the baby asa and fish oil until you can have all the testing done for if it is the infection there is not a lot you can do now, although a week of clindamycin if your doctor agrees may help in that regard.

I hope this is helpful , I know how anxious you must feel at this point. Let me know if I can help you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.