Therapeutic efficacy of gentle endometrial curettage on antibiotic‐resistant chronic endometritis in infertile women

PURPOSE: To identify the efficacy of endometrial curettage on antibiotic‐resistant chronic endometritis (CE) in infertile women. METHODS: Of 1580 women with CE, 87 with antibiotic‐resistant CE after two to five cycles of antibiotic treatment were recruited between 2019 and 2021. The women who underwent endometrial curettage without applying any force and, in the subsequent menstrual cycle, endometrial sampling for CD138 immunostaining without antibiotic use. Pregnancy outcomes after in vitro fertilization treatment were analyzed in women who did not desire endometrial curettage and in those with cured and persistent CE after endometrial curettage. RESULTS: In 64 women who underwent endometrial curettage, the number of CD138‐positive cells decreased from 28.0 ± 35.3 to 7.7 ± 14.0 (p < 0.0001), and CE in 41 women (64.1%) was cured (<5 CD138‐positive cells). The pathological findings detected 3.1% of endometrial hyperplasia and 1.6% of endometrial cancer. The ongoing pregnancy rates in women aged ≤42 without endometrial curettage were significantly lower than those of women with cured and persistent CE (26.7%, 67.6%, and 57.1%, respectively, p = 0.03). CONCLUSIONS: Gentle endometrial curettage for antibiotic‐resistant CE significantly decreased the number of CD138‐positive cells, resulting in improved pregnancy outcomes regardless of remaining CE. Endometrial curettage is also important as a screening for endometrial malignancy.