Diagnosis and management of asymptomatic chronic endometritis in infertility

Chronic endometritis (CE) is defined as a persistent inflammation of the endometrium, often caused by low-virulence pathogens, which in most cases occurs without classic clinical manifestations such as pelvic pain or vaginal discharge. This silent condition has been increasingly recognized as a determining factor in female infertility, often identified in patients with recurrent implantation failures and recurrent pregnancy losses. The diagnosis of CE represents a clinical challenge, since the absence of symptoms masks the pathology, requiring the use of precise diagnostic methods such as immunohistochemistry for the detection of CD138+ plasma cells and diagnostic hysteroscopy. This study aims to conduct a systematic literature review on current diagnostic strategies and the impact of the therapeutic management of asymptomatic chronic endometritis on improving reproductive outcomes. The methodology was based on a bibliographic search in the SciELO and LILACS databases, selecting studies published in the last decade that investigated the prevalence, diagnostic methods, and antibiotic protocols directed at CE. The results show that identification and appropriate treatment with targeted antibiotic regimens restore endometrial receptivity, significantly increasing clinical pregnancy rates and decreasing the risk of miscarriage in patients undergoing in vitro fertilization. It is concluded that asymptomatic chronic endometritis should be routinely investigated in patients with a history of unexplained infertility or previous reproductive failures, with a multidisciplinary approach being essential for treatment success.(AU)