{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T18:13:40Z","timestamp":1788459220778,"version":"build-2803163510"},"reference-count":25,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: This study aims to investigate the impact of chronic endometritis (CE) diagnosis and treatment on pregnancy outcomes during hysteroscopic fallopian tube catheterization combined with laparoscopy in infertility patients with pelvic endometriosis (EMS) and proximal tubal obstruction (PTO). Methods: A retrospective study was conducted between July 2020 and March 2022, including patients with PTO who underwent hysteroscopy\u2013laparoscopy. CE was diagnosed via CD138 immunohistochemical staining and treated with oral doxycycline. The study further assessed the prevalence of CE and evaluated the effect of its diagnosis and treatment on pregnancy outcomes. Results: A total of 454 participants with PTO were enrolled, of whom 158 had concomitant pelvic EMS. Among EMS patients, 78 underwent CD138 staining for CE diagnosis (Group A), while the rest were classified as Group B. The incidence of CE in Group A was 62.8%. These affected individuals were treated with doxycycline. The natural pregnancy rate was significantly higher in Group A than Group B (46.2% vs. 26.3%, p = 0.009). The clinical pregnancy rate and live birth rate were higher in Group A, although the differences were not statistically significant. Additionally, Group A demonstrated a significantly higher cumulative natural pregnancy rate (p &lt; 0.05). Notably, the diagnosis and treatment of CE emerged as a protective factor for cumulative natural pregnancy (HR, 1.78; 95% CI, 1.06\u20132.97; p = 0.028). Conclusions: In infertility patients with pelvic EMS complicated by PTO undergoing hysteroscopic tube catheterization combined with laparoscopy, prioritizing the diagnosis and treatment of CE is crucial for enhancing natural pregnancy outcomes.<\/jats:p>","DOI":"10.3390\/jcm15176845","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:13:25Z","timestamp":1788455605000},"page":"6845","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis and Management of Chronic Endometritis: Effects on Postoperative Pregnancy Outcomes in Endometriosis Patients with Proximal Tubal Obstruction Undergoing Hysteroscopic Tubal Catheterization and Laparoscopy"],"prefix":"10.3390","volume":"15","author":[{"given":"Peng","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Qamdo People\u2019s Hospital of Tibet Autonomous Region, Qamdo 854000, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6500-2141","authenticated-orcid":false,"given":"Yixian","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9306-588X","authenticated-orcid":false,"given":"Wei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Yunwei","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2369-0123","authenticated-orcid":false,"given":"Huili","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Xinyu","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4148-0800","authenticated-orcid":false,"given":"Ying","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Jing","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"given":"Jing","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"project-administration","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.fertnstert.2018.04.012","article-title":"Endometritis: New time, new concepts","volume":"110","author":"Kitaya","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.fertnstert.2018.03.017","article-title":"Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: A systematic review and meta-analysis","volume":"110","author":"Vitagliano","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/jog.13937","article-title":"Review: Chronic endometritis and its effect on reproduction","volume":"45","author":"Kimura","year":"2019","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Yasuo, T., and Kitaya, K. (2022). Challenges in Clinical Diagnosis and Management of Chronic Endometritis. Diagnostics, 12.","DOI":"10.3390\/diagnostics12112711"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e13369","DOI":"10.1111\/aji.13369","article-title":"Diagnosis of chronic endometritis: How many CD138+ cells\/HPF in endometrial stroma affect pregnancy outcome of infertile women?","volume":"85","author":"Li","year":"2021","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(04)17403-5","article-title":"Endometriosis","volume":"364","author":"Giudice","year":"2004","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Al-Omari, M.H., Obeidat, N., Elheis, M., Khasawneh, R.A., and Gharaibeh, M.M. (2018). Factors Affecting Pregnancy Rate Following Fallopian Tube Recanalization in Women with Proximal Fallopian Tube Obstruction. J. Clin. Med., 7.","DOI":"10.3390\/jcm7050110"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.ajog.2020.10.019","article-title":"Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease","volume":"224","author":"Ravel","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"769","DOI":"10.7150\/ijms.71972","article-title":"IL-17: An important pathogenic factor in endometriosis","volume":"19","author":"Shi","year":"2022","journal-title":"Int. J. Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Chang, C.Y., Chiang, A.J., Lai, M.T., Yan, M.J., Tseng, C.C., Lo, L.C., Wan, L., Li, C.J., Tsui, K.H., and Chen, C.M. (2022). A More Diverse Cervical Microbiome Associates with Better Clinical Outcomes in Patients with Endometriosis: A Pilot Study. Biomedicines, 10.","DOI":"10.3390\/biomedicines10010174"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Takebayashi, A., Kimura, F., Kishi, Y., Ishida, M., Takahashi, A., Yamanaka, A., Takahashi, K., Suginami, H., and Murakami, T. (2014). The association between endometriosis and chronic endometritis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0088354"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.fertnstert.2017.05.016","article-title":"Higher prevalence of chronic endometritis in women with endometriosis: A possible etiopathogenetic link","volume":"108","author":"Cicinelli","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1002\/ijgo.14326","article-title":"Existence of chronic endometritis and its influence on pregnancy outcomes in infertile women with minimal\/mild endometriosis","volume":"160","author":"Qiao","year":"2023","journal-title":"Int. J. Gynaecol. Obset."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1016\/j.jmig.2021.04.011","article-title":"Is Chronic Endometritis Associated with Tubal Infertility? A Prospective Cohort Study","volume":"28","author":"Holzer","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"American Society for Reproductive Medicine (1997). Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil. Steril., 67, 817\u2013821.","DOI":"10.1016\/S0015-0282(97)81391-X"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bourdon, M., Santulli, P., Maignien, C., Gayet, V., Pocate-Cheriet, K., Marcellin, L., and Chapron, C. (2018). The deferred embryo transfer strategy improves cumulative pregnancy rates in endometriosis-related infertility: A retrospective matched cohort study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0194800"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.fertnstert.2015.08.031","article-title":"Treatment of pain associated with deep endometriosis: Alternatives and evidence","volume":"104","author":"Ferrero","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.fertnstert.2015.09.025","article-title":"Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: Prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis","volume":"105","author":"Bouet","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1111\/j.1471-0528.1986.tb07995.x","article-title":"Endometriosis: Its association with retrograde menstruation, dysmenorrhoea and tubal pathology","volume":"93","author":"Liu","year":"1986","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Mayrhofer, D., Holzer, I., Aschauer, J., Selzer, C., Parry, J.P., and Ott, J. (2024). Incidence and Causes of Tubal Occlusion in Infertility: A Retrospective Cohort Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133961"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/j.fertnstert.2015.01.007","article-title":"Altered uterine contractility in women with chronic endometritis","volume":"103","author":"Pinto","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kitaya, K., and Yasuo, T. (2023). Commonalities and Disparities between Endometriosis and Chronic Endometritis: Therapeutic Potential of Novel Antibiotic Treatment Strategy against Ectopic Endometrium. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24032059"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lu, F., Wei, J., Zhong, Y., Feng, Y., Ma, B., Xiong, Y., Wei, K., Tan, B., and Chen, T. (2022). Antibiotic Therapy and Vaginal Microbiota Transplantation Reduce Endometriosis Disease Progression in Female Mice via NF-\u03baB Signaling Pathway. Front. Med., 9.","DOI":"10.3389\/fmed.2022.831115"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.fertnstert.2024.02.041","article-title":"In women with endometriosis, effective treatment of chronic endometritis with antibiotics lowers serum CA-125 levels","volume":"121","author":"Cicinelli","year":"2024","journal-title":"Fertil. Steril."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6845\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:21:31Z","timestamp":1788456091000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6845"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":25,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176845"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176845","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]}}}