Milann  Fertility and Birthing Hospital, Bengaluru successfully managed a
challenging case of chronic endometritis, a silent inflammatory condition of the uterus that
can affect embryo implantation and pregnancy outcomes, helping a 39-year-old woman

 

achieve an ongoing IVF pregnancy under the expert supervision of Dr. Shilpa Ellur, Senior
Consultant, Reproductive Medicine & High-Risk Obstetrics. The case highlights the importance
of routine fertility evaluations and identifying hidden uterine factors that may impact
pregnancy, even when a genetically normal embryo is available.

 

Chronic endometritis (CE) is a persistent, low grade inflammation of the endometrium, which is
the inner lining of the uterus where an embryo attaches and develops. Unlike acute infections
that usually present with fever, severe pelvic pain, and obvious symptoms, chronic endometritis
often remains silent or presents with mild symptoms such as abnormal vaginal discharge, mild

 

 

pelvic discomfort, or irregular bleeding. It is increasingly recognized as an important factor
associated with unexplained infertility, recurrent implantation failure to the uterine lining, and
recurrent pregnancy loss.

 

Mrs. K, a 39-year-old woman, along with her 40-year-old husband, visited Milann – Fertility and
Birthing Hospital, Bengaluru in June 2024 with concerns regarding difficulty conceiving their
second child for the past five years. The couple had been married for 12 years and had one
previous live birth, a 10 year old daughter. Mrs. K had regular menstrual cycles with normal

 

flow and no pain. She was a known case of hypothyroidism, a condition where the thyroid
gland does not produce enough thyroid hormones, and was taking Thyronorm 12.5 mcg. Her
husband, an IT professional, was also diagnosed with hypothyroidism and hypertension, both
of which were under control with medication.

 

Before approaching Milann, the couple had undergone two unsuccessful cycles of ovulation
induction with intrauterine insemination (IUI).

 

During evaluation, Mrs. K had a BMI of 34.6 kg/m², haemoglobin of 13 g/dL, TSH of 3.5 mIU/mL,
HbA1c of 5.3%, Anti Müllerian Hormone (AMH) of 1.27 ng/mL, and non reactive serology.
Hysterosalpingography (HSG), an imaging test used to check the condition of fallopian tubes,
and here both tubes were patent (open).

 

Pelvic ultrasound revealed an anteverted, anteflexed bulky uterus with features suggestive of
adenomyosis. Adenomyosis is a condition where tissue similar to the inner lining of the uterus

 

 

grows into the muscular wall of the uterus and may interfere with embryo implantation. The
endometrial thickness was 7.6 mm. The ovarian reserve was satisfactory, with 7–8 antral
follicles in the right ovary and 8 follicles in the left ovary. Her husband’s semen analysis showed

 

teratozoospermia, a condition where sperm have abnormal shapes that may affect their ability
to fertilize an egg. Considering the couple’s age, previous failed IUI attempts, adenomyosis, and
male factor infertility, IVF/ICSI was planned.

 

The patient underwent an antagonist stimulation protocol, where fertility medications are used
to stimulate multiple eggs while preventing premature ovulation. She received Inj. Menopur
375 IU, and oocyte retrieval was performed 35 hours after dual trigger administration. A total

 

of 10 eggs were retrieved, of which 8 were mature eggs. All eight mature eggs fertilized
successfully, resulting in eight developing embryos and five blastocysts, which are advanced
stage embryos suitable for transfer.

 

The blastocysts were graded as three 3AB, one 3BB, and one 3BC based on their appearance
and developmental quality. Considering the presence of adenomyosis, a Mirena intrauterine
system was inserted during egg retrieval to help optimize the uterine environment before
embryo transfer.

 

One 3AB blastocyst underwent PGT-A (Preimplantation Genetic Testing for Aneuploidy), a
genetic screening procedure performed on embryos before transfer to identify chromosome
abnormalities. The test showed one euploid embryo, meaning an embryo with the correct

 

number of chromosomes and a higher potential for successful implantation. The remaining
embryos were found to have chromosomal abnormalities.

 

The couple returned in May 2025 for Mirena removal and preparation for frozen embryo
transfer. However, multiple hormone replacement therapy (HRT) cycles, where medications are
used to prepare the uterine lining for embryo transfer, had to be cancelled due to persistent

 

infection symptoms and unhealthy vaginal discharge. This prompted further investigation into
the condition of the uterine lining.

 

A hysteroscopy, a minimally invasive procedure using a thin camera to examine the inside of
the uterus, was performed along with an endometrial biopsy. The biopsy samples were
evaluated through histopathological examination, culture and sensitivity testing, and
immunohistochemistry (IHC), a specialized laboratory technique that uses specific markers to
identify certain cells.

 

 

The immunohistochemistry results revealed 20 MUM-1 positive plasma cells, confirming the
diagnosis of chronic endometritis. Plasma cells are immune cells that normally help fight
infections, but their presence in increased numbers within the uterine lining indicates
persistent inflammation.

 

The patient was treated with targeted antibiotic therapy, along with vaginal probiotics to help
restore healthy vaginal bacteria.

 

Following successful treatment of chronic endometritis, a modified natural cycle preparation
was performed. The single euploid 3AB embryo was transferred, resulting in a positive
pregnancy with a beta hCG level of 590 IU/mL. The patient is currently progressing well with an
ongoing pregnancy of seven weeks.

 

Dr. Shilpa Ellur, Senior Consultant, Reproductive Medicine & High-Risk Obstetrics, Milann
Fertility and Birthing Hospital, Bengaluru, said, “Chronic endometritis is a silent but significant
cause of infertility and recurrent implantation failure, and this case reinforces the importance of

looking beyond routine evaluations when pregnancy does not occur. With advanced diagnostics

 

such as hysteroscopy and immunohistochemistry, followed by targeted treatment, we were able
to identify the hidden barrier to implantation and help the patient achieve a successful IVF
pregnancy. This outcome is a powerful reminder that personalized care and timely intervention
can transform even the most challenging fertility journeys.”

 

The patient shared, “After years of waiting and multiple unsuccessful attempts, achieving this
pregnancy feels like a dream come true. The support, guidance, and personalized care we
received at Milann gave us renewed hope. We are deeply grateful to Dr. Shilpa Ellur and the
entire team for helping us overcome this challenging journey.”

 

This case highlights the importance of considering chronic endometritis as a hidden factor in
patients facing implantation challenges. While chronic endometritis is a recognized condition in
reproductive medicine, its silent nature often makes diagnosis difficult. Through advanced

 

diagnostic evaluation, timely treatment, and personalized fertility care, Milann successfully
identified and addressed this hidden barrier, helping the couple move closer to achieving their
dream of parenthood.