Diagnosis and Management of Chronic Endometritis: Effects on Postoperative Pregnancy Outcomes in Endometriosis Patients with Proximal Tubal Obstruction Undergoing Hysteroscopic Tubal Catheterization and Laparoscopy.

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-laparoscopy. 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 < 0.05). Notably, the diagnosis and treatment of CE emerged as a protective factor for cumulative natural pregnancy (HR, 1.78; 95% CI, 1.06-2.97; 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.