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limitations of this test. Notably, endometrial epithelial cells frequently express CD138, which can reduce speci city of CD138 staining and lead to overdiagnosis [27]. Furthermore, the results of CD138 testing can vary tremendously based on the clinical laboratory, their protocols for anti-CD138 antibody selection and dilution, and timing and method of endometrial sampling [27, 32].
Several treatment regimens have been studied in women with RIF and chronic endometritis. McQueen et al. reviewed 35 cases of chronic endometritis, most of which were treated with ofoxacin 400 mg and metronidazole 500 mg twice daily for 14 days. The test of cure was 94% after a single course of antibiotics, and the cure rate was 100% after two courses. Of note, nine patients in this study received an alternative antibiotic regimen—doxycycline, doxycycline, and metronidazole, or ciprofoxacin and metronidazole [33]. Doxycycline 100 mg twice daily for 14 days is another regimen commonly used in clinical practice, with proven ef cacy in patients with RIF [34]
Conclusion
In conclusion, we described the case of a patient with RIF who failed three medicated frozen embryo transfer cycles with euploid blastocysts. Her ERA revealed a receptive endometrium and her endometrial biopsy did not show any evidence of chronic endometritis. She did not have any risk factors for Asherman’s syndrome, and her endometrial thickness was adequate during all of her frozen embryo transfer cycles. We ultimately offered her a diagnostic hysteroscopy for further endometrial assessment, as well as additional frozen embryo transfer cycles at our center. We also discussed the option of surrogacy. As evidenced by this case, RIF can be challenging for clinicians and frustrating for patients. The American Society for Reproductive Medicine (ASRM) lists signi cant uterine anomaly and unidenti ed endometrial factor among indications for use of a gestational carrier [35]. Women with severe intrauterine adhesions not amenable to surgical repair or RIF despite transfer of high-quality embryos should also be counseled on the option of surrogacy.
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Chapter 22
Recurrent Pregnancy Loss
Steven Spandorfer
Case
A 37-year-old G3P0030 with a 1-year history of trying to conceive but with 3 consecutive miscarriages is referred for an evaluation. She is currently cycle day 11 and will not had unprotected intercourse until she felt that she “better understands the cause of her miscarriages”.
All three miscarriages occurred at approximately 7–9 weeks of gestation. She did not have a D&C for any of the pregnancies and required no instrumentation in passing the pregnancies. She reports no diffculties in getting pregnant, usually conceiving in the frst 1–2 months of trying. She has had no testing yet except for preconception panels for her and her partner that were discordant for genetic abnormalities. She has taken no medications other than prenatal vitamins as recommended by her obstetrician. She specifcally denies any history of thyroid disease. She denies a family history of miscarriages or “blood clotting” disorders. She did feel “like a failure” and that she had “let her husband and her family down” with these miscarriages.
She reported menarche at age 12 and previously regular menses with 28-day cycles. Her GYN history is otherwise unremarkable. She was up to date on her routine health care maintenance. Her past medical history was not contributory. She had a surgical history signifcant for an uncomplicated tonsillectomy at age 7. Her family history was signifcant for hypothyroidism in her mother and coronary artery disease in her father. She did not have any family history of cancer. She is a non- smoker, denies illicit drug use, and consumes alcohol socially (1–2 glasses per week).
S. Spandorfer (*)
Reproductive Medicine and Ob/Gyn, The Ronald Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Medical College of Cornell University, New York, NY, USA e-mail: sdspando@med.cornell.edu
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P. H. Chung, Z. Rosenwaks (eds.), Problem-Focused Reproductive Endocrinology and Infertility, Contemporary Endocrinology, https://doi.org/10.1007/978-3-031-19443-6_22