الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Women with RIF have a high incidence of intrauterine abnormalities, and hysteroscopy is proved to be very effective in detecting and treating occult lesions that HSG or TVS had not previously identified.
Chronic endometritis is accused to be an important reason for recurrent embryo implantation failure as it has high prevalence rate among women with recurrent ICSI failure.
The presence of endometrial hyperemia, micropolyps, and mucosal edema during hysteroscopy are reliable findings of CE.
Hysteroscopy has modest accuracy in diagnosis CE due to slightly low sensitivity but, hysteroscopy is found to have high specificity and NPV which means when the hysteroscopic features are absent, diagnosis of CE is unlikely.
It has been observed that the presence of more than one of these hysteroscopic features (combination of two or more abnormal hysteroscopic findings) did significantly increase the likelihood of histologically positive CE. Since the combination of the above hysteroscopic criteria would increase the specificity and PPV of hysteroscopy in diagnosis CE.
The presence of previously mentioned abnormal hysteroscopic features during hysteroscopy should alert to the diagnosis of CE, and endometrial biopsy for histological analysis must be done at the same session preferred with CD138 IHC to confirm the diagnosis of CE. However, the absence of any abnormal hysteroscopic findings does not completely rule out the diagnosis of CE in all cases even with high specificity of hysteroscopy, so hysteroscopy alone should not be relied upon to exclude the diagnosis of CE particularly in women at high risk of CE, such as infertile women with RIF. So, plasma cell detection of endometrial biopsy specimen by using IHC with CD138 should be added side to side with hysteroscopy to increase the detection rate of CE in women with RIF.
To conclude, a negative diagnostic value of hysteroscopy is high and its ability to exclude the presence of CE should be adequate, without the use of histological confirmation. But, in patients with RIF at high risk of CE, histopathological examination of endometrium by using IHC with CD138 is important to detect most of cases with CE. Thus, combination between the two diagnostic modalities (hysteroscopy and CD138 IHC) will help in detection most of cases with CE.