Determining a Treatment Regimen With Optimal Pregnancy Outcomes in Patients With Chronic Endometritis: A Systematic Review and Network Meta‐Analysis

ABSTRACT Background and Aims Chronic endometritis (CE) negatively impacts pregnancy outcomes. This study aimed to compare the efficacy of various treatment regimens on pregnancy outcomes in women with CE. Methods We performed a systematic review followed by an NMA in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. The primary outcome indicator in the network meta‐analysis was the live birth rate, with secondary outcome including clinical pregnancy rate, ongoing pregnancy rate, and early miscarriage rate. Results A comprehensive search yielded 2290 articles, of which 24 trials fulfilled the eligibility requirements for inclusion. Out of these, 14 studies were incorporated into the network meta‐analysis to assess the pregnancy outcomes in women with CE. For live birth outcomes, antibiogram‐guided treatment had the largest surface score under the cumulative sorting curve, but the results from the network meta‐analysis indicated that no treatment improve live births in women with CE. The reports on ongoing and clinical pregnancy outcomes revealed significant findings regarding the effectiveness of Doxycycline plus Prednisone and Nitroimidazole plus Quinolones. Specifically, both treatment combinations significantly enhanced the chances of sustained pregnancy (RR = 1.82, 95% CI = 1.12–2.96 and RR = 1.81, 95% CI = 1.03–3.18, respectively) and clinical pregnancy (RR = 1.65, 95% CI = 1.11–2.44 and RR = 1.47, 95% CI = 1.03–2.10, respectively) in women with CE. Conversely, other treatment options failed to demonstrate any improvement in sustained pregnancy and clinical pregnancy outcomes. In the report focusing on early miscarriage outcomes, none of the treatments examined showed a statistically significant reduction in the rate of miscarriage. Conclusion Current evidence from this network meta‐analysis does not demonstrate that any single antibiotic regimen significantly improves live birth rates in women with CE. While secondary outcome analyses suggest potential benefits of combining antibiotics with prednisone or specific dual‐antibiotic regimens for clinical and ongoing pregnancy rates, these exploratory findings require cautious interpretation and validation through large‐scale RCTs.