Development and Preliminary Validation of the SHUDE Scoring System for Chronic Endometritis in Women With Previous Reproductive Failure Undergoing In Vitro Fertilization Treatment

BackgroundChronic endometritis (CE) has been increasingly recognized in women with infertility and previous reproductive failure, but its diagnosis remains challenging because clinical, hysteroscopic, and histopathological findings may vary between individuals.Hysteroscopy provides direct visualization of the endometrial cavity; however, individual hysteroscopic findings may have limited diagnostic value when considered in isolation.The present study aimed to develop and pilot-test the SHUDE scoring system, a standardized multidomain scoring framework for the structured assessment of CE in women with previous reproductive failure undergoing in vitro fertilization. MethodsFollowing approval from the Institutional Ethics Committee, this methodological study was conducted at a tertiary care center.Thirty eligible women with infertility and a history of reproductive failure were included for the pilot assessment of the scoring system.The SHUDE scoring system comprised six domains: demographic characteristics, reproductive history, clinical history, clinical examination, hysteroscopic findings, and evidence of endometrial tuberculosis.Content validity was assessed using a four-point relevance scale by a multidisciplinary panel of six experts comprising reproductive medicine specialists, obstetricians and gynecologists, and clinicians experienced in diagnostic hysteroscopy.The item-level content validity index (I-CVI) and scale-level content validity index based on the average method (S-CVI/Ave) were calculated.Internal consistency was assessed using Cronbach's alpha. ResultsThe six domains demonstrated acceptable content validity, with I-CVI values ranging from 0.83 to 1.00 and an overall S-CVI/Ave of 0.94.Pilot testing among 30 eligible women yielded a Cronbach's alpha of 0.84, indicating good internal consistency across the six domains. ConclusionThe SHUDE scoring system demonstrated high content validity and good internal consistency in this preliminary evaluation.These findings provide initial support for the relevance and coherence of the scoring framework but do not establish its diagnostic accuracy or an optimal diagnostic threshold.Further evaluation in larger, independent populations is required to determine its diagnostic performance, reproducibility, and potential clinical applicability.