Endometrial tuberculosis increases miscarriage risk after IVF/ICSI compared with non-specific chronic endometritis

Abstract Background Chronic endometritis (CE) has two principal subtypes—non-specific chronic endometritis (NSCE) and endometrial tuberculosis (ETB). Both can adversely affect embryo implantation. Although ETB is generally more severe, its low incidence has limited comparative data on assisted reproductive outcomes versus NSCE. A direct comparison of pregnancy outcomes following in vitro fertilization (IVF) or intracytoplasmic sperm injection-embryo transfer (ICSI-ET) between patients with ETB and those with NSCE would help clarify whether differential management strategies are warranted and provide more precise guidance for clinical practice. Methods In this single-center retrospective study, clinical data were collected from infertile patients who underwent IVF/ICSI-ET at West China Second University Hospital, Sichuan University, between January 2019 and December 2024. All patients were diagnosed via hysteroscopic endometrial biopsy. ETB was verified through histopathology along with positive nucleic acid testing for the Mycobacterium tuberculosis complex, whereas NSCE was diagnosed by histopathology in combination with CD138 immunohistochemical staining. Results A total of 409 patients were included: 27 in the ETB group and 382 in the NSCE group. No significant differences were observed between the two groups in age, duration of infertility, baseline FSH level, or number of embryos transferred (P > 0.05). The clinical pregnancy rate was comparable between the ETB group (51.9%) and the NSCE group (49.0%) (P > 0.05). However, the live birth rate was numerically lower in the ETB group (30.0%) than in the NSCE group (42.4%), though this difference was not statistically significant (P > 0.05). A significant difference was found in the miscarriage rate between the two groups with the ETB group having a higher miscarriage rate (P < 0.05). Multivariate regression analysis identified ETB as an independent risk factor for miscarriage after IVF/ICSI-ET. Conclusions In patients undergoing IVF/ICSI-ET, ETB is associated with a significantly higher risk of miscarriage compared to NSCE, despite similar clinical pregnancy rates. This underscores the need for distinct clinical management and counseling in ETB cases.