Patient: Dr. Malpani, my IVF doctor, suggested a CD138 test to check for chronic endometritis (CE). He said it could explain why my embryos aren’t implanting. Should I get it done?
Dr. Malpani: Absolutely not! The CD138 test is just another unnecessary, money-making gimmick that some IVF clinics push on patients. There’s no solid evidence that this test improves IVF success.
Patient: But isn’t chronic endometritis a real condition?
Dr. Malpani: Yes, chronic endometritis (CE) exists, but it’s overdiagnosed and overtreated in IVF. Many women have mild endometrial inflammation, which is completely normal and doesn’t affect implantation. The presence of a few plasma cells in a biopsy doesn’t mean you have a problem.
Patient: My doctor said that if my CD138 test is positive, I’ll need antibiotics to clear the infection. Won’t that help?
Dr. Malpani: That’s the trap! Many clinics use CD138 results as an excuse to prescribe unnecessary antibiotics. But the truth is:
- There’s no proof that treating CD138-positive women improves IVF success.
- The test doesn’t differentiate between mild inflammation and a real infection.
- Overuse of antibiotics can cause more harm than good.
Patient: So, what exactly does the CD138 test measure?
Dr. Malpani: It looks for plasma cells in the endometrium, which are sometimes linked to chronic endometritis. But here’s the problem—CD138 staining often picks up a few normal plasma cells that aren’t harmful at all!
Patient: But my doctor said chronic endometritis could be the reason for my recurrent implantation failure (RIF). Shouldn’t I at least check?
Dr. Malpani: That’s just speculation. There’s no strong evidence that CE causes implantation failure. Most failed IVF cycles happen because of embryo quality, not endometrial inflammation. Instead of wasting time on this test, focus on things that actually matter—like ensuring you have a good-quality embryo and a receptive endometrial lining on ultrasound.
Patient: If CE doesn’t really affect implantation, why do so many IVF clinics recommend CD138 testing?
Dr. Malpani: Simple—it’s a business! IVF is expensive, and many clinics add unnecessary tests to increase their profits. They sell it as a “customised” approach, but in reality, it’s just an expensive distraction.
Patient: Is there any situation where this test is useful?
Dr. Malpani: Very rarely. If a woman has clear symptoms of chronic endometritis—like persistent abnormal bleeding or pelvic pain—then testing might make sense. But for a woman with repeated IVF failures and no symptoms, CD138 testing is completely useless.
Patient: So, what should I do instead of this test?
Dr. Malpani: Focus on what actually improves IVF success:
- Good embryo quality (consider PGT testing if needed)
- A thick, trilaminar endometrial lining on ultrasound
- A competent IVF lab, not one that sells unproven tests
Summary
The CD138 test for chronic endometritis (CE) is marketed as a way to diagnose implantation failure in IVF, but Dr. Malpani debunks it as a misleading and unnecessary test.
Why CD138 Testing Is NOT Helpful for IVF Patients:
- Mild inflammation is common and doesn’t necessarily impact implantation.
- CD138-positive plasma cells don’t always indicate a problem.
- There’s no strong evidence that treating chronic endometritis improves pregnancy rates.
- Major fertility organisations (ASRM, ESHRE) do not recommend routine CD138 testing.
success—good-quality embryos, a receptive endometrium, and a reliable fertility specialist!
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