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Xia Q, Lv S, Xu H, Wang X, Xie Z, Lin R, Zhang J, Shu C, Chen Z, Gong X. Non-invasive evaluation of endometrial microvessels via in vivo intrauterine photoacoustic endoscopy. PHOTOACOUSTICS 2024; 36:100589. [PMID: 38318428 PMCID: PMC10839775 DOI: 10.1016/j.pacs.2024.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
The endometrium microvessel system, responsible for supplying oxygen and nutrients to the embryo, holds significant importance in evaluating endometrial receptivity (ER). Visualizing this system directly can significantly enhance ER evaluation. Currently, clinical methods like Narrow-band hysteroscopy and Color Doppler ultrasound are commonly used for uterine blood vessel examination, but they have limitations in depth or resolution. Endoscopic Photoacoustic Imaging (PAE) has proven effective in visualizing microvessels in the digestive tract, while its adaptation to uterine imaging faces challenges due to the uterus's unique physiological characteristics. This paper for the first time that uses high-resolution PAE in vivo to capture a comprehensive network of endometrial microvessels non-invasively. Followed by continuous observation and quantitative analysis in the endometrial injury model, we further corroborated that PAE detection of endometrial microvessels stands as a valuable indicator for evaluating ER. The PAE system showcases its promising potential for integration into reproductive health assessments.
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Affiliation(s)
- Qingrong Xia
- Institute of Medical Imaging, University of South China, Hengyang 421001, China
- Affiliated Nanhua Hospital, University of South China, Hengyang 421002, China
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Shengmiao Lv
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Haoxing Xu
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Xiatian Wang
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Zhihua Xie
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Riqiang Lin
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Department of Electrical and Electronic Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Jinke Zhang
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Chengyou Shu
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
| | - Zhiyi Chen
- Institute of Medical Imaging, University of South China, Hengyang 421001, China
- Institution of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha 410000, China
| | - Xiaojing Gong
- Research Center for Biomedical Optics and Molecular Imaging, Key Laboratory of Biomedical Imaging Science and System, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
- Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055, China
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Cellier M, Werlen S, Lionel M, Genod A, Felloni B, Semay T, Trombert B, Chauleur C, Raia-Barjat T. Endometrial biopsy performed before the first in vitro fertilization does not impact the early pregnancy rate. Sci Rep 2024; 14:1153. [PMID: 38212636 PMCID: PMC10784516 DOI: 10.1038/s41598-023-50715-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/23/2023] [Indexed: 01/13/2024] Open
Abstract
Endometrial biopsy (EB) has been showed to increase the rate of clinical pregnancy in patients who underwent in vitro fertilization (IVF) failures. The purpose of this work was to assess the impact of an EB performed before the first in IVF on the early pregnancy rate. Be One study is a prospective, single-centre, randomized, open-label study. In this parallel study, patients were evenly split into two groups. In one group, patients underwent an EB between days 17 and 22 of the menstrual cycle that precedes the ovarian stimulation. In the other group (control), no EB was performed. The hCG-positive rate (early pregnancy rate) was evaluated on day 14 after the ovarian puncture. In total, 157 patients were randomized in the EB group and 154 patients were in the control group. The early pregnancy rate was 33.1% (52/157) in the EB group and 29.9% (46/154) in the control group (p = 0.54). Other parameters, including perforation, endometritis, or pain level were reassuring. An EB performed during the luteal phase of the menstrual cycle preceding the stimulation of the first IVF did not increase early pregnancy rate.
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Affiliation(s)
- Mathilde Cellier
- Department of Gynecology and Obstetrics, Hôpital Nord, University Hospital, Avenue Albert Raimond, Saint Priest en Jarez, 42270, Saint-Étienne, France
| | - Sophie Werlen
- Department of Gynecology and Obstetrics, Hôpital Privé de la Loire, Saint-Étienne, France
| | - Mery Lionel
- Department of Reproductive Biology, University Hospital Saint Etienne, Saint-Étienne, France
| | - Anne Genod
- Department of Gynecology and Obstetrics, Hôpital Privé de la Loire, Saint-Étienne, France
| | - Bertrand Felloni
- Department of Gynecology and Obstetrics, Hôpital Nord, University Hospital, Avenue Albert Raimond, Saint Priest en Jarez, 42270, Saint-Étienne, France
| | - Tiphaine Semay
- Department of Gynecology and Obstetrics, Hôpital Nord, University Hospital, Avenue Albert Raimond, Saint Priest en Jarez, 42270, Saint-Étienne, France
| | - Béatrice Trombert
- Department of Public Health, University Hospital, Saint-Étienne, France
| | - Céline Chauleur
- Department of Gynecology and Obstetrics, Hôpital Nord, University Hospital, Avenue Albert Raimond, Saint Priest en Jarez, 42270, Saint-Étienne, France
- Jean Monet Saint-Etienne University, INSERM, SAINBIOSE (SAnte, INgénierie, BIOlogie, Saint- Etienne) U1059, Saint-Étienne, France
| | - Tiphaine Raia-Barjat
- Department of Gynecology and Obstetrics, Hôpital Nord, University Hospital, Avenue Albert Raimond, Saint Priest en Jarez, 42270, Saint-Étienne, France.
- Jean Monet Saint-Etienne University, INSERM, SAINBIOSE (SAnte, INgénierie, BIOlogie, Saint- Etienne) U1059, Saint-Étienne, France.
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van Hoogenhuijze NE, Lahoz Casarramona G, Lensen S, Farquhar C, Kamath MS, Kunjummen AT, Raine-Fenning N, Berntsen S, Pinborg A, Mackens S, Inal ZO, Ng EHY, Mak JSM, Narvekar SA, Martins WP, Steengaard Olesen M, Torrance HL, Mol BW, Eijkemans MJC, Wang R, Broekmans FJM. Endometrial scratching in women undergoing IVF/ICSI: an individual participant data meta-analysis. Hum Reprod Update 2023; 29:721-740. [PMID: 37336552 PMCID: PMC10628489 DOI: 10.1093/humupd/dmad014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 03/23/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND In IVF/ICSI treatment, the process of embryo implantation is the success rate-limiting step. Endometrial scratching has been suggested to improve this process, but it is unclear if this procedure increases the chance of implantation and live birth (LB) and, if so, for whom, and how the scratch should be performed. OBJECTIVE AND RATIONALE This individual participant data meta-analysis (IPD-MA) aims to answer the question of whether endometrial scratching in women undergoing IVF/ICSI influences the chance of a LB, and whether this effect is different in specific subgroups of women. After its incidental discovery in 2000, endometrial scratching has been suggested to improve embryo implantation. Numerous randomized controlled trials (RCTs) have been conducted, showing contradicting results. Conventional meta-analyses were limited by high within- and between-study heterogeneity, small study samples, and a high risk of bias for many of the trials. Also, the data integrity of several trials have been questioned. Thus, despite numerous RCTs and a multitude of conventional meta-analyses, no conclusion on the clinical effectiveness of endometrial scratching could be drawn. An IPD-MA approach is able to overcome many of these problems because it allows for increased uniformity of outcome definitions, can filter out studies with data integrity concerns, enables a more precise estimation of the true treatment effect thanks to adjustment for participant characteristics and not having to make the assumptions necessary in conventional meta-analyses, and because it allows for subgroup analysis. SEARCH METHODS A systematic literature search identified RCTs on endometrial scratching in women undergoing IVF/ICSI. Authors of eligible studies were invited to share original data for this IPD-MA. Studies were assessed for risk of bias (RoB) and integrity checks were performed. The primary outcome was LB, with a one-stage intention to treat (ITT) as the primary analysis. Secondary analyses included as treated (AT), and the subset of women that underwent an embryo transfer (AT+ET). Treatment-covariate interaction for specific participant characteristics was analyzed in AT+ET. OUTCOMES Out of 37 published and 15 unpublished RCTs (7690 participants), 15 RCTs (14 published, one unpublished) shared data. After data integrity checks, we included 13 RCTs (12 published, one unpublished) representing 4112 participants. RoB was evaluated as 'low' for 10/13 RCTs. The one-stage ITT analysis for scratch versus no scratch/sham showed an improvement of LB rates (odds ratio (OR) 1.29 [95% CI 1.02-1.64]). AT, AT+ET, and low-RoB-sensitivity analyses yielded similar results (OR 1.22 [95% CI 0.96-1.54]; OR 1.25 [95% CI 0.99-1.57]; OR 1.26 [95% CI 1.03-1.55], respectively). Treatment-covariate interaction analysis showed no evidence of interaction with age, number of previous failed embryo transfers, treatment type, or infertility cause. WIDER IMPLICATIONS This is the first meta-analysis based on IPD of more than 4000 participants, and it demonstrates that endometrial scratching may improve LB rates in women undergoing IVF/ICSI. Subgroup analysis for age, number of previous failed embryo transfers, treatment type, and infertility cause could not identify subgroups in which endometrial scratching performed better or worse. The timing of endometrial scratching may play a role in its effectiveness. The use of endometrial scratching in clinical practice should be considered with caution, meaning that patients should be properly counseled on the level of evidence and the uncertainties.
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Affiliation(s)
- Nienke E van Hoogenhuijze
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
| | - Cindy Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aleyamma T Kunjummen
- Department of Reproductive Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nick Raine-Fenning
- Nurture Fertility, The Fertility Partnership, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sine Berntsen
- Department of Obstetrics and Gynaecology, Fertility Clinic, Hvidovre, Copenhagen, Denmark
- University Hospital Hvidovre, Hvidovre, Denmark
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Shari Mackens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium
| | - Zeynep Ozturk Inal
- Department of Obstetrics, Konya Education and Research Hospital, Konya, Turkey
| | - Ernest H Y Ng
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Jennifer S M Mak
- Department of Obstetrics and Gynaecology, Assisted Reproduction Technology Unit, Prince of Wales Hospital, the Chinese University of Hong Kong 9F, Hong Kong SAR
| | - Sachin A Narvekar
- Department of Reproductive Medicine, Bangalore Assisted Conception Center, Bangalore, Karnataka, India
| | | | | | - Helen L Torrance
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, VIC, Australia
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, UK
| | - Marinus J C Eijkemans
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, VIC, Australia
| | - Frank J M Broekmans
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
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Papanikolaou E, Peitsidis N, Tsakiridis I, Michos G, Skalias A, Patoulias D, Poutoglidis A, Mamopoulos A, Athanasiadis A, Grimpizis G, Najdecki R. Endometrial scratching during hysteroscopy in women undergoing in vitro fertilization: a systematic review and meta-analysis. Front Surg 2023; 10:1225111. [PMID: 37795147 PMCID: PMC10546045 DOI: 10.3389/fsurg.2023.1225111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
Objective Endometrial scratching (ES) during hysteroscopy before embryotransfer (ET) remains doubtable on whether it benefits the reproductive outcomes. The optimal technique is not clear and repeated implantation failure as a challenging field in in vitro fertilization (IVF) seems to be the springboard for clinicians to test its effectiveness. Methods Medline, PMC, ScienceDirect, Scopus, CENTRAL, Google Scholar were searched from their inception up to April 2023 for studies to evaluate the effectiveness of adding endometrial scratching during hysteroscopy before ET. Results The initial search yielded 959 references, while 12 eligible studies were included in the analyses, involving 2,213 patients. We found that hysteroscopy and concurrent ES before ET resulted in a statistically significant improvement in clinical pregnancy rate (CPR) [RR = 1.50, (95% CI 1.30-1.74), p < 0.0001] and live birth rate (LBR) [RR = 1.67, (95% CI 1.30-2.15), p < 0.0001] with no statistically significant difference on miscarriage rate [RR = 0.80 (95% CI 0.52-1.22), p = 0.30]. Conclusion Our meta-analysis suggests that hysteroscopy with concurrent ES may be offered in IVF before ET as a potentially improving manipulation. Future randomized trials comparing different patient groups would also provide more precise data on that issue, to clarify specific criteria in the selection of patients. Systematic Review Registration PROSPERO (CRD42023414117).
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Affiliation(s)
| | - Nikolaos Peitsidis
- Assisting Nature IVF Centre and Genetics, Thessaloniki, Greece
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Michos
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Skalias
- 2nd Academic Otorhinolaryngology, Head and Neck Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Patoulias
- Department of Obstetrics and Gynaecology, Interbalkan Hospital, Thessaloniki, Greece
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology, Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigorios Grimpizis
- 1st Department of Obstetrics and Gynaecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert Najdecki
- Assisting Nature IVF Centre and Genetics, Thessaloniki, Greece
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Scheliga I, Baston-Buest DM, Poschmann G, Stuehler K, Kruessel JS, Bielfeld AP. Closer to the Reality-Proteome Changes Evoked by Endometrial Scratching in Fertile Females. Int J Mol Sci 2023; 24:13577. [PMID: 37686380 PMCID: PMC10488085 DOI: 10.3390/ijms241713577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Endometrial scratching (ES) has been widely used in assisted reproductive technology to possibly improve pregnancy rates, but its exact mechanism is still not understood or investigated, and its benefits are controversially discussed. Hypothetically, ES may trigger a local immune response, leading to an improved endometrial receptivity. So far, it has been shown that ES affects the gene expression of cytokines, growth factors, and adhesive proteins, potentially modulating inflammatory pathways and adhesion molecule expression. Our pilot study applying proteomic analysis reveals that ES probably has an impact on the proteins involved in immune response pathways and cytoskeleton formation, which could potentially increase endometrial receptivity. Specifically, proteins that are involved in the immune response and cytoskeleton regulation showed a trend toward higher abundance after the first ES. On the other hand, proteins with a decreasing abundance after the first ES play roles in the regulation of the actin cytoskeleton and cellular processes such as intracellular transport, apoptosis, and autophagy. These trends in protein changes suggest that ES may affect endometrial tissue stiffness and extracellular matrix remodeling, potentially enhancing the embryos' implantation. To our knowledge, this pilot study provides, for the first time, data investigating potential changes in the endometrium due to the scratching procedure that might explain its possible benefit for patients in infertility treatment. Furthermore, the proteome of a group of patients suffering from repeated implantation failure was compared to that of the fertile group in order to transfer the basic science to clinical routine and application.
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Affiliation(s)
- Iwona Scheliga
- Department of OB/GYN and REI (UniKiD), Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University, 40255 Duesseldorf, Germany
| | - Dunja M Baston-Buest
- Department of OB/GYN and REI (UniKiD), Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University, 40255 Duesseldorf, Germany
| | - Gereon Poschmann
- Institute for Molecular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University, 40225 Duesseldorf, Germany
| | - Kai Stuehler
- Institute for Molecular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University, 40225 Duesseldorf, Germany
- Molecular Proteomics Laboratory, Biomedical Research Centre (BMFZ), Heinrich-Heine-University, Universitätsstrasse 1, 40225 Duesseldorf, Germany
| | - Jan-Steffen Kruessel
- Department of OB/GYN and REI (UniKiD), Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University, 40255 Duesseldorf, Germany
| | - Alexandra P Bielfeld
- Department of OB/GYN and REI (UniKiD), Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine University, 40255 Duesseldorf, Germany
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Coutanceau B, Dos Santos E, Swierkowski Blanchard N, Sanchez Louboutin A, Boitrelle F, Margueritte F, Vialard F, Serazin V, Fathallah K. Should the Treatment of Patients with Repeated Embryo Implantation Failure Be Adapted as a Function of the Endometrial Cytokine Profile? A Single-Center Experience. Biomedicines 2023; 11:biomedicines11030817. [PMID: 36979796 PMCID: PMC10044898 DOI: 10.3390/biomedicines11030817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
Repeated embryo implantation failures (RIF) is a source of distress and frustration for patients and clinicians alike. Today's approaches for treating RIF are largely empirical and have limited effectiveness. The main causes of RIF are poor endometrial receptivity and poor-quality embryos. Recent studies have suggested the involvement of immune dysregulation due to an imbalance between T-helper (Th) 1 and Th2 cytokines; this opens up perspectives for treating women with RIF and increasing the implantation rate. We conducted an interventional, longitudinal, prospective cohort study of the impact of correcting the cytokine imbalance on the clinical pregnancy rate in women with RIF. Seventy-seven women with RIF underwent an endometrial biopsy during the implantation window. The cytokine profile was evaluated by studying the activation and maturation of uterine natural killer (uNK) cells, the IL-15/Fn-14 mRNA ratio (a biomarker of uNK activation/maturation), and the IL-18/TWEAK mRNA ratio (a marker of angiogenesis and the Th1/Th2 balance). Personalized treatment was initiated for women with an abnormal endometrial cytokine profile (hyper-activation or hypo-activation). We documented the clinical pregnancy rate after subsequent embryo transfers. In total, 72.7% (56/77) of patients had an abnormal endometrial cytokine profile (hyper-activation in 68.8% (n = 53) and hypo-activation in 3.9% (n = 3). After treatment (or not) as a function of the endometrial profile, the overall clinical pregnancy rate was 30.2%. Our results indicated a potential positive effect of appropriate treatment on the ongoing pregnancy rate in women with RIF, despite the small number of cases analyzed. The results must now be validated in randomized studies with larger numbers of well-characterized patients. By applying a previously published decision tree, this treatment approach could be implemented in clinics worldwide.
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Affiliation(s)
- Bérangère Coutanceau
- Department of Obstetrics and Gynaecology, Poissy-Saint-Germain-en-Laye Hospital, 78300 Poissy, France
| | - Esther Dos Santos
- Medical Biology Laboratory, Poissy-Saint-Germain-en-Laye Hospital, 78300 Poissy, France
- RhUMA Team, UMR-BREED (INRAE, UVSQ, ENVA), UFR Simone Veil-Santé, 78180 Montigny le Bretonneux, France
| | | | - Anne Sanchez Louboutin
- Department of Anatomy and Pathology, Poissy-Saint-Germain-en-Laye Hospital, 78300 Poissy, France
| | - Florence Boitrelle
- Reproductive Biology Department, Poissy-Saint-Germain-en-Laye Hospital, 78300 Poissy, France
| | - François Margueritte
- Department of Obstetrics and Gynaecology, Poissy-Saint-Germain-en-Laye Hospital, 78300 Poissy, France
| | - François Vialard
- RhUMA Team, UMR-BREED (INRAE, UVSQ, ENVA), UFR Simone Veil-Santé, 78180 Montigny le Bretonneux, France
- Department of Genetics, Poissy-Saint-Germain-en-Laye Hospital, 78300 Poissy, France
| | - Valérie Serazin
- Medical Biology Laboratory, Poissy-Saint-Germain-en-Laye Hospital, 78300 Poissy, France
- RhUMA Team, UMR-BREED (INRAE, UVSQ, ENVA), UFR Simone Veil-Santé, 78180 Montigny le Bretonneux, France
| | - Khadija Fathallah
- Department of Obstetrics and Gynaecology, Poissy-Saint-Germain-en-Laye Hospital, 78300 Poissy, France
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Celik O, Yurci A, Ersahin A, Gungor ND, Celik N, Ozcil MD, Dogan S, Dalkilic S, Dalkilic L, Ulug U, Celik S, Tinelli A. Endometrial Injury Upregulates Expression of Receptivity Genes in Women with Implantation Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3942. [PMID: 36900953 PMCID: PMC10002420 DOI: 10.3390/ijerph20053942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Homeobox genes A10 (HOXA10) and A11 (HOXA11), members of the abdominal B gene family, are responsible for embryonic survival and implantation. This study was planned to investigate whether endometrial injury alters the expression of both transcripts in women with implantation failure. METHODS A total of 54 women with implantation failure were divided into two equal groups as experimental (scratching) and sham (no scratching). Participants in the scratching group were exposed to endometrial injury in the mid-luteal phase, and those in the sham group were exposed to endometrial flushing. The scratching group, but not the sham group, underwent prior endometrial sampling. A second endometrial sampling was performed on the scratching group in the mid-luteal phase of the following cycle. The mRNA and protein levels of the HOXA10 and 11 transcripts were determined in endometrial samples collected before and after injury/flushing. Participants in each group underwent IVF/ET in the cycle after the second endometrial sampling. RESULTS Endometrial injury caused a 60.1-fold (p < 0.01) increase in HOXA10 mRNA and a 9.0-fold increase in HOXA11 mRNA (p < 0.02). Injury resulted in a significant increase in both HOXA10 (p < 0.001) and HOXA11 protein expression (p < 0.003). There was no significant change in HOXA10 and 11 mRNA expressions after flushing. Clinical pregnancy, live birth, and miscarriage rates of the both groups were similar. CONCLUSIONS Endometrial injury increases homeobox transcript expression at both mRNA and protein levels.
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Affiliation(s)
- Onder Celik
- Private Clinic Obstetrics and Gynecology, 64000 Usak, Turkey
| | - Arzu Yurci
- In Vitro Fertilization (IVF), Andrology and Genetics Center, Memorial Bahcelievler Hospital, 34180 Istanbul, Turkey
| | - Aynur Ersahin
- Department of Obstetrics and Gynecology, Bahcesehir University Goztepe Medicalpark Hospital, 34732 Istanbul, Turkey
| | - Nur D. Gungor
- Department of Obstetrics and Gynecology, Bahcesehir University Goztepe Medicalpark Hospital, 34732 Istanbul, Turkey
| | - Nilufer Celik
- Department of Biochemistry, Behcet Uz Children’s Hospital, 35210 Izmir, Turkey
| | - Mustafa D. Ozcil
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mustafa Kemal University, 31060 Hatay, Turkey
| | - Serdar Dogan
- Department of Medical Biochemistry, Faculty of Medicine, Mustafa Kemal University, 31060 Hatay, Turkey
| | - Semih Dalkilic
- Molecular Biology and Genetics Program, Department of Biology, Faculty of Science, Firat University, 23000 Elazig, Turkey
| | - Lutfiye Dalkilic
- Molecular Biology and Genetics Program, Department of Biology, Faculty of Science, Firat University, 23000 Elazig, Turkey
| | - Ulun Ulug
- Department of Obstetrics and Gynecology, School of Medicine, Halic University, 34060 Istanbul, Turkey
| | - Sudenaz Celik
- Medical Faculty, Sofia University “St. Kliment Ohridski”, 1407 Sofia, Bulgaria
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, CERICSAL (Centro di RIcerca Clinica SALentino), “Veris Delli Ponti Hospital”, 73020 Lecce, Italy
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Noori N, Ghaemdoust F, Ghasemi M, Liavaly M, Keikha N, Dehghan Haghighi J. The effect of endometrial scratching on reproductive outcomes in infertile women undergoing IVF treatment cycles. J OBSTET GYNAECOL 2022; 42:3611-3615. [PMID: 36287634 DOI: 10.1080/01443615.2022.2133995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study was a Randomised Controlled Trial aiming to evaluate the effect of Endometrial Scratching (ES) on fertility rate. Participants were primary infertile women undergoing IVF treatment. ES for the intervention group was done using endometrial aspiration in the luteal phase of the cycle before embryo transfer. In both groups, 2-3 8-celled embryos were transferred after endometrial preparation by Oestrogen and Progesterone. There were no significant differences between the two groups in terms of age, BMI and endometrial thickness (ET). No significant differences were found between intervention and control groups in chemical pregnancy rate (p = 0.410), clinical pregnancy (p = 0.822), the number of abortions (p = 0.282) and the implantation rate (p = 0.777). Local ES had no significant effects in improving the IVF success rate and reducing the embryo abortion rate.Impact statementWhat is already known on this subject? Endometrial scratching (ES) is a local injury to the endometrium that was assumed to affect implantation in IVF and IUI cycles positively. However, various studies have shown conflicting results on this matter.What do the results of this study add? Local ES had no significant effects on improving the IVF success rate and reducing the embryo abortion rate in patients with the first IVF cycle.What are the implications of these findings for clinical practice and/or further research? Larger clinical trials can measure the usefulness of ES with higher powers. However, this study, along with other clinical trials, can help evaluate the ES effect in future meta-analyses.
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Affiliation(s)
- Narjes Noori
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Faezeh Ghaemdoust
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Ghasemi
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Molood Infertility Center, Ali-ibn Abi Talib Hospital, Zahedan, Iran
| | - Mahsa Liavaly
- Department of Obstetrics and Gynecology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Narjes Keikha
- Molood Infertility Center, Ali-ibn Abi Talib Hospital, Zahedan, Iran
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Bui BN, Lensen SF, Gibreel A, Martins WP, Torrance H, Broekmans FJ. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database Syst Rev 2022; 10:CD011424. [PMID: 36278845 PMCID: PMC9590232 DOI: 10.1002/14651858.cd011424.pub4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intentional endometrial injury is being proposed as a technique to improve the probability of pregnancy in women undergoing assisted reproductive technologies (ART) such as in vitro fertilisation (IVF). Endometrial injury is often performed by pipelle biopsy and is a common gynaecological procedure with established safety. However, it causes a moderate degree of discomfort/pain and requires an additional pelvic examination. The effectiveness of this procedure outside of ART, in women or couples attempting to conceive via sexual intercourse or with intrauterine insemination (IUI), remains unclear. OBJECTIVES To assess the effectiveness and safety of intentional endometrial injury performed in infertile women or couples attempting to conceive through sexual intercourse or intrauterine insemination (IUI). SEARCH METHODS The Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, ISI Web of Knowledge, and clinical trial registries were searched from inception to 21 May 2020, as were conference abstracts and reference lists of relevant reviews and included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated any kind of intentional endometrial injury in women planning to undergo IUI or attempting to conceive spontaneously (with or without ovarian stimulation (OS)) compared to no intervention, a mock intervention, or intentional endometrial injury performed at a different time. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Primary outcomes were live birth/ongoing pregnancy and pain experienced during the procedure. Due to high risk of bias associated with many of the studies, primary analyses of all review outcomes were restricted to studies at low risk of bias. Sensitivity analysis including all studies was then performed. MAIN RESULTS We included 22 RCTs (3703 women). Most of these studies included women with unexplained infertility. Intentional endometrial injury versus either no intervention or a sham procedure The primary analysis was restricted to studies at low risk of bias, which left only one study included. We are uncertain whether endometrial injury has an effect on the probability of live birth, as only one study is included in the analysis and the confidence interval is wide (risk ratio (RR) 1.11, 95% confidence interval (CI) 0.78 to 1.59; 1 RCT, 210 participants). Evidence suggests that if the chance of live birth with no intervention/a sham procedure is assumed to be 34%, then the chance with endometrial injury would be 27% to 55%. When all studies were included in the sensitivity analysis, we were uncertain whether endometrial injury improves live birth/ongoing pregnancy, as the evidence was of very low quality (RR 1.71, 95% CI 1.32 to 2.21; 8 RCTs, 1522 participants; I² = 16%). Evidence suggests that if the chance of live birth/ongoing pregnancy with no intervention/a sham procedure is assumed to be 13%, then the chance with endometrial injury would be 17% to 28%. A narrative synthesis conducted for the other primary outcome of pain during the procedure included studies measuring pain on a zero-to-ten visual analogue scale (VAS) or grading pain as mild/moderate/severe, and showed that most often mild to moderate pain was reported (6 RCTs, 911 participants; very low-quality evidence). Timing of intentional endometrial injury Four trials compared endometrial injury performed in the cycle before IUI to that performed in the same cycle as IUI. None of these studies reported the primary outcomes of live birth/ongoing pregnancy and pain during the procedure. One study compared endometrial injury in the early follicular phase (EFP; Day 2 to 4) to endometrial injury in the late follicular phase (LFP; Day 7 to 9), both in the same cycle as IUI. The primary outcome live birth/ongoing pregnancy was not reported, but the study did report the other primary outcome of pain during the procedure assessed by a zero-to-ten VAS. The average pain score was 3.67 (standard deviation (SD) 0.7) when endometrial injury was performed in the EFP and 3.84 (SD 0.96) when endometrial injury was performed in the LFP. The mean difference was -0.17, suggesting that on average, women undergoing endometrial injury in the EFP scored 0.17 points lower on the VAS as compared to women undergoing endometrial injury in the LFP (95% CI -0.48 to 0.14; 1 RCT, 110 participants; very low-quality evidence). AUTHORS' CONCLUSIONS Evidence is insufficient to show whether there is a difference in live birth/ongoing pregnancy between endometrial injury and no intervention/a sham procedure in women undergoing IUI or attempting to conceive via sexual intercourse. The pooled results should be interpreted with caution, as the evidence was of low to very low quality due to high risk of bias present in most included studies and an overall low level of precision. Furthermore, studies investigating the effect of timing of endometrial injury did not report the outcome live birth/ongoing pregnancy; therefore no conclusions could be drawn for this outcome. Further well-conducted RCTs that recruit large numbers of participants and minimise bias are required to confirm or refute these findings. Current evidence is insufficient to support routine use of endometrial injury in women undergoing IUI or attempting to conceive via sexual intercourse.
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Affiliation(s)
- Bich Ngoc Bui
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, Netherlands
| | - Sarah F Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Ahmed Gibreel
- Obstetrics & Gynaecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Helen Torrance
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, Netherlands
| | - Frank J Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, Netherlands
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Kang Y, Wang Z, Yang Y, Liang H, Duan X, Gao Q, Yin Z. Impact of endometrial scratching on reproductive outcome in patients: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30150. [PMID: 35984122 PMCID: PMC9387958 DOI: 10.1097/md.0000000000030150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Endometrial scratching (ES) has demonstrated initial success in women with recurrent implantation failure, but the effect in women with 1 previous assisted reproductive technology (ART) failure is unknown. This meta-analysis aimed to evaluate the impact of ES as a treatment in clinical outcomes for women with at least 1 failed in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)/Intrauterine Insemination (IUI). METHODS PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for randomized controlled trial studies utilizing endometrial scratching for infertility women with at least 1 failed assisted reproductive technology (ART) to collect pregnancy outcomes, including clinical pregnancy rate (CPR), embryo implantation rate (IR), miscarriage rate (MR), live birth rate (LBR), and multiple pregnancy rate (MPR). RESULTS Sixteen randomized controlled trial (RCT) studies were included in this meta-analysis, including 1770 women in the intervention group and 1934 women in the control group. Overall, the CPR, IR and LBR were significantly higher in the intervention group than in the control group (for CPR, n = 1430, 16 studies, P = .0002, risk ratio (RR) = 1.59, 95% confidence interval [CI] [1.24, 2.03]; for IR, n = 859, 10 studies, P = .0003, RR = 1.67, 95% CI [1.26, 2.21]; for LBR, n = 156, 6 studies, P = .0005, RR = 1.59, 95% CI [1.22, 2.06]). Nonetheless, there was no significant difference in MR (n = 344, 11 studies, P = .62, risk ratio (RR) = 0.92, 95% confidence interval [CI] [0.66, 1.29]) and MPR (n = 98, 3 studies, P = .39, risk ratio (RR) = 0.81, 95% confidence interval [CI] [0.51, 1.30]) between the intervention group and the control group. CONCLUSION Endometrial scratching is considered to enhance the reproductive outcomes of embryo implantation. Additional randomized controlled studies are recommended to identify the appropriate time of invasion and the applicable population to confirm whether it can become a routine operation.
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Affiliation(s)
- YiFan Kang
- Department of Reproductive Center, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - ZhiHong Wang
- Department of Reproductive Center, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuan Yang
- Department of Reproductive Center, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - HuiZhi Liang
- Department of Reproductive Center, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xia Duan
- Department of Reproductive Center, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - QingZhuo Gao
- Department of Reproductive Center, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - ZhaoFang Yin
- Department of Reproductive Center, The First Hospital of Shanxi Medical University, Taiyuan, China
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11
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Cumulative live birth rates in egg donor IVF cycles with or without endometrial scratching: is there a residual effect in subsequent embryo transfers? Follow-up results of a RCT in clinical practice. J Gynecol Obstet Hum Reprod 2022; 51:102335. [PMID: 35144034 DOI: 10.1016/j.jogoh.2022.102335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Endometrial scratching (ES) is a simple technique that has been claimed to improve pregnancy rates in patients undergoing assisted reproduction techniques. Our objective was to acknowledge the effects of ES in subsequent embryo transfers by assessing the cumulative live birth rates (LBR) in patients undergoing egg-donor in vitro fertilization (IVF). MATERIAL AND METHODS We performed a follow-up analysis of the cumulative reproductive outcomes of the 352 patients included in the Endoscratch Trial (NCT03108157) during the twelve months following the randomization date. We compared the outcomes of patients who underwent an ES for the second and/or successive embryo transfers versus those who did not have an ES performed, in order to determine a possible carry over effect that could lead to different LBR in these groups. RESULTS Our analysis reveals that both groups (with and without ES performed before the first embryo transfer) had similar cumulative LBR (69.9% vs 65.9% in group A and B respectively, RR: 1.20, 95% confidence interval (CI): 0.92 - 1.22, p= 0.42). When we analyzed the results comparing patients who had received at least an ES before any of the embryo transfers during that period, we did not find any differences in LBR either (68.0% in patients with at least an ES and 67.8% in patients without ES, RR 1.00, 95%CI 0.87 - 1.16, p= 0.96). CONCLUSION According to our results, we cannot state that ES has a long term effect on endometrial receptivity of egg recipients as cumulative LBR do not differ from those of patients who do not receive it.
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12
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Ersahin SS, Ersahin A. Endometrial injury concurrent with hysteroscopy increases the expression of Leukaemia inhibitory factor: a preliminary study. Reprod Biol Endocrinol 2022; 20:11. [PMID: 35012573 PMCID: PMC8744211 DOI: 10.1186/s12958-021-00877-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/11/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE It is not known by which mechanism endometrial injury increases pregnancy rates. Leukaemia inhibitory factor (LIF) is a cytokine involved in wound healing and implantation. The aim of this study was to determine the change in endometrial LIF mRNA expression before and after mechanical injury during hysteroscopy. METHODS Forty patients with a history of two or more unsuccessful implantations who decided to undergo hysteroscopy in the proliferative phase were divided into two equal groups: one with endometrial injury (scratching group) and the other with noninjury (control group). Endometrial sampling was conducted before injury on the patients in the scratching group, and then injury was performed with monopolar needle forceps. Only diagnostic hysteroscopy was performed on the patients in the control group. Endometrial tissues were collected using a Pipelle catheter between Days 20 and 23 of the mid-luteal phase of the next cycles in both the scratching and control groups. Endometrial LIF mRNA expression was evaluated with the use of reverse-transcription polymerase chain reactions. RESULTS Relative changes in mRNA expression levels of the LIF gene in endometrial samples taken before and after injury were calculated using the 2-ΔΔCt method, and the fold changes obtained were compared between and within the groups. Compared with preinjury values, an 11.1-fold increase was found in postinjury LIF mRNA expression in patients with monopolar forceps injury (p < 0.001). There was a 3.9-fold significant increase in postinjury LIF mRNA levels compared with those in the control group (p < 0.02). CONCLUSIONS The fertility-promoting effect of hysteroscopy-guided mechanical endometrial injury may be mediated by LIF mRNA.
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Affiliation(s)
- Suat Suphan Ersahin
- Altınbas University Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Aynur Ersahin
- BAU Medical School Department of Obstetrics and Gynecology, IVF-Center, Istanbul, Turkey
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Fan L, Sha M, Li W, Kang Q, Wu J, Chen S, Yu N. Intrauterine administration of peripheral blood mononuclear cells (PBMCs) improves embryo implantation in mice by regulating local Treg/Th17 cell balance. J Reprod Dev 2021; 67:359-368. [PMID: 34615838 PMCID: PMC8668375 DOI: 10.1262/jrd.2021-006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/10/2021] [Indexed: 11/20/2022] Open
Abstract
Immune imbalance of Treg/Th17 cells may contribute to recurrent implantation failure (RIF) during in vitro fertilization and embryo transfer (IVF-ET). In this study, we sought to determine the effect of intrauterine administration of mouse PBMCs prior to embryo implantation on endometrial receptivity and embryo implantation, and examine the underlying mechanism of Treg/Th17 cell balance following intrauterine administration of PBMCs. Pregnant mice were randomly divided into three groups: control group, embryo implantation dysfunction (EID) group, and EID with PBMCs group, and the number of embryo implantation sites was recorded during early pregnancy (Pd7.5). The balance of Treg/Th17 cells in the peripheral blood, spleen, and local implantation sites was detected during the peri-implantation period (Pd4.0) and early pregnancy (Pd7.5). The EID group demonstrated a significant decrease in the number of embryo implantation sites, while the EID with PBMCs group demonstrated higher number of embryo implantation sites compared to the EID group. The balance of Treg/Th17 cells in the peripheral blood and spleen tissues was not significantly different between the aforementioned groups. However, the local uterine ratio of the Treg/Th17 cells increased in the EID with PBMCs group compared to that in the EID group. Collectively, we found that intrauterine administration of PBMCs prior to embryo implantation effectively promotes embryo implantation rates. This may be attributed to the improvement in the local immune balance of Treg and Th17 cells compared with the overall immune balance.
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Affiliation(s)
- Lei Fan
- Department of Obstetrics & Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Menghan Sha
- Department of Obstetrics & Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Wei Li
- Department of Obstetrics & Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Qingling Kang
- Department of Obstetrics & Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jianli Wu
- Department of Obstetrics & Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Suhua Chen
- Department of Obstetrics & Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Nan Yu
- Department of Obstetrics & Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
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Aghajanpour S, Hosseini E, Amirchaghmaghi E, Zandieh Z, Amjadi F, Yahyaei A, Zolfaghari Z, Aflatoonian K, Ashrafi M, Aflatoonian R. Differential expression of innate/adaptive immunity genes induced by endometrial scratching as a hopeful approach for implantation boosting in unexplained, repeated implantation failure: An RCT. J Reprod Immunol 2021; 148:103426. [PMID: 34653814 DOI: 10.1016/j.jri.2021.103426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/20/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endometrial scratching (ES) has been proposed as a potential treatment for implantation improvement in unexplained repeated implantation failure (uRIF) patients, however, little is known about its exact molecular mechanisms. OBJECTIVE This randomized controlled trial (RCT) was conducted on twenty uRIF patients to investigate the expression of innate and adaptive immune signaling genes after ES. METHODS Ten uRIF patients in the intervention (twice endometrial sampling in follicular and luteal phases) and 10 uRIF patients in the control group (only luteal phase sampling) were randomly enrolled. Gene expression analysis with innate and adaptive immune response PCR-array kit between intervention and control groups were performed. RESULTS Among innate immune-associated genes, a significant decrease was observed in the expression of APCS, CPR, CCL2, NLRP3, HLA-A, TLR3 and TLR4 in the intervention group. In adaptive immune-related genes, the expression level of CD80, CD86, CXCR3, IFNγ, IFNα1, IFNβ, MBL2, CCR6, CCR8 and IL17A were decreased and CSF2, GATA3, and IL4 increased significantly in the intervention group (P < 0.05). Of 14 uRIF patients, five live birth (35.71 %) was achieved. CONCLUSION ES in uRIF patients may exert positive effects on the endometrial preparation which increases its receptivity for embryo implantation by modulating the expression of an array of immune signaling pathway genes.
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Affiliation(s)
- Samaneh Aghajanpour
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Hosseini
- Department of Obstetrics and Gynecology, IVF Clinic, Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran; Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Elham Amirchaghmaghi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Zahra Zandieh
- Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fatemehsadat Amjadi
- Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azar Yahyaei
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Zahra Zolfaghari
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Mahnaz Ashrafi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Obstetrics and Gynecology Department, School of Medicine, Iran University of Medical Science, Tehran, Iran.
| | - Reza Aflatoonian
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
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Jain M, Samokhodskaya L, Mladova E, Panina O. Mucosal biomarkers for endometrial receptivity: A promising yet underexplored aspect of reproductive medicine. Syst Biol Reprod Med 2021; 68:13-24. [PMID: 34632899 DOI: 10.1080/19396368.2021.1985186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Annually, approximately 2 million assisted reproductive technology (ART) procedures are performed worldwide, of which, only ~25% lead to successful delivery. There are two major factors contributing to successful implantation: embryo quality and endometrial receptivity (ER). Although embryo quality might be assessed through morphological and genetic testing, no clinically approved techniques are available to evaluate ER. Mucus in different parts of the female reproductive tract contains many cytokines, chemokines, growth factors, and nucleic acids, which influence and reflect various implantation-related processes. Therefore, the aim of the present review was to summarize available data regarding noninvasively obtained mucosal biomarkers for ER and to investigate their ability to predict the outcome of ART procedures. A broad literature search was performed to define studies related to noninvasive ER assessments. More than 50 biomarkers detectable in endometrial fluid, embryo transfer cannula leftover cells and mucus, menstrual blood, cervicovaginal washings are discussed herein. The remarkable methodological heterogeneity of the reviewed studies complicates the comparison of their results. Nevertheless, certain promising analytical targets may already be identified, such as urocortin, activin A, IL-1β, TNF-α, IP-10, MCP-1, and several oxidative stress biomarkers. The present review contains a collection of currently available mucosal biomarker-related data, which may provide insights for future studies.Abbreviations: ART: assisted reproductive technology; ER: endometrial receptivity; IVF: in vitro fertilization; ICSI: intracytoplasmic sperm injection; IUI: intrauterine insemination; MeSH: Medical Subject Headings; hDP 200: human decidua-associated protein 200; ET: embryo transfer; IL-18: Interleukin-18; LRG: leucine-rich α2-glycoprotein; ROC: receiver operating characteristic; AUC: area under the ROC-curve; LH: luteinizing hormone; LIF: leukemia inhibitory factor; TNF-α: tumor necrosis factor alpha; IFN-γ: interferon γ; MCP-1: monocyte chemoattractant protein-1; VEGF: vascular endothelial growth factor; SOD: superoxide dismutase; CAT: catalase; LPO: lipid peroxidation; TTG: total thiol groups; TAP: total antioxidant power; CE: chronic endometritis.
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Affiliation(s)
- Mark Jain
- Medical Research and Education Center, Lomonosov Moscow State University, Moscow, Russia.,Department of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Larisa Samokhodskaya
- Medical Research and Education Center, Lomonosov Moscow State University, Moscow, Russia.,Department of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
| | | | - Olga Panina
- Medical Research and Education Center, Lomonosov Moscow State University, Moscow, Russia.,Department of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
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Tu YA, Chou CH, Yang PK, Shun CT, Wen WF, Tsao PN, Chen SU, Yang JH. Intentional endometrial injury enhances angiogenesis through increased production and activation of MMP-9 by TNF-α and MMP-3 in a mouse model. Mol Hum Reprod 2021; 27:gaab055. [PMID: 34463765 DOI: 10.1093/molehr/gaab055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 08/08/2021] [Indexed: 11/12/2022] Open
Abstract
There have been reports of improved pregnancy rates after performing intentional endometrial injuries, also known as endometrial scratching, in patients with recurrent implantation failure. In our previous study on intentional endometrial injury, we found an increased expression of matrix metalloproteinase (MMP)-3 following induced injuries to the mice endometrium. In the current study, we further examine whether the rise in MMP-3 could contribute to increased angiogenesis. Female C57B1/6 mice were obtained at 12 weeks of age, and intentional endometrial injuries were induced mechanically in the left uterine horns. Using the appropriate media, uterine-washes were performed on the injured and uninjured (control) horns of the harvested uteri. The uterine tissues were further processed for tissue lysates, histopathology and immunohistochemistry. The results show that intentional endometrial injuries caused an increase in secreted LPA in the injured horns, which were detected in the uterine-washes. In addition, LPA induced increased production of TNF-α in human endometrial epithelial cells (hEEpCs). Furthermore, TNF-α appeared to induce differential and cell-specific upregulation of the MMPs: MMP-3 was upregulated in the epithelial (hEEpCs), while MMP-9 was upregulated in the endothelial cells (human endometrial endothelial cells; hEEnCs). The upregulation of MMP-3 appeared to be necessary for the activation of MMP-9, whose active form stimulated the formation of vessel-like structure by the hEEnCs. The results of this study suggest that there may be enhanced angiogenesis following intentional endometrial injuries, which is mediated in part by TNF-α-induced and MMP-3-activated MMP-9 production.
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Affiliation(s)
- Yi-An Tu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Kai Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Fen Wen
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jehn-Hsiahn Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Das endometriale Scratching: neue Daten zur Effektivität? GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lensen SF, Armstrong S, Gibreel A, Nastri CO, Raine-Fenning N, Martins WP. Endometrial injury in women undergoing in vitro fertilisation (IVF). Cochrane Database Syst Rev 2021; 6:CD009517. [PMID: 34110001 PMCID: PMC8190981 DOI: 10.1002/14651858.cd009517.pub4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Implantation of an embryo within the endometrial cavity is a critical step in the process of in vitro fertilisation (IVF). Previous research has suggested that endometrial injury (also known as endometrial scratching), defined as intentional damage to the endometrium, can increase the chance of pregnancy in women undergoing IVF. OBJECTIVES To assess the effectiveness and safety of endometrial injury performed before embryo transfer in women undergoing in vitro fertilisation (IVF) including intracytoplasmic sperm injection (ICSI) and frozen embryo transfer. SEARCH METHODS In June 2020 we searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, LILACS, DARE and two trial registries. We also checked the reference sections of relevant studies and contacted experts in the field for any additional trials. SELECTION CRITERIA Randomised controlled trials comparing intentional endometrial injury before embryo transfer in women undergoing IVF, versus no intervention or a sham procedure. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Two independent review authors screened studies, evaluated risk of bias and assessed the certainty of the evidence by using GRADE (Grading of Recommendation, Assessment, Development and Evaluation) criteria. We contacted and corresponded with study investigators as required. Due to the high risk of bias associated with many of the studies, the primary analyses of all review outcomes were restricted to studies at a low risk of bias for selection bias and other bias. Sensitivity analysis was then performed including all studies. The primary review outcomes were live birth and miscarriage. MAIN RESULTS Endometrial injury versus control (no procedure or a sham procedure) A total of 37 studies (8786 women) were included in this comparison. Most studies performed endometrial injury by pipelle biopsy in the luteal phase of the cycle before the IVF cycle. The primary analysis was restricted to studies at low risk of bias, and included eight studies. The effect of endometrial injury on live birth is unclear as the result is consistent with no effect, or a small reduction, or an improvement (odds ratio (OR) 1.12, 95% confidence interval (CI) 0.98 to 1.28; participants = 4402; studies = 8; I2 = 15%, moderate-certainty evidence). This suggests that if the chance of live birth with IVF is usually 27%, then the chance when using endometrial injury would be somewhere between < 27% and 32%. Similarly, the effect of endometrial injury on clinical pregnancy is unclear (OR 1.08, 95% CI 0.95 to 1.23; participants = 4402; studies = 8; I2 = 0%, moderate-certainty evidence). This suggests that if the chance of clinical pregnancy from IVF is normally 32%, then the chance when using endometrial injury before IVF is between 31% and 37%. When all studies were included in the sensitivity analysis, we were unable to conduct meta-analysis for the outcomes of live birth and clinical pregnancy due to high risk of bias and statistical heterogeneity. Endometrial injury probably results in little to no difference in chance of miscarriage (OR 0.88, 95% CI 0.68 to 1.13; participants = 4402; studies = 8; I2 = 0%, moderate-certainty evidence), and this result was similar in the sensitivity analysis that included all studies. The result suggests that if the chance of miscarriage with IVF is usually 6.0%, then when using endometrial injury it would be somewhere between 4.2% and 6.8%. Endometrial injury was associated with mild to moderate pain (approximately 4 out of 10), and was generally associated with some minimal bleeding. The evidence was downgraded for imprecision due to wide confidence intervals and therefore all primary analyses were graded as moderate certainty. Higher versus lower degree of injury Only one small study was included in this comparison (participants = 129), which compared endometrial injury using two different instruments in the cycle prior to the IVF cycle: a pipelle catheter and a Shepard catheter. This trial was excluded from the primary analysis due to risk of bias. In the sensitivity analysis, all outcomes reported for this study were graded as very-low certainty due to risk of bias, and as such we were not able to interpret the study results. AUTHORS' CONCLUSIONS The effect of endometrial injury on live birth and clinical pregnancy among women undergoing IVF is unclear. The results of the meta-analyses are consistent with an increased chance, no effect and a small reduction in these outcomes. We are therefore uncertain whether endometrial injury improves the chance of live birth or clinical pregnancy in women undergoing IVF. Endometrial injury does not appear to affect the chance of miscarriage. It is a somewhat painful procedure associated with a small amount of bleeding. In conclusion, current evidence does not support the routine use of endometrial injury for women undergoing IVF.
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Affiliation(s)
- Sarah F Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Sarah Armstrong
- Department of Oncology & Metabolism, Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield, UK
| | - Ahmed Gibreel
- Obstetrics & Gynaecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Nick Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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van Hoogenhuijze NE, Mol F, Laven JSE, Groenewoud ER, Traas MAF, Janssen CAH, Teklenburg G, de Bruin JP, van Oppenraaij RHF, Maas JWM, Moll E, Fleischer K, van Hooff MHA, de Koning CH, Cantineau AEP, Lambalk CB, Verberg M, van Heusden AM, Manger AP, van Rumste MME, van der Voet LF, Pieterse QD, Visser J, Brinkhuis EA, den Hartog JE, Glas MW, Klijn NF, van der Meer S, Bandell ML, Boxmeer JC, van Disseldorp J, Smeenk J, van Wely M, Eijkemans MJC, Torrance HL, Broekmans FJM. Endometrial scratching in women with one failed IVF/ICSI cycle-outcomes of a randomised controlled trial (SCRaTCH). Hum Reprod 2021; 36:87-98. [PMID: 33289528 PMCID: PMC7801792 DOI: 10.1093/humrep/deaa268] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/27/2020] [Indexed: 11/18/2022] Open
Abstract
STUDY QUESTION Does endometrial scratching in women with one failed IVF/ICSI treatment affect the chance of a live birth of the subsequent fresh IVF/ICSI cycle? SUMMARY ANSWER In this study, 4.6% more live births were observed in the scratch group, with a likely certainty range between −0.7% and +9.9%. WHAT IS KNOWN ALREADY Since the first suggestion that endometrial scratching might improve embryo implantation during IVF/ICSI, many clinical trials have been conducted. However, due to limitations in sample size and study quality, it remains unclear whether endometrial scratching improves IVF/ICSI outcomes. STUDY DESIGN, SIZE, DURATION The SCRaTCH trial was a non-blinded randomised controlled trial in women with one unsuccessful IVF/ICSI cycle and assessed whether a single endometrial scratch using an endometrial biopsy catheter would lead to a higher live birth rate after the subsequent IVF/ICSI treatment compared to no scratch. The study took place in 8 academic and 24 general hospitals. Participants were randomised between January 2016 and July 2018 by a web-based randomisation programme. Secondary outcomes included cumulative 12-month ongoing pregnancy leading to live birth rate. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with one previous failed IVF/ICSI treatment and planning a second fresh IVF/ICSI treatment were eligible. In total, 933 participants out of 1065 eligibles were included (participation rate 88%). MAIN RESULTS AND THE ROLE OF CHANCE After the fresh transfer, 4.6% more live births were observed in the scratch compared to control group (110/465 versus 88/461, respectively, risk ratio (RR) 1.24 [95% CI 0.96–1.59]). These data are consistent with a true difference of between −0.7% and +9.9% (95% CI), indicating that while the largest proportion of the 95% CI is positive, scratching could have no or even a small negative effect. Biochemical pregnancy loss and miscarriage rate did not differ between the two groups: in the scratch group 27/153 biochemical pregnancy losses and 14/126 miscarriages occurred, while this was 19/130 and 17/111 for the control group (RR 1.21 (95% CI 0.71–2.07) and RR 0.73 (95% CI 0.38–1.40), respectively). After 12 months of follow-up, 5.1% more live births were observed in the scratch group (202/467 versus 178/466), of which the true difference most likely lies between −1.2% and +11.4% (95% CI). LIMITATIONS, REASONS FOR CAUTION This study was not blinded. Knowledge of allocation may have been an incentive for participants allocated to the scratch group to continue treatment in situations where they may otherwise have cancelled or stopped. In addition, this study was powered to detect a difference in live birth rate of 9%. WIDER IMPLICATIONS OF THE FINDINGS The results of this study are an incentive for further assessment of the efficacy and clinical implications of endometrial scratching. If a true effect exists, it may be smaller than previously anticipated or may be limited to specific groups of women undergoing IVF/ICSI. Studying this will require larger sample sizes, which will be provided by the ongoing international individual participant data-analysis (PROSPERO CRD42017079120). At present, endometrial scratching should not be performed outside of clinical trials. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by ZonMW, the Dutch organisation for funding healthcare research. J.S.E. Laven reports grants and personal fees from AnshLabs (Webster, Tx, USA), Ferring (Hoofddorp, The Netherlands) and Ministry of Health (CIBG, The Hague, The Netherlands) outside the submitted work. A.E.P. Cantineau reports ‘other’ from Ferring BV, personal fees from Up to date Hyperthecosis, ‘other’ from Theramex BV, outside the submitted work. E.R. Groenewoud reports grants from Titus Health Care during the conduct of the study. A.M. van Heusden reports personal fees from Merck Serono, personal fees from Ferring, personal fees from Goodlife, outside the submitted work. F.J.M. Broekmans reports personal fees as Member of the external advisory board for Ferring BV, The Netherlands, personal fees as Member of the external advisory board for Merck Serono, The Netherlands, personal fees as Member of the external advisory for Gedeon Richter, Belgium, personal fees from Educational activities for Ferring BV, The Netherlands, grants from Research support grant Merck Serono, grants from Research support grant Ferring, personal fees from Advisory and consultancy work Roche, outside the submitted work. C.B. Lambalk reports grants from Ferring, grants from Merck, grants from Guerbet, outside the submitted work. TRIAL REGISTRATION NUMBER Registered in the Netherlands Trial Register (NL5193/NTR 5342). TRIAL REGISTRATION DATE 31 July 2015. DATE OF FIRST PATIENT’S ENROLMENT 26 January 2016.
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Affiliation(s)
- N E van Hoogenhuijze
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - F Mol
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Reproduction and Development, Meibergdreef 9, Amsterdam, the Netherlands
| | - J S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus Medical Centre Rotterdam, 3015 GD, Rotterdam, the Netherlands
| | - E R Groenewoud
- Department of Obstetrics, Gynaecology & Reproductive Medicine, Noordwest Ziekenhuisgroep, 1782 GZ, Den Helder, the Netherlands
| | - M A F Traas
- Department of Gynaecology, Gelre Hospital, 7334 DZ, Apeldoorn, the Netherlands
| | - C A H Janssen
- Department of Gynaecology, Groene Hart Hospital, 2803 HH, Gouda, the Netherlands
| | - G Teklenburg
- Isala Fertility Clinic, Isala Hospital, 8025 AB, Zwolle, the Netherlands
| | - J P de Bruin
- Department of Gynaecology & Obstetrics, Jeroen Bosch Hospital, 5223 GZ, Den Bosch, the Netherlands
| | - R H F van Oppenraaij
- Department of Gynaecology, Maasstad Hospital, 3079 DZ, Rotterdam, the Netherlands
| | - J W M Maas
- Department of Gynaecology, Maxima Medical Centre, 5504 DB, Veldhoven, the Netherlands
| | - E Moll
- Department of Gynaecology, Onze Lieve Vrouwe Gasthuis, 1061 AE, Amsterdam, the Netherlands
| | - K Fleischer
- Department of Obstetrics & Gynaecology, Radboud University Medical Centre, 6525 GA, Nijmegen, the Netherlands
| | - M H A van Hooff
- Department of Gynaecology, Franciscus Gasthuis en Vlietland, 3045 PM, Rotterdam, the Netherlands
| | - C H de Koning
- Department of Gynaecology, Tergooi Hospital, 1213 XZ, Hilversum, the Netherlands
| | - A E P Cantineau
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - C B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - M Verberg
- Fertility Clinic, Fertility Clinic Twente, 7556 BN, Hengelo, the Netherlands
| | - A M van Heusden
- Fertility Clinic, Medisch Centrum Kinderwens, 2353 GA, Leiderdorp, the Netherlands
| | - A P Manger
- Department of Gynaecology, Diakonessenhuis, 3582 KE, Utrecht, the Netherlands
| | - M M E van Rumste
- Department of Gynaecology, Catharina Hospital, 5623 EJ, Eindhoven, the Netherlands
| | - L F van der Voet
- Department of Gynaecology, Deventer Hospital, 7416 SE, Deventer, the Netherlands
| | - Q D Pieterse
- Fertility Center, Haga Hospital, 2545 AA, The Hague, the Netherlands
| | - J Visser
- Department of Gynaecology & Obstetrics, Amphia Hospital, 4818 CK, Breda, the Netherlands
| | - E A Brinkhuis
- Department of Gynaecology & Obstetrics, Meander Hospital, 3813 TZ, Amersfoort, the Netherlands
| | - J E den Hartog
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, 6229 HX, Maastricht, the Netherlands
| | - M W Glas
- Fertility clinic, Wilhelmina Hospital Assen, 9401 RK, Assen, the Netherlands
| | - N F Klijn
- Department of Gynaecology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands
| | - S van der Meer
- Department of Gynaecology, Haaglanden Medical Centre, 2512 VA, The Hague, the Netherlands
| | - M L Bandell
- Department of Gynaecology, Albert Schweitzer Hospital, 3364 DA, Sliedrecht,the Netherlands
| | - J C Boxmeer
- Department of Gynaecology, Reinier de Graaf Gasthuis, 2625 AD, Delft, the Netherlands
| | - J van Disseldorp
- Department of Gynaecology & Obstetrics, St. Antonius Hospital, 3435 CM, Nieuwegein, the Netherlands
| | - J Smeenk
- Department of Reproductive Medicine, Elisabeth-TweeSteden Hospital, 5042 AD, Tilburg, the Netherlands
| | - M van Wely
- Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynaecology - NVOG Consortium 2.0
| | - M J C Eijkemans
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands.,Julius Centre for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - H L Torrance
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - F J M Broekmans
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands
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Rigos I, Athanasiou V, Vlahos N, Papantoniou N, Profer D, Siristatidis C. The Addition of Endometrial Injury to Freeze-All Strategy in Women with Repeated Implantation Failures. J Clin Med 2021; 10:jcm10102162. [PMID: 34067637 PMCID: PMC8156614 DOI: 10.3390/jcm10102162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Recurrent implantation failure (RIF) after IVF remains a challenging topic for fertility specialists and a frustrating reality for patients with infertility. Various approaches have been investigated and applied towards the improvement of clinical outcomes. Through a nonrandomized clinical trial, we evaluated the effect of the combination of hysteroscopic endometrial injury and the freeze-all technique on pregnancy parameters in a cohort of RIF patients; (2) Methods: The study group comprised of 30 patients with RIF that underwent a hysteroscopic endometrial injury prior to a frozen embryo transfer cycle; another 30 patients with RIF, comprising the control group, underwent a standard frozen cycle with no adjuvant treatment before. Live birth comprised the primary outcome. Logistic and Poisson regression analyses were implemented to reveal potential independent predictors for all outcomes. (3) Results: Live birth rates were similar between groups (8/30 vs. 3/30, p = 0.0876). Biochemical and clinical pregnancy and miscarriages were also independent of the procedure (p = 0.7812, p = 0.3436 and p = 0.1213, respectively). The only confounding factor that contributed to biochemical pregnancy was the number of retrieved oocytes (0.1618 ± 0.0819, p = 0.0481); (4) Conclusions: The addition of endometrial injury to the freeze-all strategy in infertile women with RIF does not significantly improve pregnancy rates, including live birth. A properly conducted RCT with adequate sample size could give a robust answer.
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Affiliation(s)
- Ioannis Rigos
- Assisted Reproduction Unit, IVF Athens Center, Leof. Kifisias 5, 15123 Athens, Greece;
- Correspondence: ; Tel.: +30-693-820-1060
| | - Vasileios Athanasiou
- Assisted Reproduction Unit, IVF Athens Center, Leof. Kifisias 5, 15123 Athens, Greece;
| | - Nikolaos Vlahos
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (N.V.); (C.S.)
| | - Nikolaos Papantoniou
- Third Department of Obstetrics and Gynecology, “Attikon Hospital”, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece;
| | | | - Charalampos Siristatidis
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (N.V.); (C.S.)
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Bui BN, Lensen SF, Gibreel A, Martins WP, Torrance H, Broekmans FJ. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database Syst Rev 2021; 3:CD011424. [PMID: 33734431 PMCID: PMC8094383 DOI: 10.1002/14651858.cd011424.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intentional endometrial injury is being proposed as a technique to improve the probability of pregnancy in women undergoing assisted reproductive technologies (ART) such as in vitro fertilisation (IVF). Endometrial injury is often performed by pipelle biopsy and is a common gynaecological procedure with established safety. However, it causes a moderate degree of discomfort/pain and requires an additional pelvic examination. The effectiveness of this procedure outside of ART, in women or couples attempting to conceive via sexual intercourse or with intrauterine insemination (IUI), remains unclear. OBJECTIVES To assess the effectiveness and safety of intentional endometrial injury performed in infertile women or couples attempting to conceive through sexual intercourse or intrauterine insemination (IUI). SEARCH METHODS The Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, ISI Web of Knowledge, and clinical trial registries were searched from inception to 21 May 2020, as were conference abstracts and reference lists of relevant reviews and included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated any kind of intentional endometrial injury in women planning to undergo IUI or attempting to conceive spontaneously (with or without ovarian stimulation (OS)) compared to no intervention, a mock intervention, or intentional endometrial injury performed at a different time or to a higher/lower degree. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Primary outcomes were live birth/ongoing pregnancy and pain experienced during the procedure. Due to high risk of bias associated with many of the studies, primary analyses of all review outcomes were restricted to studies at low risk of bias. Sensitivity analysis including all studies was then performed. MAIN RESULTS We included 23 RCTs (4035 women). Most of these studies included women with unexplained infertility. Intentional endometrial injury versus either no intervention or a sham procedure The primary analysis was restricted to studies at low risk of bias, which left only one study included. We are uncertain whether endometrial injury has an effect on the probability of live birth, as only one study is included in the analysis and the confidence interval is wide (risk ratio (RR) 1.11, 95% confidence interval (CI) 0.78 to 1.59; 1 RCT, 210 participants). Evidence suggests that if the chance of live birth with no intervention/a sham procedure is assumed to be 34%, then the chance with endometrial injury would be 27% to 55%. When all studies were included in the sensitivity analysis, we were uncertain whether endometrial injury improves live birth/ongoing pregnancy, as the evidence was of very low quality (RR 1.71, 95% CI 1.32 to 2.21; 8 RCTs, 1522 participants; I² = 16%). Evidence suggests that if the chance of live birth/ongoing pregnancy with no intervention/a sham procedure is assumed to be 13%, then the chance with endometrial injury would be 17% to 28%. A narrative synthesis conducted for the other primary outcome of pain during the procedure included studies measuring pain on a zero-to-ten visual analogue scale (VAS) or grading pain as mild/moderate/severe, and showed that most often mild to moderate pain was reported (6 RCTs, 911 participants; very low-quality evidence). Higher versus lower degree of intentional endometrial injury Evidence was insufficient to show whether there is a difference in ongoing pregnancy rates (RR 1.29, 95% CI 0.71 to 2.35; 1 RCT, 332 participants; low-quality evidence) between hysteroscopy with endometrial injury and hysteroscopy alone. Evidence suggests that if the chance of ongoing pregnancy with hysteroscopy alone is 10%, then the chance with hysteroscopy with endometrial injury would be 7% to 24%. This study did not report the primary outcomes of live birth and pain during the procedure. Timing of intentional endometrial injury Four trials compared endometrial injury performed in the cycle before IUI to that performed in the same cycle as IUI. None of these studies reported the primary outcomes of live birth/ongoing pregnancy and pain during the procedure. One study compared endometrial injury in the early follicular phase (EFP; Day 2 to 4) to endometrial injury in the late follicular phase (LFP; Day 7 to 9), both in the same cycle as IUI. The primary outcome live birth/ongoing pregnancy was not reported, but the study did report the other primary outcome of pain during the procedure assessed by a zero-to-ten VAS. The average pain score was 3.67 (standard deviation (SD) 0.7) when endometrial injury was performed in the EFP and 3.84 (SD 0.96) when endometrial injury was performed in the LFP. The mean difference was -0.17, suggesting that on average, women undergoing endometrial injury in the EFP scored 0.17 points lower on the VAS as compared to women undergoing endometrial injury in the LFP (95% CI -0.48 to 0.14; 1 RCT, 110 participants; very low-quality evidence). AUTHORS' CONCLUSIONS Evidence is insufficient to show whether there is a difference in live birth/ongoing pregnancy between endometrial injury and no intervention/a sham procedure in women undergoing IUI or attempting to conceive via sexual intercourse. The pooled results should be interpreted with caution, as the evidence was of low to very low quality due to high risk of bias present in most included studies and an overall low level of precision. Furthermore, studies investigating the effect of timing of endometrial injury did not report the outcome live birth/ongoing pregnancy; therefore no conclusions could be drawn for this outcome. Further well-conducted RCTs that recruit large numbers of participants and minimise bias are required to confirm or refute these findings. Current evidence is insufficient to support routine use of endometrial injury in women undergoing IUI or attempting to conceive via sexual intercourse.
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Affiliation(s)
- Bich Ngoc Bui
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, Netherlands
| | - Sarah F Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Ahmed Gibreel
- Obstetrics & Gynaecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Helen Torrance
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, Netherlands
| | - Frank J Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, Netherlands
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Maranhão KDS, Mariz MEGDSM, Araújo EADD, Souza GRD, Taveira KVM, Morais DB. Factors related to infertility in Brazil and their relationship with success rates after assisted reproduction treatment: an integrative review. JBRA Assist Reprod 2021; 25:136-149. [PMID: 32759095 PMCID: PMC7863087 DOI: 10.5935/1518-0557.20200051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This integrative review evaluated the most commonly diagnosed causes of infertility in men and women in Brazil, as well as the medically assisted reproduction technologies regularly employed in these cases. We searched in four electronic databases (PubMed, including Medline; Scopus; Web of Science and LILACS), and two grey literature (Google Scholar and OpenGrey), guided by the focused question: "What are the main factors responsible for male and female infertility in Brazil, and what are its relationships with success rates after assisted reproduction treatment?". We included interventional or observational studies, without limitation by language or year of publication. Our searches in the electronic indexers recovered 1,119 articles, and after analyzing the inclusion and exclusion criteria, 27 articles composed the body of analysis for this review. We grouped the studies into four themes: factors responsible for male and female infertility, assisted reproductive technologies (ART) used in the infertility treatment, assisted reproduction procedures, and clinical predictors of success rates in ART. Despite the scarcity of studies analyzing the association between infertility and assisted reproductive technologies in Brazil, it was possible to infer that the most prevalent infertility cause in women was endometriosis, while in men it was azoospermia. The most widely assisted reproductive technology applied in the country is the intracytoplasmic injection of spermatozoa (ICSI), ensuring better success rates in the treatment of infertility for men and women.
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Yang SY, Chon SJ, Lee SH. The effects of diagnostic hysteroscopy on the reproductive outcomes of infertile women without intrauterine pathologies: a systematic review and meta-analysis. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2020; 26:300-317. [PMID: 36312304 PMCID: PMC9328608 DOI: 10.4069/kjwhn.2020.12.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/13/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Hysteroscopy can be used both to diagnose and to treat intrauterine pathologies. It is well known that hysteroscopy helps to improve reproductive outcomes by treating intrauterine pathologies. However, it is uncertain whether hysteroscopy is helpful in the absence of intrauterine pathologies. This study aimed to confirm whether hysteroscopy improves the reproductive outcomes of infertile women without intrauterine pathologies. Methods We conducted a systematic review of 11 studies retrieved from Ovid-MEDLINE, Ovid-Embase, and the Cochrane Library. Two independent investigators extracted the data and used risk-of-bias tools (RoB 2.0 and ROBINS-I) to assess their quality. Results Diagnostic hysteroscopy prior to in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) was associated with a higher clinical pregnancy rate (CPR) and live birth rate (LBR) than non-hysteroscopy in patients with recurrent implantation failure (RIF) (odds ratio, 1.79 and 1.46; 95% confidence interval, 1.40–2.30 and 1.08–1.97 for CPR and LBR, respectively) while hysteroscopy prior to first IVF was ineffective. The overall meta-analysis of LBR showed statistically significant findings for RIF, but a subgroup analysis showed effects only in prospective cohorts (odds ratio, 1.40 and 1.47; 95% confidence interval, 0.62–3.16 and 1.04–2.07 for randomized controlled trials and prospective cohorts, respectively). Therefore, the LBR should be interpreted carefully and further research is needed. Conclusion Although further research is warranted, hysteroscopy may be considered as a diagnostic and treatment option for infertile women who have experienced RIF regardless of intrauterine pathologies. This finding enables nurses to educate and support infertile women with RIF prior to IVF/ICSI.
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Affiliation(s)
- Soo Yeon Yang
- Department of Medical Device Management and Research and Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Seung-Joo Chon
- Department of Obstetrics and Gynecology, Gil Hospital, Gachon University of Medicine, Incheon, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea
- Corresponding author: Seon Heui Lee Department of Nursing Science, College of Nursing, Gachon University, 191 Hambangmoe-ro, Yeonsu-gu, Incheon 21936, Korea Tel: +82-32-820-4230 E-mail:
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Chen T, Shi H, Fang LL, Su YC. The effect of endometrial injury on reproductive outcomes of frozen-thawed embryo transfer cycles in women with one implantation failure. J Int Med Res 2020; 48:300060520913130. [PMID: 32216503 PMCID: PMC7133396 DOI: 10.1177/0300060520913130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ting Chen
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Center for Reproductive Medicine, Zhengzhou Maternity Hospital Affiliated to HeNan University, HeNan, China
| | - Hao Shi
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lan Lan Fang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Chun Su
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Palomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update 2020; 27:584-618. [PMID: 33302299 DOI: 10.1093/humupd/dmaa051] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. An endometrial component has been suggested to contribute to subfertility and poor reproductive outcomes in affected women. OBJECTIVE AND RATIONALE The aim of this review was to determine whether there is sufficient evidence to support that endometrial function is altered in women with PCOS, whether clinical features of PCOS affect the endometrium, and whether there are evidence-based interventions to improve endometrial dysfunction in PCOS women. SEARCH METHODS An extensive literature search was performed from 1970 up to July 2020 using PubMed and Web of Science without language restriction. The search included all titles and abstracts assessing a relationship between PCOS and endometrial function, the role played by clinical and biochemical/hormonal factors related to PCOS and endometrial function, and the potential interventions aimed to improve endometrial function in women with PCOS. All published papers were included if considered relevant. Studies having a specific topic/hypothesis regarding endometrial cancer/hyperplasia in women with PCOS were excluded from the analysis. OUTCOMES Experimental and clinical data suggest that the endometrium differs in women with PCOS when compared to healthy controls. Clinical characteristics related to the syndrome, alone and/or in combination, may contribute to dysregulation of endometrial expression of sex hormone receptors and co-receptors, increase endometrial insulin-resistance with impaired glucose transport and utilization, and result in chronic low-grade inflammation, immune dysfunction, altered uterine vascularity, abnormal endometrial gene expression and cellular abnormalities in women with PCOS. Among several interventions to improve endometrial function in women with PCOS, to date, only lifestyle modification, metformin and bariatric surgery have the highest scientific evidence for clinical benefit. WIDER IMPLICATIONS Endometrial dysfunction and abnormal trophoblast invasion and placentation in PCOS women can predispose to miscarriage and pregnancy complications. Thus, patients and their health care providers should advise about these risks. Although currently no intervention can be universally recommended to reverse endometrial dysfunction in PCOS women, lifestyle modifications and metformin may improve underlying endometrial dysfunction and pregnancy outcomes in obese and/or insulin resistant patients. Bariatric surgery has shown its efficacy in severely obese PCOS patients, but a careful evaluation of the benefit/risk ratio is warranted. Large scale randomized controlled clinical trials should address these possibilities.
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Affiliation(s)
- Stefano Palomba
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano of Reggio Calabria, Reggio Calabria, Italy
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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Günther V, von Otte S, Maass N, Alkatout I. Endometrial "Scratching" An update and overview of current research. J Turk Ger Gynecol Assoc 2020; 21:124-129. [PMID: 32517438 PMCID: PMC7294834 DOI: 10.4274/jtgga.galenos.2020.2019.0175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
About one in every six couples is affected by sterility. Assisted reproduction procedures are currently the treatment of choice for a number of patients who desire children. Many causes of sterility can be overcome with the aid of in vitro fertilization, but successful implantation of the embryos is the major limiting factor. Failure of implantation may occur repetitively. In the treatment of sterility, many approaches have been used to overcome the barrier of implantation failure and improve the chances of successful nidation. Scratching the endometrium prior to embryo transfer has been suggested as one means of enhancing the likelihood of implantation. The current literature was examined to investigate if there was any possible benefit from endometrial scratching. The studies were divided according to whether the women suffered from recurrent implantation failure or not. In summary, it was found that unselected subfertile women generally benefit less from endometrial scratching, but scratching appears to be successful in women who have experienced repeated implantation failure. Although the heterogeneous body of data on the subject deserves further clarification. The latest data presented at “European Society of Human Reproduction and Embryology” 2018 in Barcelona suggested that the method should be abandoned.
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Affiliation(s)
- Veronika Günther
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany.,University Fertility Center, Ambulanzzentrum des UKSH gGmbH, Kiel, Germany
| | - Sören von Otte
- University Fertility Center, Ambulanzzentrum des UKSH gGmbH, Kiel, Germany
| | - Nicolai Maass
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany
| | - Ibrahim Alkatout
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany
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Endometrial Scratching Effect on Clinical Pregnancy Rates in Patients Undergoing Egg Donor In Vitro Fertilization Cycles: the ENDOSCRATCH Randomized Clinical Trial (NCT03108157). Reprod Sci 2020; 27:1863-1872. [PMID: 32468267 DOI: 10.1007/s43032-020-00204-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/06/2020] [Indexed: 12/21/2022]
Abstract
The potential benefit of endometrial scratching (ES) on embryo implantation is still a controversial subject. At present, the single retrospective study in egg donor IVF cycles concluded that ES has no beneficial effect. Our objective was to determine if there are differences in clinical pregnancy rates (CPR) in egg donor cycles when an ES is performed. This is a randomized controlled trial (RCT) in egg donor IVF patients conducted at ProcreaTec Fertility Center in Madrid. Three hundred fifty-two patients were included in total. One hundred sixty-one patients completed the protocol in group A and 172 patients in group B. Patients allocated to group A received an ES in the luteal phase of the cycle preceding the embryo transfer cycle. Group B patients did not receive any intervention. Primary outcome of this RCT was CPR. Secondary outcomes were implantation (IR), miscarriage (MR), ongoing pregnancy (OPR), multiple pregnancy (MulPR), and live birth rates (LBR). CPR was 104 of 161 (64.6%) in group A and 102 of 172 (59.3%) in group B (RR 1.09, 95% confidence interval (CI) (0.92-1.29); p = 0.378). OPR, MR, MulPR, and LBR were also comparable. No major complications were detected after ES and pregnancy complications were comparable. Our results show that there is no beneficial role of ES in egg donor IVF cycles, considering these patients as the ideal model as they share homogeneous embryo quality and endometrial preparation protocols. This trial was registered on April 5, 2017, as the ENDOSCRATCH trial (NCT03108157).
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Sar-Shalom Nahshon C, Sagi-Dain L, Wiener-Megnazi Z, Dirnfeld M. The impact of intentional endometrial injury on reproductive outcomes: a systematic review and meta-analysis. Hum Reprod Update 2020; 25:95-113. [PMID: 30388238 DOI: 10.1093/humupd/dmy034] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endometrial injury is an intentional damage made to the endometrium, usually produced by a Pipelle catheter. Over the last two decades, endometrial injury has been studied to improve implantation rates and decrease the incidence of implantation failure in invitro fertilization (IVF) cycles. Recently, additional studies of endometrial injury, performed not only in patients with implantation failure but also in intrauterine insemination cycles, have been conducted, and the endometrial injury made by hysteroscopy has been researched. The evidence describing the impact of endometrial injury is controversial; therefore, we conducted a systematic review and meta-analysis to examine the issue. OBJECTIVE AND RATIONALE Our objective is to review the research that has been done until now and perform a meta-analysis regarding endometrial injury and its influence on implantation success and pregnancy rates in patients with at least one failed IVF cycle. In particular, we aim to study the efficacy of the procedure and look for confounding factors, such as maternal age, in assessing the efficacy of endometrial injury. SEARCH METHODS The systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Study protocol can be assessed at PROSPERO International prospective register of systematic reviews (registration number CRD42018092773). Searches were conducted by an experienced research librarian in the following databases: MEDLINE(R) using the OvidSP interface and PUBMED, Embase, Web of Science and Cochrane Library. This review considered for inclusion randomized-controlled trials examining the success of performing local endometrial injury on IVF outcomes in women with previous failed IVF cycles. OUTCOMES Ten studies, comprising a total of 1260 patients, were selected. Overall, when studying the effect of endometrial injury on clinical pregnancy rates (CPRs) and live birth rates (LBRs), higher rates were shown in the endometrial injury group. However, endometrial injury did not significantly improve CPRs and LBRs, when considering sub-group analyses of studies including patients with two or more failed IVF cycles, studies examining older patients or studies which did not include hysteroscopy. There was no significant difference found regarding multiple pregnancy rates, while a handful of studies showed an improvement in miscarriage rates. WIDER IMPLICATIONS Endometrial injury should be used restrictively and not routinely in clinics. Maternal age and number of previous failed treatment cycles may be contributing factors which can influence the results when studying the effect of endometrial local injury. It is possible that the relative contribution of endometrial receptivity to the chances of implantation decreases with any additional failed cycle. The optimal study to prove the efficacy of local endometrial injury on implantation and pregnancy rates, should be a random-controlled trial studying the effect of local endometrial injury in oocyte donation cycles, in recipients with repeated implantation failure. This kind of study will conclude whether local endometrial injury is an efficient procedure with minimum confounding factors, and may assist in defining the population, even outside of donation cycles, that will benefit from the procedure.
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Affiliation(s)
- Chen Sar-Shalom Nahshon
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion Haifa, Israel
| | - Lena Sagi-Dain
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion Haifa, Israel
| | - Zofnat Wiener-Megnazi
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion Haifa, Israel
| | - Martha Dirnfeld
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion Haifa, Israel
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Recurrent implantation failure: which patients benefit from endometrial scratching prior to IVF? Arch Gynecol Obstet 2020; 301:817-822. [PMID: 31897673 DOI: 10.1007/s00404-019-05424-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Endometrial scratching (ES) using a biopsy catheter prior to the IVF cycle in the repeated implantation failure (RIF) population has been suggested, but no convincing evidence of its benefit has been presented until now. METHODS A retrospective mono-center study among 300 consecutive IVF-RIF cycles following evaluation of the ovarian reserve, hysterosalpingography or hysteroscopy, pelvic ultrasound, thrombophilia evaluation, karyotyping and assessment of male sperm parametrs. The findings within normal limits. All the patients offered ES, 78 consented and underwent ES prior to their next IVF cycle. RESULTS A comparison of treatment outcomes between the post-ES cycles (n = 78) and the non-ES cycles (222) demonstrated the following: 34 (43.5%) versus 14 (6.3%) conceptions, respectively (p = 0.001) and 30 (38.4%) versus 2 (0.9%) clinical pregnancies, respectively (p < 0.001%), emphasizing an extremely high biochemical pregnancy rate among the non-ES cycles. Implantation rate was 19.7% versus 0.4%, respectively (p < 0.001) and live birth rate was 33.33% (26 newborns) versus 0.45% (1 newborn), respectively (p < 0.001). Since there were more embryos available for transfer and more top-quality embryos in the post-ES-IVF conception cycles, the role of ES became questionable. A multivariate analysis that included ES and the percentage of top-quality embryos demonstrated that ES was an independent factor highly correlated with conception in this particular RIF population. CONCLUSIONS ES proved to be an efficient tool in a particular subgroup of RIF patients with fertility investigation results within normal limits, an optimal ovarian response to gonadotropins, and a high percentage of top-quality embryos. Nevertheless, the results should not be overestimated, since the study has limitations related to its retrospective model.
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Gibreel A, Ali R, Hemida R, Sherif L, El-Adawi N. Endometrial scratch for infertile polycystic ovary syndrome (PCOS) women undergoing laparoscopic ovarian drilling: a randomized controlled trial. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2019. [DOI: 10.1186/s43043-019-0001-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gricius R, Balciuniene G, Jakubauskiene L, Ramasauskaite D. The Significance of Endometrial Scratching for Clinical Pregnancy Rate in Long Agonist and Antagonist Protocols. ACTA ACUST UNITED AC 2019; 55:medicina55090527. [PMID: 31450870 PMCID: PMC6780940 DOI: 10.3390/medicina55090527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Assisted reproductive techniques today have helped many infertile couples achieve their desired pregnancy. However, unsuccessful implantation is usually the key failure in in vitro fertilization cycles. Many factors are now being studied to improve the implantation rate, one being endometrial artificial injury (endometrial scratching). The purpose of this study was to assess whether local endometrial artificial injury improved pregnancy rate, in long agonist and antagonist protocols. Materials and Methods: A retrospective analysis was carried out at the JSC Baltic American Clinic from January 1, 2016 to December 31, 2018. Women who were undergoing in vitro fertilization treatment were enrolled in the study. Medical data including demographic factors, menstrual history, and anamnesis of infertility were collected from medical records. Subjects were divided into intervention and control groups. The outcome of this study was clinical pregnancy rate (CPR). Results: A total of 137 women presenting with primary or secondary infertility were enrolled in the study. Clinical pregnancy was observed in 44/71 (61.9%) patients in the intervention group and 33/66 (50%) in the group without endometrial scratching (p value = 0.16). CPR in the intervention group was significantly higher in the patient group that had undergone ovarian stimulation with a long agonist protocol rather than the antagonist protocol (73.8% vs. 41.4%; p value = 0.006). In the multivariable logistic regression model, previously failed in vitro fertilization (IVF) (odds ratio (OR) = 0.07, 95% confidence interval (CI) 0.01–0.47), stimulation with the long agonist protocol (OR = 19.89, 95% CI 3.57–18.63), antagonist protocol (OR = 0.05, 95% CI 0.01–0.34), number of embryos (OR = 1.37, 95% CI 1.05–1.38), and number of blastocysts (OR = 2.96, 95% CI 1.43–8.36) remained important independent prognostic factors for clinical pregnancy. Conclusions: Our study findings indicate that randomized controlled studies are required to define patients for this procedure and to prove the effect and safety of local endometrial injury, before it is introduced to routine clinical practice.
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Affiliation(s)
- Rimantas Gricius
- JSC Baltic Amrican Clinic, 10103 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Greta Balciuniene
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania.
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine,Faculty of Medicine,Vilnius University, 03101 Vilnius, Lithuania.
| | - Lina Jakubauskiene
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine,Faculty of Medicine,Vilnius University, 03101 Vilnius, Lithuania
| | - Diana Ramasauskaite
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine,Faculty of Medicine,Vilnius University, 03101 Vilnius, Lithuania
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Gürgan T, Kalem Z, Kalem MN, Ruso H, Benkhalifa M, Makrigiannakis A. Systematic and standardized hysteroscopic endometrial injury for treatment of recurrent implantation failure. Reprod Biomed Online 2019; 39:477-483. [PMID: 31405721 DOI: 10.1016/j.rbmo.2019.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
RESEARCH QUESTION To investigate the effect of hysteroscopic endometrial injury for treatment of recurrent implantation failure (RIF). DESIGN This prospective and randomized controlled trial included 239 patients who had failed to achieve a clinical pregnancy after the transfer of at least four good-quality embryos in a minimum of three fresh or frozen-thawed embryo transfer cycles and were under the age of 40 years, who were randomized into two groups. The injury group (n = 124) received endometrial injury during their hysteroscopic procedure, whereas the control group (n = 115) did not. Patients who had endometrial pathologies were excluded from the study. RESULTS There were no statistically significant differences in duration of gonadotrophin use (8.23 versus 8.30 days), total dose of gonadotrophins (2330 versus 2338 IU), number of oocytes (7.03 versus 8.21), number of mature oocytes (5.27 versus 6.02), number of fertilized oocytes (4.19 versus 4.55), number of good-quality embryos (2.07 versus 2.43), number of embryos transferred (1.97 versus 1.93) or endometrial thickness (9.04 versus 9.35 mm) between the injury group and control group, respectively. Clinical pregnancy rates (25.8% versus 15.6%, P = 0.047), live birth rates (21.8% versus 12.2%, P = 0.049) and implantation rates (14.2% versus 8.8%, P = 0.036) were significantly different, favouring the injury group. CONCLUSION This study suggests that endometrial injury is beneficial in RIF patients to increase the odds of implantation, clinical pregnancy and live birth.
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Affiliation(s)
- Timur Gürgan
- Gürgan Clinic Women's Health and IVF Centre, Ankara, Turkey; Bahcesehir University, Faculty of Medicine, Department of Obstetrics and Gynecology Istanbul, Turkey.
| | - Ziya Kalem
- Gürgan Clinic Women's Health and IVF Centre, Ankara, Turkey
| | - Müberra N Kalem
- Bahcesehir University, Faculty of Medicine, Department of Obstetrics and Gynecology Istanbul, Turkey
| | - Halil Ruso
- Gürgan Clinic Women's Health and IVF Centre, Ankara, Turkey; Gazi University, Faculty of Medicine, Department of Histology and Embryology, Ankara, Turkey
| | - Moncef Benkhalifa
- Reproductive Medicine and Reproductive Genetics University Hospital and PERITOX Laboratory, Picardy Jules Verne University, Amiens, France
| | - Antonis Makrigiannakis
- University of Crete, Medical School, Department of Obstetrics and Gynecology, Heraklion, Greece
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van Hoogenhuijze NE, Kasius JC, Broekmans FJM, Bosteels J, Torrance HL. Endometrial scratching prior to IVF; does it help and for whom? A systematic review and meta-analysis. Hum Reprod Open 2019; 2019:hoy025. [PMID: 30895265 PMCID: PMC6396643 DOI: 10.1093/hropen/hoy025] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 12/06/2018] [Accepted: 12/19/2018] [Indexed: 12/16/2022] Open
Abstract
STUDY QUESTION What is the effect of endometrial scratching in patients with or without prior failed ART cycles on live birth (LBR) and clinical pregnancy rates (CPR)? SUMMARY ANSWER It remains unclear if endometrial scratching improves the chance of pregnancy and, if so, for whom. WHAT IS KNOWN ALREADY Endometrial scratching is hypothesized to improve embryo implantation in ART. Multiple studies have been published, but it remains unclear if endometrial scratching actually improves pregnancy rates and, if so, for which patients. STUDY DESIGN, SIZE, DURATION For this review, a systematic search for published articles on endometrial scratching and ART was performed on 12 February 2018, in Pubmed, Embase and the Cochrane Library. PARTICIPANTS/MATERIALS, SETTING, METHODS Randomized controlled trials (RCTs) that evaluated endometrial scratching in the cycle prior to the stimulation cycle and reported CPR or LBR were included. RCTs investigating the effect of scratching during the stimulation cycle, or prior to cryo-thaw cycles were excluded. Studies were assessed using the Cochrane Risk of Bias tool. The effect of scratching was assessed for three different patient groups: patients with no prior IVF/ICSI treatment (Group 0), patients with one failed full IVF/ICSI cycle, including cryo-thaw cycles (Group 1) and patients with two or more failed full IVF/ICSI cycles (Group 2). A meta-analysis was performed when statistical heterogeneity was low; otherwise, a descriptive analysis was performed. MAIN RESULTS AND THE ROLE OF CHANCE Fourteen RCTs involving 2537 participants were included. Most RCTs contained a high or unclear risk of bias on one or more items. Substantial clinical and statistical heterogeneity was present; therefore meta-analysis for LBR and CPR could only be performed on Group 1. For this group, no differences between scratch and control were found for both LBR (risk ratio (RR) 1.01 [95%CI 0.68–1.51]) and CPR (RR 1.04 [95%CI 0.74–1.45]). For Groups 0 and 2, pooled analysis could not be performed, and for both groups the results of the individual RCTs were negative, neutral and positive. Miscarriage and multiple pregnancy rates were evaluated for the three groups (0, 1 and 2) together. Both outcomes were not significantly different between scratch and control (miscarriage rate RR 0.82 [95%CI 0.57–1.17] and multiple pregnancy rate RR 1.06 [95%CI 0.84–1.35]). Subgroup analysis, excluding trials with a risk of unintentional endometrial injury in the control group, was performed for Group 0 and 2 for LBR and CPR, and for the overall groups for miscarriage rate and multiple pregnancy rate. This reduced the heterogeneity and allowed for pooled analysis in these subgroups. Results of pooled analysis for the subgroups of Group 0 and 2 showed no significant difference for LBR, but CPR was significantly improved after endometrial scratching (Group 0 RR 1.28 [95%CI 1.02–1.62] and Group 2 RR 2.03 [95%CI 1.20–3.43]). Subgroup analysis of the overall groups showed no significant difference for miscarriage and multiple pregnancy rate. LIMITATIONS REASONS FOR CAUTION The main limitations were that many RCTs had a high or unclear risk of bias on one or several items, clinical heterogeneity was still present despite categorizing into three populations, and that not all RCTs could be included in the analyses because separate data for our three groups could not be provided. WIDER IMPLICATIONS OF THE FINDINGS It remains unclear if endometrial scratching improves the chance of pregnancy for women undergoing ART and, if so, for whom. This means endometrial scratching should not be offered in daily practice until results from large and well-designed RCTs and an individual patient data analysis become available. STUDY FUNDING/COMPETING INTERESTS No specific funding was sought for the study. The Department of Reproductive Medicine and Gynaecology funds of the University Medical Center of Utrecht were used to support the authors throughout the study period and preparation of the manuscript. None of the authors has a conflict of interest to declare. REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- N E van Hoogenhuijze
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht University, Room Number: F05.126, Utrecht, The Netherlands
- Correspondence address. E-mail:
| | - J C Kasius
- Department of Gynaecology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
| | - F J M Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht University, Room Number: F05.126, Utrecht, The Netherlands
| | - J Bosteels
- Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium Centre for Evidence-Based Medicine, Cochrane Belgium, Leuven, Belgium
| | - H L Torrance
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht University, Room Number: F05.126, Utrecht, The Netherlands
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Vitagliano A, Andrisani A, Alviggi C, Vitale SG, Valenti G, Sapia F, Favilli A, Martins WP, Raine-Ferring N, Polanski L, Ambrosini G. Endometrial scratching for infertile women undergoing a first embryo transfer: a systematic review and meta-analysis of published and unpublished data from randomized controlled trials. Fertil Steril 2019; 111:734-746.e2. [PMID: 30683590 DOI: 10.1016/j.fertnstert.2018.12.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate endometrial scratch injury (ESI) as an intervention to improve IVF outcome in women undergoing a first ET. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Infertile women undergoing a first fresh/frozen embryo transfer. INTERVENTION(S) We included published and unpublished data from randomized controlled trials in which the intervention group received ESI and controls received placebo or no intervention. Pooled results were expressed as relative risk (RR) with 95% confidence interval (CI). The review protocol was registered in PROSPERO to start the data extraction (CRD42018087786). MAIN OUTCOME MEASURE(S) Ongoing pregnancy/live birth rate (OPR/LBR), clinical pregnancy rate (CPR), multiple pregnancy rate (MPR), miscarriage rate (MR), and ectopic pregnancy rate (EPR). RESULT(S) Seven studies were included (1,354 participants). We found a nonsignificant difference between groups in terms of OPR/LBR, CPR, MR, MPR, and EPR. Subgroup analysis found that ESI on the day of oocyte retrieval (achieved by a Novak curette) reduced OPR/LBR (RR 0.31, 95% CI 0.14-0.69) and CPR (RR 0.36, 95% CI 0.18-0.71), whereas ESI during the cycle preceding ET (performed through soft devices) had no effect on OPR/LBR and CPR. No difference in the impact of ESI was observed between fresh and frozen embryo transfer. CONCLUSION(S) Current evidence does not support performing ESI with the purpose of improving the success of a first ET attempt.
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Affiliation(s)
- Amerigo Vitagliano
- Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy.
| | - Alessandra Andrisani
- Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Fabrizio Sapia
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Nick Raine-Ferring
- Division of Obstetrics and Gynaecology, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Lukasz Polanski
- Division of Obstetrics and Gynaecology, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom; NURTURE Fertility, Nottingham, United Kingdom
| | - Guido Ambrosini
- Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy
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Bui BN, Torrance HL, Janssen C, Cohlen B, de Bruin JP, den Hartog JE, van der Linden PJQ, Deurloo KL, Maas JWM, van Oppenraaij R, Cantineau A, Lambalk CB, Visser H, Brinkhuis E, van Disseldorp J, Schoot BC, Lardenoije C, van Wely M, Eijkemans MJC, Broekmans FJM. Does endometrial scratching increase the rate of spontaneous conception in couples with unexplained infertility and a good prognosis (Hunault > 30%)? Study protocol of the SCRaTCH-OFO trial: a randomized controlled trial. BMC Pregnancy Childbirth 2018; 18:511. [PMID: 30594169 PMCID: PMC6311044 DOI: 10.1186/s12884-018-2160-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022] Open
Abstract
Background In the Netherlands, couples with unexplained infertility and a good prognosis to conceive spontaneously (i.e. Hunault > 30%) are advised to perform timed intercourse for at least another 6 months. If couples fail to conceive within this period, they will usually start assisted reproductive technology (ART). However, treatment of unexplained infertility by ART is empirical and can involve significant burdens. Intentional endometrial injury, also called ‘endometrial scratching’, has been proposed to positively affect the chance of embryo implantation in patients undergoing in vitro fertilization (IVF). It might also be beneficial for couples with unexplained infertility as defective endometrial receptivity may play a role in these women. The primary aim of this study is to determine whether endometrial scratching increases live birth rates in women with unexplained infertility. Method A multicentre randomized controlled trial will be conducted in Dutch academic and non-academic hospitals starting from November 2017. A total of 792 women with unexplained infertility and a good prognosis for spontaneous conception < 12 months (Hunault > 30%) will be included, of whom half will undergo endometrial scratching in the luteal phase of the natural cycle. The women in the control group will not undergo endometrial scratching. According to Dutch guidelines, both groups will subsequently perform timed intercourse for at least 6 months. The primary endpoint is cumulative live birth rate. Secondary endpoints are clinical and ongoing pregnancy rate; miscarriage rate; biochemical pregnancy loss; multiple pregnancy rate; time to pregnancy; progression to intrauterine insemination (IUI) or IVF; pregnancy complications; complications of endometrial scratching; costs and endometrial tissue parameters associated with reproductive success or failure. The follow-up duration is 12 months. Discussion Several small studies show a possible beneficial effect of endometrial scratching in women with unexplained infertility trying to conceive naturally or through IUI. However, the quality of this evidence is very low, making it unclear whether these women will truly benefit from this procedure. The SCRaTCH-OFO trial aims to investigate the effect of endometrial scratching on live birth rate in women with unexplained infertility and a good prognosis for spontaneous conception < 12 months. Trial registration NTR6687, registered August 31st, 2017. Protocol version Version 2.6, November 14th, 2018.
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Affiliation(s)
- B N Bui
- University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - H L Torrance
- University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - C Janssen
- Groene Hart Hospital, Gouda, The Netherlands
| | - B Cohlen
- Isala Fertility Clinic, Zwolle, The Netherlands
| | - J P de Bruin
- Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - J E den Hartog
- Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | | | - J W M Maas
- Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - A Cantineau
- University Medical Centre Groningen, Groningen, The Netherlands
| | - C B Lambalk
- Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
| | - H Visser
- Tergooi Hospital, Hilversum, The Netherlands
| | - E Brinkhuis
- Meander Medical Centre, Amersfoort, The Netherlands
| | | | - B C Schoot
- Catharina Hospital, Eindhoven, The Netherlands
| | | | - M van Wely
- Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynecology - NVOG Consortium 2.0, Amsterdam, The Netherlands
| | - M J C Eijkemans
- University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - F J M Broekmans
- University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
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The effect of day 6 endometrial injury of the ICSI cycle on pregnancy rate: A randomized controlled trial. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2018.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Eskew AM, Reschke LD, Woolfolk C, Schulte MB, Boots CE, Broughton DE, Jimenez PT, Omurtag KR, Keller SL, Ratts VS, Odem RR, Jungheim ES. Effect of endometrial mechanical stimulation in an unselected population undergoing in vitro fertilization: futility analysis of a double-blind randomized controlled trial. J Assist Reprod Genet 2018; 36:299-305. [PMID: 30397897 DOI: 10.1007/s10815-018-1356-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Implantation failure is a major limiting factor of successful in vitro fertilization (IVF). The objective of this study was to determine if endometrial mechanical stimulation (EMS) by endometrial biopsy in the luteal phase of the cycle prior to embryo transfer (ET) improves clinical outcomes in an unselected subfertile population. METHODS Double-blind, randomized controlled trial of EMS versus sham biopsy and odds of clinical pregnancy after IVF and embryo transfer. Secondary outcomes included spontaneous miscarriage and live birth. RESULTS One hundred women enrolled and were randomized from 2013 to 2017. Enrollment was terminated after futility analysis showed no difference in clinical pregnancy between EMS versus control, 47.2% vs 61.7% (OR 0.55, 95% CI 0.25-1.23, p = 0.15). There were no significant differences between women who underwent EMS and those who did not in terms of positive pregnancy test 54.7% vs 63.8% (OR 0.69, 95% CI 0.31-1.53, p = 0.36), miscarriage 7.5% vs 2.1% (OR 3.76 95% CI 0.41-34.85, p = 0.22), or live birth 43.4% vs 61.7% (OR 0.48 95% CI 0.21-1.06, p = 0.07). CONCLUSIONS EMS in the luteal phase of the cycle preceding embryo transfer does not improve clinical outcomes in an unselected subfertile population and may result in a lower live birth rate. We caution the routine use of EMS in an unselected population.
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Affiliation(s)
- Ashley M Eskew
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA.
| | - Lauren D Reschke
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Candice Woolfolk
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Maureen B Schulte
- Reproductive Medical Associates of St. Louis, 641 N New Ballas, Creve Coeur, MO, 63141, USA
| | - Christina E Boots
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, 259 E. Erie Street, Chicago, IL, 60611, USA
| | - Darcy E Broughton
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Patricia T Jimenez
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Kenan R Omurtag
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Sarah L Keller
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Valerie S Ratts
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Randall R Odem
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Emily S Jungheim
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
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Siristatidis C, Rigos I, Pergialiotis V, Karageorgiou V, Christoforidis N, Daskalakis G, Bettocchi S, Makrigiannakis A. Endometrial injury for patients with endometriosis and polycystic ovary syndrome undergoing medically assisted reproduction: current data and a protocol. Horm Mol Biol Clin Investig 2018; 35:/j/hmbci.ahead-of-print/hmbci-2018-0040/hmbci-2018-0040.xml. [PMID: 30144383 DOI: 10.1515/hmbci-2018-0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/11/2018] [Indexed: 01/13/2023]
Abstract
We propose a study protocol capable of improving clinical outcomes following medically assisted reproduction (MAR) in infertile women with endometriosis and polycystic ovary syndrome (PCOS). The proposed research derives from the published evidence on the positive impact from endometrial injury (EI) and the beneficial nature of the intervention towards improved implantation rates. We primarily refer to the cluster of events and hypotheses, such as the mechanical cascade, the inflammatory response per se, the events accompanying wound healing, the immune cell recruitment and protein involvement, alterations in gene expression and the neo-angiogenesis theories, which have been previously investigated for this purpose. We are also exploring the possible problems in MAR cycles with negative outcomes in PCOS and endometriosis patients and we are proposing potential mechanisms on how this intervention might work. Our hypothesis states that the EI before the initiation of the MAR cycle can affect clinical pregnancy rates in patients with the aforementioned pathologies.
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Affiliation(s)
- Charalampos Siristatidis
- Third Department of Obstetrics and Gynecology, "Attikon Hospital", Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari, Athens 12642, Greece, Phone: 0030-6932294994
| | - Ioannis Rigos
- Third Department of Obstetrics and Gynecology, "Attikon Hospital", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Pergialiotis
- Third Department of Obstetrics and Gynecology, "Attikon Hospital", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - George Daskalakis
- First Department of Obstetrics and Gynaecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefano Bettocchi
- Second Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University "Aldo Moro", Bari, Italy
| | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
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Maged AM, Rashwan H, AbdelAziz S, Ramadan W, Mostafa WAI, Metwally AA, Katta M. Randomized controlled trial of the effect of endometrial injury on implantation and clinical pregnancy rates during the first ICSI cycle. Int J Gynaecol Obstet 2018; 140:211-216. [PMID: 29048754 DOI: 10.1002/ijgo.12355] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/24/2017] [Accepted: 10/18/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess whether endometrial injury in the cycle preceding controlled ovarian hyperstimulation during intracytoplasmic sperm injection (ICSI) improves the implantation and pregnancy rates. METHODS Between January 1, 2016, and March 31, 2017, a randomized controlled trial was conducted at a center in Egypt among 300 women who met inclusion criteria (first ICSI cycle, aged <40 years, day-3 follicle-stimulating hormone <10 IU/L, normal serum prolactin, no uterine cavity abnormality). The women were randomly allocated using a web-based system to undergo endometrial scratch in the cycle preceding controlled ovarian hyperstimulation (n=150) or to a control group (n=150). Only data analysts were masked to group assignment. The primary outcomes were the implantation and clinical pregnancy rates at 14 days and 4 weeks after embryo transfer, respectively. Analyses were by intention to treat. RESULTS The implantation rate was significantly higher in the endometrial scratch group (41.3% [90/218]) than in the control group (30.0% [63/210]; P<0.001). The clinical pregnancy rate was also significantly higher in the endometrial scratch group (44.2% [61/138]) than in the control group (30.4% [41/135]; P<0.001). CONCLUSION Endometrial injury in the cycle preceding the stimulation cycle improved implantation and pregnancy rates during ICSI. CLINICALTRIALS.GOV: NCT02660125.
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Affiliation(s)
- Ahmed M Maged
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hamsa Rashwan
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Suzy AbdelAziz
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Wafaa Ramadan
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Walaa A I Mostafa
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Ahmed A Metwally
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Maha Katta
- Department of Obstetrics and Gynecology, Beni-Suef University, Beni Suef, Egypt
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Abstract
PURPOSE OF REVIEW To review updated information on the influence of endometrial scratching on IVF. RECENT FINDINGS Endometrial receptivity remains an important rate-limiting step affecting the success of IVF. The current evidence on the effect of endometrial scratching on IVF ranges from marked improvement, no difference to a potentially negative impact. The heterogeneity of studies presents a challenge in interpretation of data for routine clinical practice. SUMMARY Endometrial scratching performed in the preceding cycle is associated with improved clinical pregnancy and live birth rates in women with recurrent implantation failure, but not in unselected subfertile women undergoing IVF. Most of the current literature are underpowered and at high risk of bias.
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Abstract
PURPOSE OF REVIEW Since its first description in 2003, the endometrial scratching procedure has been the topic of over 1000 studies. This procedure, used to improve endometrial receptivity for assisted reproduction, is accessible - any gynecologist can easily perform it - and has been adapted into clinical routine by some reproductive units. However, the available data are controversial, and no biological plausibility exists to support the use of this intervention. This study aims to critically review the existing data, focusing on the last 2 years, regarding the efficiency of endometrial scratching. RECENT FINDINGS A total of five randomized controlled studies, one meta-analysis, and a systematic review related to endometrial scratching/injury were published in 2014 and 2015. Considerable heterogeneity exists among these studies regarding the selected population, type of treatment, and even timing and devices used to perform the endometrial injury. Importantly, none of these studies reported improved reproductive outcomes in terms of live birth rates following endometrial scratching. SUMMARY Overall, data from properly designed and powered randomized controlled studies demonstrate no beneficial effect of this intervention that is based on unknown biological effects. Endometrial scratching produces pain, costs money, and the side-effects of systematic scratching in the production of Asherman syndrome remain to be seen. Think before scratching.
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Wadhwa L, Mishra M. Therapeutic Efficacy of Endometrial Scratching in Repeated Controlled Ovarian Stimulation (COS) Failure Cycles. J Hum Reprod Sci 2018; 11:59-71. [PMID: 29681718 PMCID: PMC5892106 DOI: 10.4103/jhrs.jhrs_130_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: The objective of the study was (1) “to evaluate the therapeutic efficacy of endometrial scratching in repeated controlled ovarian stimulation (COS) failure cycles.” And (2) “to compare differences in pregnancy outcome by endometrial scratching in early (D2–D4) and late follicular phases (D7–D9) of the same stimulation cycle.” Materials and Methods: Women attending infertility clinic in a tertiary care center and who have two or more repeated COS failure cycles and planned for COS with intrauterine insemination (IUI) were included in the study which is a prospective parallel, interventional, single-blinded, randomized control study, in 1:1 allocation ratio. A total of 165 patients were recruited and randomly allocated into three groups: Group A (n = 55) underwent endometrial scratching on D2–D4 of the same COS cycle, Group B (n = 55) on D7–D9, and Group C (n = 55) no intervention done. All the patients underwent COS according to standard protocol followed by IUI. Results: Clinical pregnancy rate was 12.73% (odds ratio [OR] =0.87 95% confidence interval [CI] =0.288–2.55, P = 1), 16.36% (OR = 1.15; 95% CI = 0.40–3.23, P = 1), and 14.54%, respectively, in Group A, B, and C, respectively (P = 0.86), as per intention to treat analysis. Using Chi-square test, P value between Group A and B was 0.787, between Group A and C was 1.000, and between Group B and C was 1.000. As per protocol analysis, clinical pregnancy rate was 13.46% (OR = 0.83; 95% CI = 0.27–2.5, P = 0.74), 19.57% (OR = 1.3 95%; CI = 0.45–3.73, P = 0.41), and 15.69%. Using Chi-square test, Pvalue between Group A and B was 0.588, between Group A and C was 0.967, and between Group B and C was 0.815. No abortions and multiple pregnancies occurred in either of the groups. Conclusion: The effect found was of good quantum in Group B as per protocol analysis which could be of clinical relevance if larger sample size would have been taken. Endometrial scratching is a cost-effective and easy technique which may improve clinical pregnancy rates in previous COS failure cycles, but more trials are needed to be conducted using larger sample size to achieve the improved and significant outcome.
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Affiliation(s)
- Leena Wadhwa
- Department of Obstetrics and Gynecology, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Mona Mishra
- Department of Obstetrics and Gynecology, ESI-PGIMSR, Basaidarapur, New Delhi, India
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Endometriales Scratching. GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-017-0152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Helmy MEE, Maher MA, Elkhouly NI, Ramzy M. A randomized trial of local endometrial injury during ovulation induction cycles. Int J Gynaecol Obstet 2017; 138:47-52. [PMID: 28397981 DOI: 10.1002/ijgo.12178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/08/2017] [Accepted: 04/07/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the effect of endometrial injury on pregnancy outcomes among infertile women taking clomifene citrate. METHODS A prospective randomized trial was undertaken at an Egyptian hospital between January 26, 2015, and July 17, 2016. Eligible women (≥1 year primary/secondary/unexplained infertility, aged 20-35 years, day-2 follicle-stimulating hormone <12 IU/L, normal prolactin/thyroid function/uterine cavity, ≥1 patent tube, male partner with normal semen count and motility, 3 cycles of clomifene citrate without success) were randomly allocated (1:1) using computer-generated numbers into intervention (received endometrial injury on cycle day 15-24) or control groups (sham procedure). Women began ovulation induction on days 3-5 of the following cycle. Participants and investigators were not masked to group assignment. The primary outcomes were clinical pregnancy, spontaneous abortion, and multiple pregnancy rates. Women who completed follow-up were included in analyses. RESULTS The intervention group included 52 women and the control group 53 women. The clinical pregnancy rate was significantly higher in the intervention group (37% [n=19]) than in the control group (13% [n=7]; P=0.006). No differences between the intervention and control groups were noted for spontaneous abortion rate (11% [2/19] vs 29% [2/7]; P=0.287) or multiple pregnancy rate (11% [2/19] vs 14% [1/7]; P=0.790). No adverse effects were reported. CONCLUSION Endometrial injury before ovulation induction could improve chances of pregnancy and its outcomes. CLINICALTRIALS.GOV: NCT02345837.
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Affiliation(s)
- Medhat E E Helmy
- Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt
| | - Mohammad A Maher
- Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt
| | - Nabih I Elkhouly
- Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt
| | - Mahmoud Ramzy
- Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt
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Ashrafi M, Tehraninejad ES, Haghiri M, Masomi M, Sadatmahalleh SJ, Arabipoor A. The effect of endometrial scratch injury on pregnancy outcome in women with previous intrauterine insemination failure: A randomized clinical trial. J Obstet Gynaecol Res 2017; 43:1421-1427. [PMID: 28612975 DOI: 10.1111/jog.13401] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 11/30/2022]
Abstract
AIM Endometrial scratch injury (ESI) has been recently proposed to enhance the implantation rate in assisted reproductive technology cycles. The present study was conducted to determine the effect of ESI on pregnancy rate in women with intrauterine insemination (IUI) failure. METHODS This prospective randomized controlled study was carried out in Imam-Khomeini Hospital and Royan Institute, Tehran, during a 12-month period from January 2013 to January 2014. After assessment, 169 patients who had IUI failure twice or more (no chemical or clinical pregnancy) with normal uterine anatomy and hysterosalpingography, were enrolled. They were randomly assigned into two groups. In the experimental group, all patients underwent ESI at day 8 or 9 of stimulation phase in the present IUI cycle, whereas no intervention was performed on the control group. IUI outcome was then compared between the two groups. RESULTS A total of 150 patients completed the IUI cycle during the study. The chemical pregnancy rate was 10.7% and 2.7% in the experimental and control groups, respectively, without significant difference (P = 0.09). Also no significant differences were detected in terms of clinical pregnancy and miscarriage rates between the two groups (P > 0.05). CONCLUSIONS No significant beneficial effect of ESI on fertility outcome in patients with repeated IUI failure was detected when it was carried out on day 8 or 9 of the same IUI stimulation cycle. Also, however, no negative impact secondary to ESI was observed. Therefore, confirmation or refutation of this hypothesis requires further studies with a larger sample size. IRCT201507271141N19.
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Affiliation(s)
- Mahnaz Ashrafi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Obstetrics and Gynecology Department, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran.,Obstetrics and Gynecology Department, Faculty of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Ensieh Shahrokh Tehraninejad
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Obstetrics and Gynecology Department, Faculty of Medicine, Tehran University of Medical Science, Tehran, Iran.,Vali-e-Asr Reproductive Health Research Center, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansooreh Haghiri
- Obstetrics and Gynecology Department, Faculty of Medicine, Tehran University of Medical Science, Tehran, Iran.,Vali-e-Asr Reproductive Health Research Center, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Masomi
- Vali-e-Asr Reproductive Health Research Center, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Arezoo Arabipoor
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Siristatidis C, Kreatsa M, Koutlaki N, Galazios G, Pergialiotis V, Papantoniou N. Endometrial injury for RIF patients undergoing IVF/ICSI: a prospective nonrandomized controlled trial. Gynecol Endocrinol 2017; 33:297-300. [PMID: 27910711 DOI: 10.1080/09513590.2016.1255325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
To evaluate the effect of endometrial injury on clinical outcomes in subfertile women with repeated implantation failures (RIF) undergoing assisted reproduction. In this prospective nonrandomized controlled trial, 103 subfertile women with RIF were included. Fifty-one underwent endometrial injury through hysteroscopy in the early follicular phase of the previous cycle and 52 underwent the standard protocol without any intervention. Live birth and miscarriage were the primary outcomes. Clinical and in vitro fertilization (IVF) cycle characteristics, were also compared between groups. Both groups were comparable in terms of baseline and cycle characteristics. Live birth rates were significantly higher in the study, compared with the control group (18/51 vs. 8/52, odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.10-0.64; p = 0.020), although miscarriage rates were similar (7/51 vs. 10/52, OR= 0.25; 95%CI= 0.12-0.66; p = 0.452). The rest of the outcomes parameters were comparable between groups. Logistic regression analysis revealed that endometrial injury and duration of subfertility were independent predictors of live birth after control of other variables (OR = 2.818; 95%CI = 1.044-7.605; p = 0.041 and OR = 0.674; 95%CI = 0.461-0.985, p = 0.042, respectively). Endometrial injury induced through office hysteroscopy in the preceding cycle in subfertile women with RIF improves live birth rates.
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Affiliation(s)
- Charalampos Siristatidis
- a Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens , Chaidari , Athens , Greece
| | - Maria Kreatsa
- a Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens , Chaidari , Athens , Greece
| | - Nikoleta Koutlaki
- b Department of Obstetrics and Gynaecology , Medical School, Democritus University of Thrace , Alexandroupolis , Greece , and
| | - George Galazios
- b Department of Obstetrics and Gynaecology , Medical School, Democritus University of Thrace , Alexandroupolis , Greece , and
| | - Vasileios Pergialiotis
- c 3rd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens , Chaidari , Athens , Greece
| | - Nikolaos Papantoniou
- c 3rd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens , Chaidari , Athens , Greece
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Seval MM, Şükür YE, Özmen B, Kan Ö, Sönmezer M, Berker B, Atabekoğlu C. Does adding endometrial scratching to diagnostic hysteroscopy improve pregnancy rates in women with recurrent in-vitro fertilization failure? Gynecol Endocrinol 2016; 32:957-960. [PMID: 27258405 DOI: 10.1080/09513590.2016.1190818] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To investigate the effect of additional endometrial scratching procedure during hysteroscopy on assisted reproductive technology (ART) cycle outcomes in repeated implantation failure (RIF) patients without endometrial or uterine abnormalities on hysteroscopic evaluation. MATERIALS AND METHODS Three hundred and forty-five RIF patients who underwent ART at a university-based infertility clinic between January 2011 and June 2015 were recruited in this retrospective cohort study. Uterine cavities of all included patients were evaluated by diagnostic hysteroscopy 7-14 days prior to the subsequent ART cycle. Women without endometrial abnormalities were allocated into two groups; the scratching group was consisted of patients who underwent endometrial scratching by using monopolar electric energy with needle forceps during hysteroscopy, and the control group was consisted of patients who underwent only diagnostic hysteroscopy. RESULTS The implantation rate was significantly higher in the scratching group than the control group (37.7% versus 24.5%; p = 0.04). Clinical and ongoing pregnancy rates were also found to be significantly higher in the scratching group than the control group (37.7% versus 27.6%; p = 0.03; and 33.3% versus 23%; p = 0.03, respectively). CONCLUSION Endometrial scratching during diagnostic hysteroscopy seems to enhance implantation and as well pregnancy rates in comparison to diagnostic hysteroscopy alone.
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Affiliation(s)
- Mehmet Murat Seval
- a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey
| | - Yavuz Emre Şükür
- a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey
| | - Batuhan Özmen
- a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey
| | - Özgür Kan
- a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey
| | - Murat Sönmezer
- a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey
| | - Bülent Berker
- a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey
| | - Cem Atabekoğlu
- a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey
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Celik O, Acet M, Kucuk T, Haberal ET, Acet T, Bozkurt M, Sahin L, Verit FF, Caliskan E. Surgery for Benign Gynecological Disorders Improve Endometrium Receptivity. Reprod Sci 2016; 24:174-192. [DOI: 10.1177/1933719116654993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Onder Celik
- Private Clinic, Obstetrics and Gynecology, Usak, Turkey
| | - Mustafa Acet
- Department of Obstetrics and Gynecology, Medipol University School of Medicine, Istanbul, Turkey
| | - Tansu Kucuk
- Department of Obstetrics and Gynecology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Esra Tustas Haberal
- Obstetrics and Gynecology, Umraniye Education and Research Hospital, İstanbul, Turkey
| | - Tuba Acet
- Obstetrics and Gynecology, Medicine Hospital, Istanbul, Turkey
| | - Murat Bozkurt
- Department of Obstetrics and Gynecology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Levent Sahin
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
| | - Fatma Ferda Verit
- Obstetrics and Gynecology, Süleymaniye Education and Research Hospital, İstanbul, Turkey
| | - Eray Caliskan
- Department of Obstetrics and Gynecology, Bahcesehir University School of Medicine, Kocaeli, Turkey
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Shokeir T, Ebrahim M, El-Mogy H. Hysteroscopic-guided local endometrial injury does not improve natural cycle pregnancy rate in women with unexplained infertility: Randomized controlled trial. J Obstet Gynaecol Res 2016; 42:1553-1557. [PMID: 27363928 DOI: 10.1111/jog.13077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/14/2016] [Accepted: 05/07/2016] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the efficacy of a hysteroscopic site-specific local endometrial injury (LEI) in a group of women with unexplained infertility (UI) undergoing expectant management with no fertility treatment versus no intervention. METHODS This open-label, randomized controlled trial (RCT) was conducted between June 2013 and July 2015. Hysteroscopic site-specific LEI was determined by patient identification number, and 120 women were included. Eligible participants were randomly assigned to receive either a single, site-specific LEI guided by hysteroscopy (study group, n = 60) or no intervention (control group, n = 60). Natural cycle folliculometry and timed intercourse were carried out for all participants for 3 months. Successful clinical pregnancy confirmed on ultrasound was the primary outcome measure, and first trimester miscarriage rate was the secondary outcome. RESULTS After identification, baseline clinical demographics were similar in the two groups. No statistically significant differences were noted in cumulative pregnancy rates in women with LEI compared with those without (16.7% and 11.7 %, respectively; OR, 2.83; 95%CI: 1.07-7.48; P = 0.4). One first trimester miscarriage was reported in the control group (14.3%). CONCLUSION Local endometrial injury for natural cycle conception in women with UI is not justified. Further RCT are warranted to prove or disprove this.
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Affiliation(s)
- Tarek Shokeir
- Department of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Mohamed Ebrahim
- Department of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Hosam El-Mogy
- Department of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt.
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Lensen SF, Manders M, Nastri CO, Gibreel A, Martins WP, Templer GE, Farquhar C. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database Syst Rev 2016:CD011424. [PMID: 27296541 DOI: 10.1002/14651858.cd011424.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intentional endometrial injury is currently being proposed as a technique to improve the probability of pregnancy in women undergoing assisted reproductive technologies (ART) such as in vitro fertilisation (IVF). Endometrial injury is often performed by pipelle biopsy or a similar technique, and is a common, simple, gynaecological procedure that has an established safety profile. However, it is also known to be associated with a moderate degree of discomfort/pain and requires an additional pelvic examination. The effectiveness of this procedure outside of ART, in women or couples attempting to conceive via sexual intercourse or with low complexity fertility treatments such as intrauterine insemination (IUI) and ovulation induction (OI), remains unclear. OBJECTIVES To evaluate the effectiveness and safety of intentional endometrial injury in subfertile women and couples attempting to conceive through sexual intercourse or intrauterine insemination (IUI). SEARCH METHODS We searched the Cochrane Gyanecology and Fertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, DARE, ISI Web of Knowledge and ClinicalTrials.gov; as well as reference lists of relevant reviews and included studies. We performed the searches from inception to 31 October 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated any kind of intentional endometrial injury in women planning to undergo IUI or attempting to conceive spontaneously (with or without OI) compared to no intervention, a mock intervention or intentional endometrial injury performed at a different time or to a higher/lower degree. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data and assessed trial quality using GRADE methodology. The primary outcomes were live birth/ongoing pregnancy and pain experienced during the procedure. Secondary outcomes were clinical pregnancy, miscarriage, ectopic pregnancy, multiple pregnancy and bleeding secondary to the procedure. We combined data to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I(2) statistic. MAIN RESULTS Nine trials, which included a total of 1512 women, met the inclusion criteria of this Cochrane review. Most of these studies included women with unexplained infertility. In seven studies the women were undergoing IUI and in two studies the women were trying to conceive from sexual intercourse. Eight trials compared intentional endometrial injury with no injury/placebo procedure; of these two trials also compared intentional endometrial injury in the cycle prior to IUI with intentional endometrial injury in the IUI cycle. One trial compared higher vs. lower degree of intentional endometrial injury. Intentional endometrial injury vs. either no intervention or a sham procedureWe are uncertain whether endometrial injury improves live birth/ongoing pregnancy as the quality of the evidence has been assessed as very low (risk ratio (RR) 2.22, 95% confidence interval (CI) 1.56 to 3.15; six RCTs, 950 participants; I² statistic = 0%, very low quality evidence). When we restricted the analysis to only studies at low risk of bias the effect was imprecise and the evidence remained of very low quality (RR 2.64, 95% CI 1.03 to 6.82; one RCT, 105 participants; very low quality evidence). Endometrial injury may improve clinical pregnancy rates however the evidence is of low quality (RR 1.98, 95% CI 1.51 to 2.58; eight RCTs, 1180 participants; I² statistic = 0%, low quality evidence).The average pain experienced by participants undergoing endometrial injury was 6/10 on a zero-10 visual analogue scale (VAS)(standard deviation = 1.5). However, only one study reported this outcome. Higher vs. lower degree of intentional endometrial injuryWhen we compared hysteroscopy with endometrial injury to hysteroscopy alone, there was no evidence of a difference in ongoing pregnancy rate (RR 1.29, 95% CI 0.71 to 2.35; one RCT, 332 participants; low quality evidence) or clinical pregnancy rate (RR 1.15, 95% CI 0.66 to 2.01; one RCT, 332 participants, low quality evidence). This study did not report the primary outcome of pain during the procedure. Timing of intentional endometrial injuryWhen endometrial injury was performed in the cycle prior to IUI compared to the same cycle as the IUI, there was no evidence of a difference in ongoing pregnancy rate (RR 0.65, 95% CI 0.37 to 1.16, one RCT, 176 participants; very low quality evidence) or clinical pregnancy rate (RR 0.82, 95% CI 0.50 to 1.36; two RCTs, 276 participants; very low quality evidence). Neither of these studies reported the primary outcome of pain during the procedure.In all three comparisons there was no evidence of an effect on miscarriage, ectopic pregnancy or multiple pregnancy. No studies reported bleeding secondary to the procedure. AUTHORS' CONCLUSIONS It is uncertain whether endometrial injury improves the probability of pregnancy and live birth/ongoing pregnancy in women undergoing IUI or attempting to conceive via sexual intercourse. The pooled results should be interpreted with caution as we graded the quality of the evidence as either low or very low. The main reasons we downgraded the quality of the evidence were most included studies were at a high risk of bias and had an overall low level of precision. Further well-conducted RCTs that recruit large numbers of participants and minimise internal bias are required to confirm or refute these findings.
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Affiliation(s)
- Sarah F Lensen
- Department of Obstetrics and Gynaecology, University of Auckland, Park Rd, Grafton, Auckland, New Zealand, 1142
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