Endometrial Injury and Sub Endometrial Doppler Study to Predict Uterine Receptivity in Women with Unexplained Infertility: A Randomized Controlled Trial

Manal A Farahat,Mona Omar

doi:10.4236/ojog.2019.96084

Abstract

Objectives: The aim of this work was to compare the effectiveness and safety of endometrial scratching at different times of the menstrual cycle on cumulative pregnancy rate and also to assess and clarify its relationship and effect on sub-endometrial vasculature blood flow by Doppler ultrasound, in cases of unexplained infertility attempting to conceive spontaneously (without ovulation induction). Study Design: A prospective randomized clinical control study. Patients and Methods: A total of 252 eligible participants were included in the study and randomly allocated using block randomization into three groups: Group A (n = 84): endometrial scratching was performed during the pre-ovulatory days and Group B (n = 84): endometrial scratching has been done at day 7 of the cycle. Group C (control group): includes 84 cases without endometrial scratching. The Doppler ultrasound will be done. The pulsatility index (PI) and resistance index (RI) of endometrial and sub endometrial arteries were calculated. All women were followed up to 3 months. Results: Cumulative pregnancy rate is 21.42% and 28.57% in the study groups A and B respectively which is higher than group C (control group) (4.76%) but with statistically insignificant P-value = 0.254. There is statistically significant difference in RI & PI between the studied groups and the control group on day 13 (P value Conclusion: Endometrial scratching is a cost-effective and easy technique which may improve clinical pregnancy rates and endometrial blood flow in women with unexplained infertility.

Highlights

Patients and Methods: A total of 252 eligible participants were included in the study and randomly allocated using block randomization into three groups: Group A (n = 84): endometrial scratching was performed during the pre-ovulatory days and Group B (n = 84): endometrial scratching has been done at day 7 of the cycle
Endometrial scratching is a simple, low-cost procedure, corrects asynchrony between endometrium and the conceptus and promotes purposeful disruption of the endometrium resulting in wound healing by inducing a significant increase in the local secretion of pro-inflammatory cytokines such as macrophage inflammatory protein-1E, tumor necrosis factor-α, osteopontin, interleukins, growth factors, and dendritic cells which in turn promotes successful implantation [5]
The endometrial scratching is associated with pregnancy rates (21.42%) and (28.57%) in group A and B respectively, which is higher than control group without use of any ovulation inducing drugs

Summary

Introduction

Infertility is the inability to achieve a pregnancy after 12 months of unprotected intercourse [1].In the absence of a definable cause for a couple’s to achieve pregnancy, unexplained infertility can be diagnosed; the prevalence is about 15% - 30% and diagnosed by exclusion [2].Early embryo abnormalities or implantation failure are the main possible causes of unexplained infertility, which explain loss of about 75% of pregnancies immediately after conception [2].Deregulation in different factors and signaling molecules such as prostaglandins, cytokines, integrins, and leukemia inhibitory factor leads to poor endometrial receptivity and repeated implantation failure [3].Aiming to improve success, different modifications and adjuvants to IVF are given to these patients in spite of lack of data to support their effectiveness; endometrial scratching is one of these techniques which has evidence of higher live-birth rates [4].Endometrial scratching is a simple, low-cost procedure, corrects asynchrony between endometrium and the conceptus and promotes purposeful disruption of the endometrium resulting in wound healing by inducing a significant increase in the local secretion of pro-inflammatory cytokines such as macrophage inflammatory protein-1E, tumor necrosis factor-α, osteopontin, interleukins, growth factors, and dendritic cells which in turn promotes successful implantation [5]. In the absence of a definable cause for a couple’s to achieve pregnancy, unexplained infertility can be diagnosed; the prevalence is about 15% - 30% and diagnosed by exclusion [2]. Deregulation in different factors and signaling molecules such as prostaglandins, cytokines, integrins, and leukemia inhibitory factor leads to poor endometrial receptivity and repeated implantation failure [3]. Endometrial scratching is a simple, low-cost procedure, corrects asynchrony between endometrium and the conceptus and promotes purposeful disruption of the endometrium resulting in wound healing by inducing a significant increase in the local secretion of pro-inflammatory cytokines such as macrophage inflammatory protein-1E, tumor necrosis factor-α, osteopontin, interleukins, growth factors, and dendritic cells which in turn promotes successful implantation [5]

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