Endometrial injury concurrent with hysteroscopy increases the expression of Leukaemia inhibitory factor: a preliminary study

Suat Suphan Ersahin,Aynur Ersahin

doi:10.1186/s12958-021-00877-z

Abstract

ObjectiveIt 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.MethodsForty 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.ResultsRelative 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).ConclusionsThe fertility-promoting effect of hysteroscopy-guided mechanical endometrial injury may be mediated by LIF mRNA.

Highlights

Implantation failure is a rate-limiting step in patients using assisted reproductive technology
Cases that turned into interventional hysteroscopy due to an endometrial pathology detected by diagnostic hysteroscopy were excluded from the study
There are clinical data that endometrial injury is beneficial for the success of achieving pregnancy in patients with recurrent implantation failure, this does not mean that endometrial scratching should be offered to everyone in daily practice [7,8,9]

Summary

Introduction

Implantation failure is a rate-limiting step in patients using assisted reproductive technology In terms of both the patient and the physician, the number of interventions after this stage is very limited. While implantation rates increase in caesarean scar tissue, uncontrolled and sharp curettages may lead to adhesion and infertility. For this reason, the necessary care should be shown while performing mechanical injury. Endometrial injury was reported to increase clinical pregnancy and live birth rates in patients with recurrent implantation failure [6], endometrial injury in the unselected patient group did not always yield the expected positive results [7, 8]. There is no clinical study showing the net effect of mechanical damage on the endometrium

Methods

Results

Conclusion