The Effect of Endometrial Injury on Pregnancy Rate in Women with Previous Intracytoplasmic Sperm Injection Failure/ a Randomized Clinical Trial

Abstract

Local injury to the endometrium using a pipell endometrial sampler doubles the incidence of successful pregnanciesin patients undergoing in vitro fertilization. This study was confirmed by Local injury to endometriam of IVF patients in controlled ovarian hyperstimulation cycle may increase the incidence of embryo implantation.The successful pregnancy outcome of patients undergoing ovarian stimulation for IVF or related advanced reproductive technologies depend on several factors. Among these,embryo quality and intrauterine environment play a major role for achievement and further continuation of pregnancy.to review the effect of local injury to the endometrium on the outcome of ICSI and embryo transfer.This prospective observational study was conducted in ART unit at Ain Shams University Maternity Hospital during the period from July 2013 to July 2014. One hundered women,aged 23-40 years,with one or more failed ICSI cycle participated in this study. Nulligravidae represented 84% of all women in the study.The mean age was (30.38±4.41 years),the mean duration of marriage (7.54±4.95 years) and the mean duration of infertility (7.28±5.03 years),84% of patients were nulligravidae while 16% had history of abortions,none of our patients had previous full term pregnancy or live born children,88% of women involved in the study had a single failed trial while 12% had previous two failed trials. The highest percentage of cases showed normal hysteroscopic findings (52%),while endometritis showed the least percentage (4%),adhesions were found in (10%),polypi in (14%),congenital uterine malformation in (14%) and myoma in (4). 78% of cases had no intervention (only diagnostic hysteroscopy),while 22% of cases had operative interventions in the form of adhesiolysis (4%),polypectomy in (12%) and resection of a septum in (2%).The range of pain score was 2-10 with a mean (4.74±1.84min) while the range of duration of procedure was 1-25 with a mean (5.16±4.69 min).No statistically significant difference was found as regards the presence of abnormal hysteroscopic findings in relation to the number of failed trials (P>0.05).There was no statistically significant difference between the two groups (diagnostic and operative groups) as regards the meanage,duration of marriage,duration of infertility and number of failed trials (P>0.05). Operative hysteroscopy showed significantly longer duration than diagnostic (11.73 ±6.2 vs 3.26 ±1.29 min),respectively (P<0.001).Cases of diagnostic hysteroscopy showed significantly lower VAS when compared to cases of operative hysteroscopy with a mean of (4.54 ± 1.42 vs 6.11 ± 2.6),respectively (P<0.001),while operative hysteroscopy showed significantly higher VAS than diagnostic (P<0.001).There was no statistically significant difference between hysteroscopic modality as regards the distribution of acceptability (P>0.05),although acceptability of office hysteroscopy was higher in diagnostic group,yet the difference didn’t reach statistical significance.This technique has permitted complete elimination of any type of pre-medication,analgesia,or anesthesia,making the procedure faster,more acceptable and complication-free.In our study patient’s overall acceptability was 86%. The patient acceptability was non-significantly higher in diagnostic compared to operative hysteroscopy (89.7% vs 72.7%),respectively. As regards patients acceptability of office hysteroscopy,those who accepted the procedure showed significantly lower rate of pain and when compared to cases not accepting hysteroscopy (P<0.05). There was a significant correlation between the pain and duration of the procedure (r = 0.35,P<0.001). This signifies that the longer the duration of the procedure,the higher the pain in our study.Outpatient management is a comparatively new concept in gynecology. Patients may favor the outpatient approach because they spend less time in hospital. However,it is important to tailor this management according to patient status.