Abstract
Background: To investigate whether hysteroscopic endometrial mechanical stimulation improves pregnancy outcomes in patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods: We conducted a systematic search in electronic databases including PubMed, Embase, Cochrane Library, Web of Science from their inception to Feb 20th, 2021, as well as a manual search. All publications on the impact of hysteroscopic endometrial mechanical stimulation on IVF/ICSI outcomes were retrieved. Two reviewers independently screened the retrieved studies using stringent inclusion and exclusion criteria; data were subsequently extracted, and risk of bias was assessed. Meta-analysis of the selected studies was performed using Revman 5.3. Results: Eight studies involving 1494 patients were eligible for inclusion, including 5 randomized controlled trials and 3 prospective non-randomized simultaneous controlled experimental studies. We found that compared with the control group, hysteroscopic endometrial mechanical stimulation effectively increased live birth rate [risk ratio (RR) = 2.15, 95% confidence interval (CI) (1.78, 2.60), p < 0.00001] and clinical pregnancy rate [RR = 1.95, 95% CI (1.28, 2.98), p = 0.002], and also decreased abortion rate [RR = 0.54, 95% CI (0.35, 0.86), p = 0.009]. Subgroup analyses revealed that, hysteroscopic endometrial mechanical stimulation administered in the luteal phase in patients undergoing their first IVF/ICSI cycle was associated with significantly higher live birth rate and clinical pregnancy rate, as well as a significantly lower abortion rate. Discussion: Endometrial mechanical stimulation may improve live birth rate, clinical pregnancy rate and reduce abortion rate in patients with normal hysteroscopic findings who are undergoing IVF/ICSI. The benefits may be even greater if this therapy is given in the luteal phase and in patients who are in their first IVF/ICSI cycle. However, due to the limited quantity and quality of the included studies and variable stimulation methods, these findings should be interpreted with caution, and more high-quality studies are needed to confirm this conclusion.
Highlights
As the prevalence of infertility increases year by year, the number of patients seeking assisted reproduction is increasing
(1) study type: randomized controlled trials (RCTs) and non-RCTs; (2) study subjects: infertile patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), regardless of nationality, ethnicity, or duration of illness; no acute inflammation or systemic disease; (3) interventions: hysteroscopy combined with endometrial mechanical stimulation followed by IVF/ICSI in the treatment group; while hysteroscopy or other examination excluded endometrial lesions and IVF/ICSI subsequently in the control group; (4) outcome measures: live birth rate, clinical pregnancy rate, and abortion rate; (5) published studies or with publication year; with adequate description of sample size and results
Hysteroscopic endometrial mechanical stimulation significantly improved the live birth rate both in patients with at least one failed cycle [risk ratio (RR) = 1.90, 95% confidence interval (CI) (1.41, 2.56), p < 0.0001] and in patients undergoing their first IVF/ICSI cycle [RR = 2.39, 95% confidence intervals (95% CI) (1.88, 3.05), p < 0.00001] (Fig. 5)
Summary
As the prevalence of infertility increases year by year, the number of patients seeking assisted reproduction is increasing. To investigate whether hysteroscopic endometrial mechanical stimulation improves pregnancy outcomes in patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). We found that compared with the control group, hysteroscopic endometrial mechanical stimulation effectively increased live birth rate [risk ratio (RR) = 2.15, 95% confidence interval (CI) (1.78, 2.60), p < 0.00001] and clinical pregnancy rate [RR = 1.95, 95% CI (1.28, 2.98), p = 0.002], and decreased abortion rate [RR = 0.54, 95% CI (0.35, 0.86), p = 0.009]. Hysteroscopic endometrial mechanical stimulation administered in the luteal phase in patients undergoing their first IVF/ICSI cycle was associated with significantly higher live birth rate and clinical pregnancy rate, as well as a significantly lower abortion rate. Discussion: Endometrial mechanical stimulation may improve live birth rate, clinical pregnancy rate and reduce abortion rate in patients with normal hysteroscopic findings who are undergoing IVF/ICSI. Due to the limited quantity and quality of the included studies and variable stimulation methods, these findings should be interpreted with caution, and more high-quality studies are needed to confirm this conclusion
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
