Local Endometrial Injury Research Articles

O-056 Can we tailor ART to endometriosis patients?

Abstract ART remains an effective treatment for endometriosis-associated infertility, although there is evidence that pregnancy rates are diminished in women with endometriosis compared with other etiologies of infertility. In this lecture, the literature relating to endometriosis-associated infertility will be evaluated and recommendations will be made on the management of patients both pre-ART and during ART in order to improve ART outcomes in women with endometriosis. Surgery as an adjuvant to ART appears to have a favorable effect in patients with minimal to mild endometriosis prior to IVF. However, this evidence is based on only one study and more research is needed. As deep endometriosis (DE) is usually accompanied by advanced intra-abdominal disease resulting in distortion of the pelvic anatomy and tubal dysfunction, it is not surprising that IVF is considered as first line treatment. Observational data are available on the outcomes of DE surgery regarding conception rates in infertile patients with endometriosis suggesting that surgery may increase natural pregnancy rates as well as improve IVF outcomes. However, randomized trials comparing IVF to DE surgery are non-existent, as DE surgery is still mainly performed for pain and reduced quality of life rather than for treating infertility. In order to improve IVF success rates in endometriosis, various pre-ART treatments have been suggested. The oldest one relates to the use of gonadotropin releasing hormone (GnRH) agonist prior to IVF. Currently there is uncertainty as to whether long-term GnRH agonist therapy is beneficial when compared to standard IVF/ICSI in endometriosis. In addition, there is no evidence to support the use of oral GnRH antagonists and oral contraceptives as pre-treatment prior to ART, but results of ongoing studies will determine further. More recent studies support defects in endometrial receptivity as a cause of IVF failure. In recent years a new marker for endometrial receptivity in endometriosis emerged: BCL6, a biomarker for endometrial inflammation as it stimulates endometrial cytokine expression. Prospective cohort data provide a proof of concept that high BCL6 expression is associated with adverse IVF outcomes in women with endometriosis and that patients with high BCL6 expression may benefit from medical and surgical treatment prior to IVF. In order to improve IVF success rates in endometriosis, various pre-ART treatments have been suggested. The oldest one relates to the use of gonadotropin releasing hormone (GnRH) agonist prior to IVF. Contrary to previous findings, there is currently uncertainty as to whether long-term GnRH agonist therapy is beneficial when compared to standard IVF in endometriosis. In addition, there is also no evidence to support the use of oral GnRH antagonists and oral contraceptives as pre-treatment prior to ART in endometriosis, but results of ongoing studies will determine further. It has been hypothesized that applying local endometrial injury might induce a beneficial effect on endometrial receptivity prior to ART. However, scratching the endometrium as well as infusing fluids (Lipiodol and ExEm gel) into the uterine cavity (uterine bathing) in endometriosis patients prior to ART did not improve IVF success. During ART, a specific protocol for ART in women with endometriosis cannot be recommended. Both GnRH agonist and antagonist protocols can be used. For ovarian stimulation, a higher dose of gonadotropins may be required in stage III-IV endometriosis due to a poorer ovarian response. There is insufficient evidence for the routine use of prophylactic antibiotics at the time of oocyte retrieval in patients with endometriosis, but their use is recommended in patients with endometrioma. Considering fertilization, there appears no added benefit in using ICSI over IVF in endometriosis unless male-factor infertility is present. Finally, there is insufficient evidence to recommend any particular luteal support in women with endometriosis undergoing ART.

RETRACTION: A randomized trial of local endometrial injury during ovulation induction cycles.

Helmy, M. E. E., Maher, M. A., Elkouly, N. I., Ramzy, M. (2017) A randomized trial of local endometrial injury during ovulation induction cycles. International Journal of Gynecology & Obstetrics, 138: 47-52. https://doi.org/10.1002/ijgo.12178. The above article, published online on 11 April 2017 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Professor Michael Geary, the International Federation of Gynecology and Obstetrics, and John Wiley and Sons Ltd. Concerns were raised by a third party about inconsistencies in the data of this article and the authors were asked to provide an explanation. The authors responded to the journal's inquiry, but could not share original data. Following the authors response, an independent review concluded that the sample size calculations were not reproducible, that the analysis of live births was misreported, and that, due to the absence of original data, the journal was not able to reproduce the calculations for relative risks reported in the manuscript. The journal has determined that these errors fundamentally compromise the conclusions of the article and that they could not be addressed by a correction. As such, the journal is issuing this retraction. The authors disagree with this retraction.

Effect of endometrial injury on pregnancy outcomes in infertile women undergoing intrauterine insemination.

One of the most common treatments for infertility is intrauterine insemination (II). The objective of this study was to determine the effect of endometrial injury on pregnancy outcomes in unexplained infertility in women undergoing II. In this randomized clinical trial, 122 women with unexplained infertility who were referred to Shariati Hospital from 2018 to 2020 were enrolled. They underwent ovulation induction using letrozole and gonadotropins. On day 9 of stimulation, they were randomly assigned to two similar groups of the same size. The first group underwent endometrial local injury by pipelle endometrial sampling, and the second group (control group) received no intervention. Only 1 II cycle was performed for each patient. Patients with negative pregnancy outcomes were followed up for 3 months. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, miscarriage rate, and spontaneous pregnancy rate after the II cycle were compared between the two groups. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, and miscarriage rate in the same II cycle were not different between the two groups (p>0.05). However, the spontaneous pregnancy rate after the II cycle was significantly higher in the endometrial injury group (p=0.02). Endometrial injury increases pregnancy rates in later cycles but not in the same II cycle.

Subtle changes in perivascular endometrial mesenchymal stem cells after local endometrial injury in recurrent implantation failure

Improvements in reproductive techniques have resulted in the live birth rates from IVF procedures increasing from 5% to approximately 30% in recent decades but has plateaued since. Emerging preclinical and clinical data implicates endometrial receptivity deficiencies in patients with recurrent implantation failure (RIF) as the predominant factor hindering successful implantation. Mechanisms on how local endometrial injury (LEI) improves implantation rates in patients with RIF are currently unknown. We hypothesized that LEI may influence perivascular endometrial mesenchymal stem/progenitor cells (eMSCs) which are thought to regenerate the stromal vascular component of the functional layer every month. Here, we assessed the effect of LEI on the proportion and function of eMSCs present in consecutive LEI biopsies. Consecutive paired mid-luteal phase endometrial biopsies obtained from patients with RIF were digested to single cells and the proportion of SUSD2-expressing cells determined. Growth kinetics and decidualization were compared between the consecutive LEI samples. A mid-luteal LEI altered the decidualization capacity of SUSD2+ eMSCs in women with RIF, but not their proportion or clonogenicity. With the potential of LEI to improve IVF outcomes in women with RIF, additional investigations are needed to understand the impact of the altered decidualization response in eMSCs.

ЛОКАЛЬНОЕ ПОВРЕЖДЕНИЕ ЭНДОМЕТРИЯ ПЕРЕД ПЕРЕНОСОМ РАЗМОРОЖЕННЫХ ЭМБРИОНОВ У ПАЦИЕНТОК С ГИПОПЛАЗИЕЙ СЛИЗИСТОЙ ОБОЛОЧКИ МАТКИ

The study aims to examine the influence of local endometrial injury on the results of thawed embryo transfer programs in patients with endometrial hypoplasia based on the analysis of clinical cases. The author analyzes two clinical cases of performing scratching prior to the implementation of the assisted reproductive technologies program in patients with “thin” endometrium and evaluates its effectiveness. Embryo implantation is a key stage limiting the effectiveness of assisted reproductive technologies, and depends on the receptivity and selectivity of the endometrium, the quality of the blastocyst, as well as on their cross-interaction. At the same time, two-thirds of im-plantation failures may be associated with endometrium impaired susceptibility. Endometrial hypoplasia is believed to be associated with a decrease in the probability of embryo attachment. Various therapeutic approaches have been proposed to improve its receptivity. The technology of local damage to the uterine mucosa was applied before the program of assisted reproductive technologies in two patients with “thin” endometrium. Following the transfer of thawed embryos, uterine pregnancy occurred in both cases, which ended with operative delivery on time.

The effect of local endometrial injury on the success of intrauterine insemination

To determine the effect of local endometrial injury on implantation success in patients diagnosed with unexplained infertility and undergoing intrauterine insemination (IUI) after ovulation induction with gonadotropins. In this prospective randomized controlled trial, 82 infertile patients underwent IUI following ovulation induction with gonadotropin. In the study group (n:40), local endometrial injury (stratch) was performed to the posterior side of the endometrial cavity with a biopsy catheter between the 21-26th days of luteal phase of the cycle preceding ovarian stimulation. There was no statistically significant difference between the study and the control groups in terms of age of female, age of male, duration of infertility, BMI, serum FSH and LH levels, mean dose of gonadotropin and mean duration of ovulation induction (p>0.05). Clinical pregnancy was achieved in two patients (4.76%) in control group and four (10%) patients in the study group, with no significant difference between groups (p=0.18). All pregnancies achieved in the control and the study groups passed 12th gestational weeks and continued. Ectopic pregnancy, multiple pregnancy and abortion was not observed in any patient in both groups. In the study group, pain level immediately after endometrial biopsy procedure was evaluated with visual analog scale (VAS) and it was established that only one (2.5%) patient experienced severe pain after the procedure. Although local endometrial damage in the menstural period before ovulation induction and IUI cycle increases clinical pregnancy rates in the infertile patients, this increase is not statistically significant. Multi-center randomized controlled studies are needed for local endometrial damage to be recommended routinely in clinical practice.

Endometrial local injury, a simple procedure that improves IVF outcome in a selected population of patients

Embryo implantation, an essential prelude for the establishment of pregnancy, is successful upon the interaction of a high-quality embryo with a receptive uterus. Nevertheless, ‘inadequate uterine receptivity’ which has been pointed out as the cause for approximately two-thirds of repeated implantation failures (RIF, [1-3]), combined with the low rate of implantation (~25%) obtained upon transfer of good embryos in IVF, makes implantation the rate-limiting step for the success of ART.

The Significance of Endometrial Scratching for Clinical Pregnancy Rate in Long Agonist and Antagonist Protocols.

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.

Is There any Impact of Local Endometrial Injury on Implantation and Clinical Pregnancy Rates in the First in Vitro Fertilization Cycles

Is There any Impact of Local Endometrial Injury on Implantation and Clinical Pregnancy Rates in the First in Vitro Fertilization Cycles

DOES ENDOMETRIAL INJURY IMPROVE THE OUTCOMES IN PATIENTS WITH RECURRENT IMPLANTATION FAILURE?

Recurrent implantation failure refers to a failure to achieve a clinical pregnancy after transfer of atleast four good-quality embryos in a minimum of three fresh or frozen cycles in a woman under theage of 40 years. We present this retrospective study, in which we proposed local endometrial injuryfor the management of the uterine factors in the case of 30 couples with recurrent implantationfailure. Our conclusion was that local endometrial injury improved the clinical pregnancy rate forthese couples, especially when the study population met specific criteria.

Impact of local endometrial injury on in vitro fertilization/intracytoplasmic sperm injection outcomes: A systematic review and meta-analysis.

Recent studies have revealed positive effects of endometrial injury on clinical pregnancy rates, but with inconsistent results. The aim of this meta-analysis was to assess the efficacy of endometrial injury (biopsy and/or hysteroscopy) as a potential treatment measure for implantation failure in the in vitro fertilization population. We searched in PubMed for studies comparing the efficacy of endometrial injury versus no intervention in women with at least one implantation failure. A random-effects model was used to evaluate the clinical pregnancy rate (CPR) and the live birth rate (LBR). Seventeen studies (11 randomized and 6 non-randomized studies) were included in this meta-analysis, including 1864 women in the intervention group and 2193 women in the control group. Overall, the CPR and LBR were significantly higher in the intervention group than in the control group (for CPR, n = 3997, 16 studies, P < 0.00001, risk ratio (RR) = 1.47, 95% confidence interval [CI] [1.24, 1.74]; for LBR, n = 2361, 11 studies, P = 0.003, RR = 1.41, 95% CI [1.12, 1.78]). However, after excluding the non-randomized studies, there was no significant difference in CPR (P = 0.29 for endometrial biopsy, P = 0.05 for hysteroscopy) and LBR (P = 0.23 for endometrial biopsy, P = 0.39 for hysteroscopy) between the intervention group and the control group. There is still insufficient evidence to support the use of endometrial injury in women with implantation failure. Robust randomized controlled studies should be designed and performed before clinical implementation of endometrial injury.

The impact of intentional endometrial injury on reproductive outcomes: a systematic review and meta-analysis.

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. 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. 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. 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. 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.

New progress on the effect of endometrial local injury on endometrial receptivity

Endometrial receptivity refers to the ability of the endometrium to receive the embryo, which is the key factor for the implantation. Endometrial local injury, a kind of local minor mechanical injury to endometrium, is documented to improve endmetrial receptivity and embryo implantation rate. In this article, the effect of endometrial local injury on endometrial receptivity will be discussed in terms of clinical research, morphology, expression of bioactive factors associated with endometrial receptivity and genetics. Key words: Wounds and injuries; Embryo transfer; Endometrium/PA; Review

The effects of local endometrial injury by hysteroscopy on in vitro fertilization outcome

Bacngraund/Aim. Regardless of embryos quality, an appropriate endometrial thickness and a successful embryo transfer (ET), implantation remains a difficulty for a favorable outcome of an in vitro fertilization (IVF). Numerous studies with the aim of increasing implantation rate and pregnancy rate suggest local endometrial injury (LEI) prior to the IVF procedure. Hysteroscopy is a method becoming more widely used both with patients after a failed IVF cycle and with patients before the first IVF, considering the large incidence of uterus cavum pathological states which have a negative impact on the favorable outcome. However, there is still no consensus reached over LEI, the way and time of its performing or its impact. The aim of this research was to determine the effect of hysteroscopically made local endometrial lesion on the IVF procedure outcome, both in the first and in the next IVF cycle and also to examine if the new method of LEI provoking using bipolare electrode has a favorable impact on post IVF pregnancy success. Methods. Total of 81 patients had hysteroscopy performed 30? 50 days prior to IVF, 40 of which had LEI made during hysteroscopy (the LEI group) using bipolar electrode in a way not described in any available literature. Remaning histeroscopically treated patients (n = 41) had no LEI (the non-LEI group). The control group included 151 patient who had IVF performed with no prior hysteroscopy and LEI. Results. The rate of clinical pregnancies after LEI was statistically more significant in comparison to the control group (52.50% vs 34.44%, p &lt; 0.05) and it meant 2.1 time bigger chance to conceive (OR=2.10; 95% CI: 1.04 ? 4.26; p &lt; 0.05). We noticed differences in the implantation rate between the LEI group and the non-LEI group on one side and the control group on the other, in favor of the two groups subjected to hysteroscopy (23.89%, 25.47% vs 18.18%, respectively), but they were not of any statistical significance. Not significantly higher rate of pregnancy was present, after the first and the next IVF, both in the LEI and the non-LEI group when compared to the control one. Conclusion. New method of LEI provoking by bipolar electrode in the process of hysteroscopy is a simple and safe method allowing higher rate of clinical pregnancies and doubling the probabilty of the positive IVF outcome.

Comparison of pregnancy rates between patients with and without local endometrial scratching before intrauterine insemination

ObjectivesTo determine the implantation success of local endometrial injury in patients undergoing intrauterine insemination following ovulation induction with gonadotropins as an infertility treatment. Material and methodsIn this prospective randomized controlled trial, ovulation induction was performed with gonadotropins in 80 patients following intrauterine insemination. In 40 patients, local endometrial injury (scratch) was performed in the midluteal phase of the cycle preceding ovarian stimulation with a Novak curette to the posterior side of the endometrial cavity. ResultsFifteen pregnancies (37.5%) and 11 clinical pregnancies (27.5%) occurred in the intervention group, whereas eight pregnancies (20%) and five clinical pregnancies (12.5%) occurred in the control group. Although the pregnancy rates and clinical pregnancy rates were increased in the intervention group, no statistically significant difference was found between the intervention and control groups (pregnancy rates: P=0.084; clinical pregnancy rates: P=0.094). ConclusionPerforming local endometrial injury (scratch) in the cycle preceding ovulation induction in patients with a diagnosis of infertility and indication for intrauterine insemination increased the pregnancy and clinical pregnancy rates. This increase was not, however, statistically significant. More randomized, controlled, prospective studies with larger patient numbers are required before the use of iatrogenic induction of local endometrial injury can be recommended in routine clinical practice.

Effect of local endometrial injury in proliferative vs. luteal phase on IVF outcomes in unselected subfertile women undergoing in vitro fertilization

BackgroundMechanical endometrial injury prior to IVF has been suggested as a means to increase implantation rates by improving endometrial receptivity. However, the effects of endometrial injury in proliferative vs. luteal phase have not been studied before. This study aimed to explore whether endometrial injury in the proliferative phase of the preceding cycle before in vitro fertilization/embryo transfer (IVF-ET) improves the clinical outcomes in unselected subfertile women compared with injury in luteal phase.MethodsA group of 142 patients who were good responders to hormonal stimulation were randomized into four groups: injury group (group A: endometrial injury in proliferative phase, n = 38; group B: endometrium injury in luteal phase, n = 32), and non-injury group as control (group C: non-injury in proliferative phase, n = 36; group D: non-injury in luteal phase, n = 36). Patients in injury groups underwent endometrial injury in either proliferative phase or luteal phase in the preceding cycle before IVF treatment. Clinical outcomes including implantation, pregnancy, and live birth rates were analyzed among the four groups.ResultsThe baseline characteristics of the four groups including age, body mass index, duration, type and causes of infertility were similar. There were no significant differences in implantation, clinical pregnancy or live birth rates between injury group and non-injury group. Moreover, there were also no significant differences in implantation, clinical pregnancy, or live birth rates in injury in proliferative phase compared with luteal phase.ConclusionsEndometrial injury in the cycle preceding IVF of unselected subfertile women does not increase implantation, clinical pregnancy, or live birth rates. Furthermore, there is no significant difference in clinical outcomes between endometrial injury in the proliferative phase and injury in the luteal phase.Trial registrationThis study was retrospectively registered on May 26th, 2017 (ChiCTR-IOR-17011506).

Effect of local endometrial injury in proliferatitve phase is the same as luteal phase in unselected infertile women undergoing in vitro fertilization

To explore whether endometrial injury in proliferation phase preceding cycle before in vitro fertilization/embryo transfer (IVF-ET) increase the clinical outcomes in unselected subfertile woman compared with injury in luteal phase. This is prospective study. Patients underwent endometrial injury in proliferation phase or luteal phase preceding cycle before IVF treatment. Clinical outcomes including implantation, pregnancy, and live birth rates were analyzed. A group of 142 patients, who were good responders to hormonal stimulation, were selected for this study. The inclusion criteria include: (a) infertile women indicated for IVF treatment and (b) a normal uterine cavity demonstrated by saline infusion sonogram. The exclusion criteria include: (i) endometrium with polyp or fibroid; (ii) hydrosalpinx. Recruited participants were randomized into four groups: injury group (group A: injury endometrium in proliferation phase, n=38; group B: injury endometrium in luteal phase, n=32), and non-injury group as control (group C: non-injury in proliferation phase, n=36; group D: non-injury in luteal phase, n=36). Baseline characteristics including the age, body mass index, duration, type and causes of subfertility, and Clinical outcomes including implantation, pregnancy, and live birth rates were analyzed. The SPSS statistical software (version 22.0) was used for data analysis. Quantitative data were presented as mean and SD (mean ± SD). Associations between: implantation, clinical pregnancy, live birth rates were tested by X2 test. All statistical tests and the value were two-sided, and the limit of statistical significance was P<0.05. 1. There were no significant differences in the baseline characteristics and cycle characteristics among the four groups, such as the dose and duration of hormonal stimulation, peak estradiol, the number of oocytes retrieved, rate of fertilization, the number of good-quality of embyos transferred. 2. Base on injury and non-injury treatment, implantation and pregnancy outcomes at our primary end points are assessed. There were no significant differences in implantation, clinical pregnancy, miscarriage rate, live birth rate between injury group and non-injury group. 3. Subgroup analysis was performed by stratifying women into those undergoing injury in proliferation phase and luteal phase. Mean implantation rates were similar among the four groups. There were also no significant differences in biochemical pregnancy, clinical pregnancy, miscarriage rate, ectopic pregnancy, multiple pregnancies, live birth rate among the four groups. Endometrial injury in the cycle preceding IVF of unselected subfertile women does not increase implantation, clinical pregnancy, or live birth rates compared with non-injury to the endometrium. Furthermore, endometrial injury in the proliferation phase results in the same effects on the clinical outcomes as the luteal phase.

Local endometrial injury in women with failed IVF undergoing a repeat cycle: A randomized controlled trial

ObjectiveTo evaluate the effectiveness of local endometrial injury in women undergoing in vitro fertilization (IVF) with at least one previous unsuccessful attempt. Study designRandomized controlled trial. Recruited women were randomized into two groups. In group A (pipelle group), women underwent pipelle biopsy twice in the luteal phase in the cycle prior to IVF. In group B (control), women did not undergo any intervention prior to IVF. The primary outcome was clinical pregnancy rate. The secondary outcomes included live birth, miscarriage, multiple pregnancy and preterm delivery rates. ResultsOne hundred and eleven women were included in the study with 55 in the pipelle group and 56 in the control arm. The baseline clinical characteristics were similar in both groups. The clinical pregnancy rates were not significantly different between pipelle and control group (34.09% vs. 27.65%; Odds ratio, OR 1.35, 95% confidence interval, CI 0.55–3.30). The live birth (31.81% vs. 25.53%; OR 1.36, 95% CI 0.55–3.39), multiple pregnancy (33.33% vs. 61.54%; OR 0.31, 95% CI 0.07–1.47), miscarriage (6.66% vs. 7.69%; OR 0.86, 95% CI 0.05–15.23) and preterm delivery rates (35.71% vs. 66.66%; OR 0.28, 95% CI 0.05–1.4) were also not significantly different between the two groups. ConclusionCurrent study did not find any improvement in IVF success rates following endometrial injury in woman undergoing IVF after previous failed attempt.

A randomized trial of local endometrial injury during ovulation induction cycles.

To investigate the effect of endometrial injury on pregnancy outcomes among infertile women taking clomifene citrate. A prospective randomized trial was undertaken at an Egyptian hospital between January 26, 2015, and July 17, 2016. Eligible women (≥1year primary/secondary/unexplained infertility, aged 20-35years, day-2 follicle-stimulating hormone <12IU/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. 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. Endometrial injury before ovulation induction could improve chances of pregnancy and its outcomes. CLINICALTRIALS.GOV: NCT02345837.

Endometrial injury, the quality of embryos, and blastocyst transfer are the most important prognostic factors for in vitro fertilization success after previous repeated unsuccessful attempts

PurposeThe purpose of this study was to find out the most important prognostic factors for achieving a pregnancy after in vitro fertilization (IVF) in women with history of repeated unsuccessful IVF attempts.MethodsWe analyzed factors affecting pregnancy rate in a retrospective study including 429 IVF/ICSI cycles performed in women younger than 40 years with at least three previous consecutive failed IVF/ICSI attempts.ResultsClinical pregnancy was observed in 140/429 (32.6%) cycles. Clinical pregnancy rate (CPR) was significantly higher in cycles with LEI compared to cycles without LEI before embryo transfer (44.4 vs 26.54%, p = 0.007). The CPR was also higher in cycles with day 5 blastocyst- compared with day 3 cleavage-stage embryo transfers (45.51 vs 26.54%, p < 0.001). In multivariate logistic regression model, only transfer of at least one good quality embryo (OR = 4.32, 95% CI 2.41–7.73), local endometrial injury (OR = 1.73, 95% CI 1.02–2.92), and transfer on day 5 (OR = 3.02, 95% CI 1.53–5.94) remained important independent prognostic factors for clinical pregnancy.ConclusionsThese results suggest that hysteroscopy with local injury to the endometrium prior to ovarian stimulation for IVF/ICSI can improve implantation and pregnancy rates in women experiencing recurrent IVF failure. However, large studies are needed to confirm these findings.