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Category: Volume 07 Issue 07 July 2019
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Title: Role of endometrial scratching in IVF- ET cycles in women with recurrent implantation failure

Authors: Avani Pillai, Fessylouis T, Ramesh P, Aparna N

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.95

Abstract

Introduction: Developing a receptive endometrium for implantation of the embryo during In vitro fertilization (IVF) treatment is considered the rate-limiting step for its success. Recurrent implantation failure (RIF) has always been a difficult situation to deal with. Our Objective was to evaluate the role of hysteroscopic endometrial scratching in improving the implantation rate and the pregnancy outcome in IVF-ET (embryo transfer) cycles in women with RIF.

Materials and Methods: We did a prospective study including 58 patients with RIF and sonologically normal endometrium, who underwent IVF-ET between September 2016 and August 2018. Of these 32 women underwent hysteroscopic endometrial scratching in the previous cycle whereas 26 of them did not undergo the procedure. The implantation rate, overall pregnancy rate, clinical pregnancy rate and live birth rate were compared between the two groups.

Results: The implantation rate in patients who underwent hysteroscopic endometrial scratching prior to IVF-ET was comparable to that in the subjects who did not undergo the procedure (18.8% versus 13.2%, p= 0.569). The overall pregnancy rate (40.6% versus 38.5%, p= 0.87), clinical pregnancy rate (37.5% versus 34.6%, p= 0.82) and live birth rate (21.9% versus 19.2%, p= 0.80) were also comparable between the two groups. 

Conclusion: Our study did not show statistically significant improvement in the pregnancy outcome after hysteroscopic endometrial injury in IVF-ET cycles. Hysteroscopic endometrial injury in IVF -ET cycles in women with recurrent implantation failure may not be beneficial in improving the pregnancy outcome.

Keywords: Endometrial scratching, Pre – IVF hysteroscopy, Recurrent implantation failure, Endometrial receptivity, IVF embryo transfer, Endometrial injury.

References

  1. De Mouzon J, Goossens V, Bhattacharya S, Castilla JA, Ferraretti AP, Korsak V, Kupka M, Nygren KG, Nyboe Andersen A: Assisted reproductive technology in Europe, 2006: results generated from European registers by ESHRE. HumReprod 2010, 25:1851-1862. 
  1. Cross JC, Werb Z, Fisher SJ. Implantation and the placenta: key pieces of the development puzzle. Science 1994;266: 1508–18.
  2. Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergo­ing in vitro fertilization. FertilSteril 2003;79(6):1317-22.
  3. Li 2009 Li R, Hao G. Local injury to the endometrium: its effect on implantation. Current Opinion in Obstetrics and Gynecology 2009;21(3):236–9. [PUBMED: 19352180]
  4. Garris 2003 Garris DR, Garris BL. Cytomorphometric analysis and surface ultrastructure of developing decidua. Tissue and Cell 2003;35(4):233–42. [PUBMED: 12921706]
  5. Gnainsky Y, Granot I, Aldo PB, Barash A, Or Y, Schechtman E et al. Local injury of the endometrium induces an inflammatory response that promotes successful implantation. FertilSteril 2010:94(6):2030-6.
  6. Lass 1998 Lass A, Peat D, Avery S, Brinsden P. Histological evaluation of endometrium on the day of oocyte retrieval after gonadotrophin-releasing hormone agonist-follicle stimulating hormone ovulation induction for in-vitro fertilization. Human Reproduction 1998;13(11):3203–5. [PUBMED: 9853881]
  7. Ubaldi 1997 Ubaldi F, Bourgain C, Tournaye H, Smitz J, Van Steirteghem A, Devroey P. Endometrial evaluation by aspiration biopsy on the day of oocyte retrieval in the embryo transfer cycles in patients with serum progesterone rise during the follicular phase. Fertility and Sterility 1997; 67(3):521–6. [PUBMED: 9091341] 
  8. Zhou L, Li R, Wang R, Huang HX, Zhong K. Endometrial injury in COH cycle. FertilSteril 2008;89(5):1166-76.
  9. Kalma Y, Granot I, Gnainsky Y, Or Y, Czernobilsky B, Dekel N, Barash A. Endometrial biopsy-induced gene modulation: first evidence for the expression of bladder-transmembranaluroplakinIb in human endometrium. Fertil Steril 2009;91(4)
  10. Song H, Lim H, Paria BC, Matsumoto H, Swift LL, Morrow J et al. Cytosolic phospolipase A2 alpha deficiency is crucial for ‘on time’ embryo implantation that directs subsequent development. Development 2002;129:2879-89.
  11. Carson DD, Julian J, Lessey BA, Prakobphol A, Fisher SJ. MUC1 is a scaffold for selection ligands in the human uterus. Front Biosci 2006;11:2903-8.
  12. Tarek El-Toukhy, Rudi Campo, Sesh Kamal Sunkara, Yacoub Khalaf and Arri Coomarasamy. A multi-centre randomised controlled study of pre-IVF outpatient hysteroscopy in women with recurrent IVF implantation failure: Trial of Outpatient Hysteroscopy - [TROPHY] in IVF. Reproductive Health 2009, vol.6:20  
  13. Carolina O Nastri, Sarah F Lensen, Ahmed Gibreel, Nick Raine-Fenning, Rui A Ferriani, Siladitya Bhattacharya, Wellington P Martins. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Database of Systematic Reviews 2015, Issue 3. DOI: 10.1002/14651858.CD009517.pub3
  14. Van Hoogenhuijze NE, Kasius JC, Broekmans FJM, Bosteels J, Torrance HL et al. Endometrial scratching prior to IVF; does it help and for whom? A systematic review and meta-analysis. Hum Reprod Open. 2019 Jan 29;2019(1):hoy025. doi: 10.1093/hropen/hoy025.
  15. Nikoletta Panagiotopoulou, Stamatios Karavolos, Meenakshi Choudhary et al  Endometrial injury prior to assisted reproductive techniques for recurrent implantation failure: a systematic literature review. European journal of obstetrics and gynaecology and reproductive biology, october 2015,volume 193, pages 27–33
  16. Siristatidis C, Kreatsa M, Koutlaki N, Galazios G, Pergialiotis V, Papantoniou N et al. Endometrial injury for RIF patients undergoing IVF/ICSI: a prospective nonrandomized controlled trial. Gynecol Endocrinol. 2017 Apr;33(4):297-300. doi: 10.1080/09513590.2016.1255325. Epub 2016 Dec 2.
  17. Yeung TW, Chai J, Li RH, Lee VC, Ho PC, Ng EH et al. The effect of endometrial injury on ongoing pregnancy rate in unselected subfertile women undergoing in vitro fertilization: a randomized controlled trial. Hum Reprod. 2014 Nov;29(11):2474-81.
  18. Nastri CO, Gibreel A, Raine-Fenning N, Maheshwari A, Ferriani RA, Bhattacharya S, Martins WP. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD009517.DOI: 10.1002/14651858.CD009517.pub2.

Corresponding Author

Dr Fessylouis T

Associate Professor, Dept of Reproductive Medicine and Surgery, Amrita Institute of Medical Sciences, Kochi, India