The effect of endometrial scratch on pregnancy outcomes of frozen-thawed embryo transfer: a propensity score-matched study

Abstract

Aims

To study the effect of endometrial scratch (ES) performed on Days 2 to 5 of the menstrual cycle on pregnancy outcomes of frozen-thawed embryo transfer (FET).

Materials and methods

We conducted a retrospective study including 5769 women undergoing FET from January 2018 to August 2019. The endometrial scratching group (group ES) consisted of 827 patients and the control group (group non-ES) comprised 4942 patients. A propensity score matching (PSM) method using the nearest neighbor matching at a proportion of 1:1 was performed. Subsequently, we compared the pregnancy outcomes of each group after PSM.

Results

After PSM, there were significant differences in implantation (36.1% vs. 47.0%, p = .005), clinical pregnancy (45.4% vs. 58.3%, p = .007), and live birth (33.5% vs. 47.2%, p = .003) rates in matched patients with two previous implantation failures. In the matched patients with at least three previous implantation failures, we also detected increase rates of implantation (31.0% versus 40.1%, p = .028), clinical pregnancy (39.8% versus 57.0%, p = .019), live birth (32.3% versus 47.3%, p = .036). In contrast, no significant difference in pregnancy outcomes was found in women with no previous implantation failure or only one failure.

Conclusions

Endometrial scratch on day 2 to day 5 of the menstrual cycle in women with at least two previous implantation failures who underwent FET increased their implantation, clinical pregnancy, and live birth rates, and did not increase miscarriage or ectopic pregnancy rates compared to the non-ES group.

子宫内膜搔刮术对冻融胚胎移植妊娠结局的影响:一项倾向评分匹配研究 摘要

目的:研究月经周期第2 ∼ 5天行子宫内膜搔刮术( ES )对冻融胚胎移植( FET )妊娠结局的影响。

材料和方法:我们对2018年1月至2019年8月接受FET的5769名妇女进行了回顾性研究。内膜搔刮组( ES组) 827例, 对照组(非ES组) 4942例。采用1 : 1比例的最近邻匹配进行倾向得分匹配( PSM )方法。随后, 我们比较了PSM后各组的妊娠结局。

结果: PSM后, 与前两次植入失败相匹配的患者在植入率( 36.1 % vs 47.0 % , p OOV0.05 )、临床妊娠率( 45.4 % vs 58.3 % , p ¼ . 007 )、活产率( 33.5 % vs . 47.2 % , p OOV0.03 )方面存在显著差异。至少3例匹配的先前植入失败患者中, 我们还检测到植入率( 31.0 %比 40.1 % , p ¼ . 028 )、临床妊娠率( 39.8 %对 57.0 % , p ¼ . 019 )、活产率( 32.3 %对 47.3 % , p ¼ . 036 )的增加。相比之下, 无先前植入失败或仅有一次失败的妇女, 其妊娠结局无明显差异。

结论: 在月经周期第2-5天行子宫内膜搔刮术, 至少有2例先前植入失败的妇女, 接受FET后, 其植入率、临床妊娠率和活产率均增加, 且与未植入ES组相比, 流产或异位妊娠率未增加。

Keywords:

• Endometrial scratch
• frozen-thawed embryo transfer
• pregnancy outcome
• propensity score matching

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the Key R&D and Promotion Projects in Henan Province under Grant [number: 182102310136].