Does adding endometrial scratching to diagnostic hysteroscopy improve pregnancy rates in women with recurrent in-vitro fertilization failure?

Abstract

Objective: To investigate the effect of additional endometrial scratching procedure during hysteroscopy on assisted reproductive technology (ART) cycle outcomes in repeated implantation failure (RIF) patients without endometrial or uterine abnormalities on hysteroscopic evaluation.

Materials and methods: Three hundred and forty-five RIF patients who underwent ART at a university-based infertility clinic between January 2011 and June 2015 were recruited in this retrospective cohort study. Uterine cavities of all included patients were evaluated by diagnostic hysteroscopy 7–14 days prior to the subsequent ART cycle. Women without endometrial abnormalities were allocated into two groups; the scratching group was consisted of patients who underwent endometrial scratching by using monopolar electric energy with needle forceps during hysteroscopy, and the control group was consisted of patients who underwent only diagnostic hysteroscopy.

Results: The implantation rate was significantly higher in the scratching group than the control group (37.7% versus 24.5%; p = 0.04). Clinical and ongoing pregnancy rates were also found to be significantly higher in the scratching group than the control group (37.7% versus 27.6%; p = 0.03; and 33.3% versus 23%; p = 0.03, respectively).

Conclusion: Endometrial scratching during diagnostic hysteroscopy seems to enhance implantation and as well pregnancy rates in comparison to diagnostic hysteroscopy alone.

Chinese abstract

目的: 研究宫腔镜操作同时进行刮宫对宫腔镜检查子宫内膜或子宫未见异常的反复种植失败 (RIF) 患者辅助生殖周期 (ART) 结局的影响。

材料与方法: 本回顾性队列研究共纳入345例在2011年1月至2015年6月期间, 就诊于大学附属医院生殖中心接受ART治疗的RIF患者。在ART周期开始前7 ∼ 14天通过诊断性宫腔镜对所有患者的子宫容受性进行评估。未发现子宫内膜异常的女性被分为2组；刮宫组患者在宫腔镜检查时用持针钳单极电进行刮宫, 对照组仅行诊断性宫腔镜。

结果: 刮宫组的种植率显著高于对照组 (37.7% vs 24.5%; p = 0.04) 。刮宫组的临床妊娠与持续妊娠率也显著高于对照组 (分别为37.7% versus 27.6%; p = 0.03; 33.3% versus 23%; p = 0.03) 。

结论: 与单纯诊断性宫腔镜相比, 在诊断性宫腔镜操作同时进行刮宫也许可提高种植率与妊娠率。

Keywords:

• Assisted reproductive technology
• endometrial scratching
• hysteroscopy
• infertility
• ovulation induction

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Corrigendum

Declaration of interest

The authors report no conflicts of interest.