The effect of endometrial injury on implantation and clinical pregnancy rates

Abstract

Aim: To assess the effect of endometrial scratching (ES) on in vitro fertilization-embryo transfer outcome (IVF-ET)

Materials and methods: Retrospective matched case control study including all fresh IVF cycles performed between January 2006 and December 2012 at an academic IVF center. ES with an endometrial biopsy catheter was performed in the cycle preceding the index IVF cycle. Patients (n = 238) were pair matched with controls according to age, number of previous failed IVF cycles and number of embryos transferred.

Results: Demographic and cycle characteristics were comparable in all of the following: age, number of previous cycles, number of collected oocyte, number of embryos transferred and quality of transferred embryos. Implantation, clinical and ongoing pregnancy rates were comparable in both groups (28%, 34% and 18.4% vs 30%, 40.3% and 29%, in ES group and controls, respectively). Logistic regression analysis found no significant association between ES and pregnancy rate.

Conclusions: Mechanical endometrial stimulation did not improve implantation and pregnancy rates. Furthermore, no factors that may predict which patients could benefit from ES were identified. Further prospective studies are warranted to evaluate possible benefits in different subsets of patients such as patients with recurrent implantation failures.

Chinese abstract

目的：本研究旨在评估在子宫内膜搔刮术（ES）对体外受精-胚胎移植（IVF-ET）结局的影响。

材料与方法：选择2006年1月至2012年12月在生殖中心进行首次体外受精（IVF）周期的患者纳入本回顾性病例对照研究。在开始IVF周期前先使用子宫内膜活组织取样器行子宫内膜搔刮术。根据年龄、IVF已失败次数和移植胚胎数选择对照组238例与238名患者行配对研究。

结果：在年龄、已行周期数、取卵数、移植胚胎数和移植胚胎质量方面进行人口统计学和周期特征的比较。对比ES组与对照组的胚胎移植率、临床妊娠率和继续妊娠率（分别为28%、34%和18.4% 对比 30%、40.3%和29%）。Logistic回归分析表明ES与妊娠率无明显相关性。

结论：对子宫内膜的机械性刺激不会提高胚胎移植率和妊娠率。同时, 暂无因素可用于预测何类患者更适用于ES。需要进一步的前瞻性研究以评估对不同类型的患者如复发性植入失败的患者的适应情况。

Keywords:

• Endometrial disruption
• endometrial injury
• endometrial scratching
• implantation failure
• IVF-ET outcome
• pipelle

Acknowledgements

The authors would like to acknowledge Mrs. Amit Nahman and Mrs. Lihi Dor for their invaluable assistance in developing the database.

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.