Success Rate of Hysteroscopy and Endometrial Scratching in Repeated Implantation Failure: A Randomized Controlled Clinical Trial
DOI:
https://doi.org/10.31661/gmj.v10i.1399Keywords:
Infertility; Hysteroscopy; Endometrial ScratchingAbstract
Background: Endometrial receptivity is one of the most important factors in vitro fertilization (IVF) success rate. Many different methods have been suggested to enhance the rate of implantation in IVF\ intracytoplasmic sperm injection (ICSI) cycles. Endometrial injury, as an intentional trauma aimed at improving the fertility results, has gained significant popularity among women seeking pregnancy. This study was conducted to determine the success rate of hysteroscopy and scratching before microinjection in cases of repeated implantation failure. Materials and Methods: This prospective, randomized controlled trial consist of 228 women who were referred to the Al-Zahra Infertility clinic for fertility treatment with the history of failure in at least two ICSI cycles. The patients were divided into two groups. The first group was treated by hysteroscopy without intervention, while the second group underwent hysteroscopy and scratching in the luteal phase of the menstrual cycle prior to microinjection cycle. The controlled ovarian stimulation (COS) was performed in all patients using the antagonist method. The success was considered based on the observation of the fetal heart activity in ultrasound. Results: The success rate of hysteroscopy and scratching (41.5%) was higher compared to hysteroscopy alone (34.3%), but this difference was not statistically significant based on the Chi-square test (P=0.280). The rate of miscarriage in hysteroscopy plus scratching and hysteroscopy alone were 5.7% and 12.4%, respectively which were not statistically different (P=888). Furthermore, the effect of hysteroscopy and scratching on visualizing the fetal heart activity was not statistically different compared to hysteroscopy alone (P=0.223). Conclusion: The results showed that the success rate in hysteroscopy plus endometrial scratching was not significantly different from hysteroscopy alone. [GMJ.2021;10:e1399]
References
Ramezani M, Ashtiyani S, Shamsi M, Taheri S. The opinion and views of Rhaze, s, Avicenna, s and Jorjani, s views on fertility and infertility. Asia Pac J Oncol Nurs. 2013;3(2):504-15. Rohani Z, Naroienejad M. Evaluation of the prevalence of fallopian tube abnormality in primary and secondary infertility based on hysterosalpingography findings. Razi Journal of Medical Sciences. 2007;13(53):105-11. Behdani R. Laparoscopic study on 75 cases of secondary infertility in Roointan Arash Hospital, 1993-96. Arch Iran Med. 2000;58(1):87-91. Nyboe Andersen A, Goossens V, Bhattacharya S, Ferraretti A, Kupka M, De Mouzon J, et al. Assisted reproductive technology and intrauterine inseminations in Europe, 2005: results generated from European registers by ESHRE: ESHRE. The European IVF Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod. 2009;24(6):1267-87. https://doi.org/10.1093/humrep/dep035PMid:19225009 Agostini F, Monti F, Fagandini P, De Pascalis LLD, La Sala GB, Blickstein I. Parental mental representations during late pregnancy and early parenthood following assisted reproductive technology. J Prenat Med. 2009;37(4):320-7. https://doi.org/10.1515/JPM.2009.062PMid:19290854 Potdar N, Gelbaya T, Nardo LG. Endometrial injury to overcome recurrent embryo implantation failure: a systematic review and meta-analysis. Reproductive biomedicine online. 2012;25(6):561-71. https://doi.org/10.1016/j.rbmo.2012.08.005PMid:23063812 Almog B, Shalom-Paz E, Dufort D, Tulandi T. Promoting implantation by local injury to the endometrium. Int J Fertil Steril. 2010;94(6):2026-9. https://doi.org/10.1016/j.fertnstert.2009.12.075PMid:20171615 Mirkin S, Arslan M, Churikov D, Corica A, Diaz J, Williams S, et al. In search of candidate genes critically expressed in the human endometrium during the window of implantation. Hum Reprod. 2005;20(8):2104-17. https://doi.org/10.1093/humrep/dei051PMid:15878921 Finn C, Martin L. Endocrine control of the timing of endometrial sensitivity to a decidual stimulus. Biol Reprod. 1972;7(1):82-6. https://doi.org/10.1093/biolreprod/7.1.82PMid:5050152 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. Int J Fertil Steril. 2003;79(6):1317-22. https://doi.org/10.1016/S0015-0282(03)00345-5 Zhou L, Li R, Wang R, Huang H-x, Zhong K. Local injury to the endometrium in controlled ovarian hyperstimulation cycles improves implantation rates. Int J Fertil Steril. 2008;89(5):1166-76. https://doi.org/10.1016/j.fertnstert.2007.05.064PMid:17681303 Karimzade MA, Oskouian H, Ahmadi S, Oskouian L. Local injury to the endometrium on the day of oocyte retrieval has a negative impact on implantation in assisted reproductive cycles: a randomized controlled trial. Obstet Gynecol Int. 2010;281(3):499-503. https://doi.org/10.1007/s00404-009-1166-1PMid:19568761 Wu M, Yin Y, Zhao M, Hu L, Chen Q. The low expression of leukemia inhibitory factor in endometrium: possible relevant to unexplained infertility with multiple implantation failures. Cytokine. 2013;62(2):334-9. https://doi.org/10.1016/j.cyto.2013.03.002PMid:23541977 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. .Int J Fertil Steril. 2010;94(6):2030-6. https://doi.org/10.1016/j.fertnstert.2010.02.022PMid:20338560 PMCid:PMC3025806 Gibreel A, Badawy A, El-Refai W, El-Adawi N. Endometrial scratching to improve pregnancy rate in couples with unexplained subfertility: a randomized controlled trial. J Obstet Gynaecol Res. 2013;39(3):680-4. https://doi.org/10.1111/j.1447-0756.2012.02016.xPMid:23106834 El-Toukhy T, Campo R, Khalaf Y, Tabanelli C, Gianaroli L, Gordts SS, et al. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. The Lancet. 2016;387(10038):2614-21. https://doi.org/10.1016/S0140-6736(16)00258-0 Yeung TWY, Chai J, Li RHW, Lee VCY, Ho PC, Ng EHY. The effect of endometrial injury on ongoing pregnancy rate in unselected subfertile women undergoing in vitro fertilization: a randomized controlled trial. Hum Reprod . 2014;29(11):2474-81. https://doi.org/10.1093/humrep/deu213PMid:25205759 Shahrokh Tehraninejad E, Dashti M, Hossein Rashidi B, Khorrami N, Azimi Nekou E. Evaluating the effects of local endometrial injury on the success rate of frozen embryo transfer (FET). Research in Medicine. 2015;39(3):121-6. Farzadi L, Fakour A, Ghasemzadeh A, Hamdi K, Fard SA, Nouri M, et al. The effect of local endometrial injury and GnRH agonist on pregnancy rate in patients with recurrent implantation failure. Int J Womens Health Reprod Sci. 2016;4:34-7. https://doi.org/10.15296/ijwhr.2016.08 Ko Jky, Ng Ehy. Scratching and IVF: any role?. Curr Opin Obstet Gynecol. 2016;28(3):178-83. https://doi.org/10.1097/GCO.0000000000000264PMid:26950730 Parsanezhad ME, Dadras N, Maharlouei N, Neghahban L, Keramati P, Amini M. Pregnancy rate after endometrial injury in couples with unexplained infertility: A randomized clinical trial. Iran J Reprod Med. 2013;11(11): 869-74. Fleming TP, Watkins AJ, Velazquez MA, Mathers JC, Prentice AM, Stephenson J, et al. Origins of lifetime health around the time of conception: causes and consequences. The Lancet. 2018; ;391(10132):1842-1852. https://doi.org/10.1016/S0140-6736(18)30312-X Narvekar SA, Gupta N, Shetty N, Kottur A, Srinivas M, Rao KA. Does local endometrial injury in the nontransfer cycle improve the IVF-ET outcoe in the subsequent cycle in patients with previous unsuccessful IVF? A randomized controlled pilot study. J Hum Reprod Sci. 2010;3(1): :15-9. https://doi.org/10.4103/0974-1208.63116PMid:20607003 PMCid:PMC2890904 Nossair WS, El Behery MM, Farag MAS. Endometrial scratch-suction and implantation failure. Open J Obstet Gynecol. 2014;4(05): 217-227. https://doi.org/10.4236/ojog.2014.45036 Zarei A, Alborzi S, Dadras N, Azadi G. The effects of endometrial injury on intrauterine insemination outcome: A randomized clinical trial. Iran J Reprod Med. 2014;12(9): 649-52.
