It is uncertain whether endometrial injury improves the probability of pregnancy and live birth/ongoing pregnancy in women undergoing IUI or attempting to conceive via sexual intercourse. The pooled results should be interpreted with caution as we graded the quality of the evidence as either low or very low. The main reasons we downgraded the quality of the evidence were most included studies were at a high risk of bias and had an overall low level of precision. Further well-conducted RCTs that recruit large numbers of participants and minimise internal bias are required to confirm or refute these findings.
There are insufficient data available to draw conclusions on the effectiveness of timed intercourse for the outcomes of live birth, adverse events and clinical pregnancy. Timed intercourse may improve pregnancy rates (clinical or self-reported pregnancy, not yet confirmed by ultrasound) compared to intercourse without ovulation prediction. The quality of this evidence is low to very low and therefore findings should be regarded with caution. There is a high risk of publication bias, as one large study remains unpublished 8 years after recruitment finished. Further research is required, reporting clinically relevant outcomes (live birth, clinical pregnancy rates and adverse effects), to determine if timed intercourse is safe and effective in couples trying to conceive.
Methods: Retrospective analysis of all cases referred for sonographic evaluation of an IUD location from July 2012-November 2014. Images were reviewed for IUD position, uterine position, cervico-uterine angle and CD scar size. IUD malposition was defined as complete or partial IUD localisation outside the endometrial cavity using 3D sonography. Patient characteristics and sonographic findings were compared between those with a normal in utero IUD position and those who had a malpositioned IUD using t and x 2 tests. Logistic regression analysis was used to control for potential confounders associated with IUD malposition. Finally, within the prior CD group, patients with in utero IUD position were compared to those with malpositioned IUD. Results: 303 women had an ultrasound for IUD localisation during the study period. In 240 (79.2%) cases, the IUD was normally located in the uterine cavity, in 48 (15.8%) it was malpositioned and in 15 (4.95%) it was poorly or not visualised. In 33 cases it was seen in the lower uterine segment, 5 were in the cervix, 7 were embedded in the myometrium and 3 perforated through the serosa. Women with prior CD had 2.8-fold higher odds of having a malpositioned IUD compared to women without prior CD, after adjustment for BMI, uterine position and cervico-uterine angle (OR: 2.79, 95% CI: 1.11-6.98, p = 0.03). No other risk factors were significantly associated with IUD malposition. Within women with prior CD, women with a prominent CD defect had 6-fold higher odds of having a malpositioned IUD as compared to women with a minimal defect, adjusting for cervico-uterine angle (OR: 6.36 Objectives: To appraise the available evidence for both intentional and unintentional endometrial injury. Methods: We searched Ovid Medline and Pubmed looking for studies evaluating the effect of endometrial injury (intentional and unintentional) in subfertile women. Only RCTs were meta-analysed. Results: 734 studies were identified and 33 RCTs were included; their quality was rated as very low to moderate. Intentional endometrial injury increased live birth and clinical pregnancy both in ART cycles (RR = 1.42 95%CI 1.08-1.85, 1496 women and RR = 1.38 95%CI 1.15-1.65, 2031 women, respectively) and in women undergoing IUI or attempting natural conception (RR = 2.30 95%CI 1.36-3.87, 485 women and RR = 1.91 95%CI 1.54-2.39, 1028 women, respectively). The benefit was only significant in the subgroup of studies undertaken in women with previously failed embryo transfers. Regarding unintentional injury, hysteroscopy prior to ART improved live birth and clinical pregnancy (RR = 1.72 95%CI 1.36-2.17, 723 women and RR = 1.40 95%CI 1.19-1.66, 2227 women, respectively). Hysterosalpingogram before IUI or natural conception increased clinical pregnancy (RR = 2.16 95%CI 1.05-4.44, 828 women) but not live birth (RR = 1.57 95%CI 0.73-3.40, 492 women). There was no evidence of effect of both interventions on miscarriage or multiple pregnancy. Conclusions: Intentional endometrial injury is associated with a small increase in...
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