Does local endometrial injury in the nontransfer cycle improve the IVF-ET outcome in the subsequent cycle in patients with previous unsuccessful IVF? A randomized controlled pilot study

Abstract

BACKGROUND:Management of repeated implantation failure despite transfer of good-quality embryos still remains a dilemma for ART specialists. Scrapping of endometrium in the nontransfer cycle has been shown to improve the pregnancy rate in the subsequent IVF/ET cycle in recent studies.AIM:The objective of this randomized controlled trial (RCT) was to determine whether endometrial injury caused by Pipelle sampling in the nontransfer cycle could improve the probability of pregnancy in the subsequent IVF cycle in patients who had previous failed IVF outcome.SETTING:Tertiary assisted conception center.DESIGN:Randomized controlled study.MATERIALS AND METHODS:100 eligible patients with previous failed IVF despite transfer of good-quality embryos were randomly allocated to the intervention group and control groups. In the intervention group, Pipelle endometrial sampling was done twice: One in the follicular phase and again in the luteal phase in the cycle preceding the embryo transfer cycle.OUTCOME MEASURE:The primary outcome measure was live birth rate. The secondary outcome measures were implantation and clinical pregnancy rates.RESULTS:The live birth rate was significantly higher in the intervention group compared to control group (22.4% and 9.8% P = 0.04). The clinical pregnancy rate in the intervention group was 32.7%, while that in the control group was 13.7%, which was also statistically significant (P = 0.01). The implantation rate was significantly higher in the intervention group as compared to controls (13.07% vs 7.1% P = 0.04).CONCLUSIONS:Endometrial injury in nontransfer cycle improves the live birth rate, clinical pregnancy and implantation rates in the subsequent IVF-ET cycle in patients with previous unsuccessful IVF cycles.

Knowing a cross-talk between embryo and endometrium can help to achieve successful pregnancy outcome in recurrent implantation failure

“…Narvekar et al has demonstrated that the live birth rates, clinical pregnancy and implantation rates significantly increased after endometrial scraping in the preceding cycle in patients with good-quality embryos. 5 The exact mechanism for such effect is not fully understood. However, it is postulated that biopsy/scratching induces an inflammatory response that elevated proinflamatory cytokines, as well as increased MIP-1B expression in the regenerative endometrium, this could play a significant role in implantation process.…”

Endometrial Ice Application Prior to Embryo Transfer in Cases of Recurrent Unexplained <i>In-Vitro</i> Fertilization Failure: A Pilot Study

“…After that, many trials were performed on women with recurrent implantation failure. Most of these trials showed significant implantation rates improvement on doing the endometrial injury in the preceding cycle [2] [9] [10], while another trial showed no benefit of such a scratching procedure [11].…”

“…Hatching, opposition, adherence, penetration and finally invasion are the steps needed for the blastocyst for successful implantation to happen. And the endometrium should be also prepared by estrogen and progesterone and needs to be in time [2]. Barash …”

Assessment and treatment of repeated implantation failure (RIF)

“…Several investigators have suggested that patients with RIF may benefit from endometrial stimulation induced by local injury resulting from a uterine endometrial biopsy catheter in the cycle that precedes the actual treatment cycle [9,58,66,80]. In a randomized controlled trial that included 100 patients with a diagnosis of RIF, Narvekar et al [66] performed two endometrial samplings, one in the follicular phase and the other in the luteal phase of the cycle, antecedent to the embryo transfer cycle.…”

“…In a randomized controlled trial that included 100 patients with a diagnosis of RIF, Narvekar et al [66] performed two endometrial samplings, one in the follicular phase and the other in the luteal phase of the cycle, antecedent to the embryo transfer cycle. The authors reported significant improvement in the clinical pregnancy rate (32.7 % vs13.7 %), the live birth rate (22.4 % vs 9.8 %) and the implantation rate (13.07 % vs 7.1 %) in patients who underwent the intervention as compared to those who did not.…”