Effect of local endometrial injury in proliferative vs. luteal phase on IVF outcomes in unselected subfertile women undergoing in vitro fertilization

Abstract

BackgroundMechanical endometrial injury prior to IVF has been suggested as a means to increase implantation rates by improving endometrial receptivity. However, the effects of endometrial injury in proliferative vs. luteal phase have not been studied before. This study aimed to explore whether endometrial injury in the proliferative phase of the preceding cycle before in vitro fertilization/embryo transfer (IVF-ET) improves the clinical outcomes in unselected subfertile women compared with injury in luteal phase.MethodsA group of 142 patients who were good responders to hormonal stimulation were randomized into four groups: injury group (group A: endometrial injury in proliferative phase, n = 38; group B: endometrium injury in luteal phase, n = 32), and non-injury group as control (group C: non-injury in proliferative phase, n = 36; group D: non-injury in luteal phase, n = 36). Patients in injury groups underwent endometrial injury in either proliferative phase or luteal phase in the preceding cycle before IVF treatment. Clinical outcomes including implantation, pregnancy, and live birth rates were analyzed among the four groups.ResultsThe baseline characteristics of the four groups including age, body mass index, duration, type and causes of infertility were similar. There were no significant differences in implantation, clinical pregnancy or live birth rates between injury group and non-injury group. Moreover, there were also no significant differences in implantation, clinical pregnancy, or live birth rates in injury in proliferative phase compared with luteal phase.ConclusionsEndometrial injury in the cycle preceding IVF of unselected subfertile women does not increase implantation, clinical pregnancy, or live birth rates. Furthermore, there is no significant difference in clinical outcomes between endometrial injury in the proliferative phase and injury in the luteal phase.Trial registrationThis study was retrospectively registered on May 26th, 2017 (ChiCTR-IOR-17011506).

Endometrial scratching prior to IVF; does it help and for whom? A systematic review and meta-analysis

“…Since the publication of the abovementioned reviews, multiple RCTs on endometrial injury prior to ART have been carried out. While the first trials mainly focused on patients with RIF, more recent studies have shifted their focus to also include patients in earlier stages of IVF/ICSI treatment (Mahran et al , 2016; Liu et al , 2017; Tk et al , 2017; Maged et al , 2018). The increase in number of published studies not only calls for an updated review of the existing body of evidence, but also has created the possibility to subgroup patients according to the number of failed IVF/ICSI cycles.…”

Effect of endometrial injury during menstruation on clinical outcomes in frozen–thawed embryo transfer cycles: A randomized control trial

“…compared performing EI in the luteal phase and in the proliferative and suggested that there was no significant difference in terms of clinical outcomes . We believe performing EI in the proliferative phase may influence the characteristic and function of the proliferative endometrium. On the other hand, performing EI on the third day of the menstrual cycle may promote epithelial cells and stromal cells proliferation and differentiation.…”

Endometrial local injury, a simple procedure that improves IVF outcome in a selected population of patients

“…Yeung, et al [14] however, did not test a homogeneous population of IVF patients with RIF. Even more concerning was the fact that participants in this study as well as in the study by Liu, et al [15] were subjected, prior to the endometrial biopsy, to either Saline Infusion Sonogram (SIS) or hysteroscopy. These procedures, on their own, could cause mechanical injury that may positively affect endometrial receptivity, leaving no potential for benefi cial effect of the biopsy.…”