Hysteroscopic‐guided local endometrial injury does not improve natural cycle pregnancy rate in women with unexplained infertility: Randomized controlled trial

Shokeir, Tarek; Ebrahim, Mohamed A.; El-Mogy, Hosam

doi:10.1111/jog.13077

Cited by 21 publications

(17 citation statements)

References 14 publications

(27 reference statements)

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“…We are aware that there are many methods to induce endometrial injury and there is no universal standard of practice. We know some investigators use a more invasive approach such as hysteroscopy-induced endometrial injury (Huang et al, 2011;Shokeir et al, 2016). However, most investigators use a more gentle approach using ES by pipelle (Nastri et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

The effect of endometrial scratch on natural-cycle cryopreserved embryo transfer outcomes: a randomized controlled study

Mak

Chung

et al. 2017

Reproductive BioMedicine Online

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The benefit of endometrial scratch (ES) prior to embryo transfer is controversial. Systemic analysis has confirmed its potential benefit, especially in women with repeated IVF failures, yet most studies have focused on fresh embryo transfer, and its effect on vitrified-warmed embryo transfer (FET) cycles is yet to be explored. We hereby present our prospective, double-blind, randomized controlled study on the evaluation of the implantation and pregnancy rate after ES prior to natural-cycle FET. A total of 299 patients underwent natural-cycle FET and were randomized to receive ES (n = 115) or endocervical manipulation as control (n = 114) prior to FET cycle, and a total of 196 patients had embryo transfer (93 patients in each group). Our study showed no significant difference in the implantation and pregnancy rate, as well as the clinical and ongoing pregnancy or live birth rates between the two groups. It appears that ES does not have any beneficial effect on an unselected group of women undergoing FET in natural cycles. Further studies on its effect in women with recurrent implantation failure after IVF are warranted.

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Section: Discussionmentioning

confidence: 99%

The effect of endometrial scratch on natural-cycle cryopreserved embryo transfer outcomes: a randomized controlled study

Mak

Chung

et al. 2017

Reproductive BioMedicine Online

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“…Therefore these results should be interpreted with caution. Since publication of this review, one other study on endometrial injury in women with unexplained infertility has been published, reporting a non-significant difference in clinical pregnancy rates (CPR) between the intervention and control group (16.7 vs. 11.7%) [15]. Notably, this study was not adequately powered to detect the observed difference; a difference which may be clinically relevant.…”

Section: Introductionmentioning

confidence: 99%

Does endometrial scratching increase the rate of spontaneous conception in couples with unexplained infertility and a good prognosis (Hunault > 30%)? Study protocol of the SCRaTCH-OFO trial: a randomized controlled trial

Bui

Torrance

Janssen

et al. 2018

BMC Pregnancy Childbirth

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BackgroundIn the Netherlands, couples with unexplained infertility and a good prognosis to conceive spontaneously (i.e. Hunault > 30%) are advised to perform timed intercourse for at least another 6 months. If couples fail to conceive within this period, they will usually start assisted reproductive technology (ART). However, treatment of unexplained infertility by ART is empirical and can involve significant burdens. Intentional endometrial injury, also called ‘endometrial scratching’, has been proposed to positively affect the chance of embryo implantation in patients undergoing in vitro fertilization (IVF). It might also be beneficial for couples with unexplained infertility as defective endometrial receptivity may play a role in these women. The primary aim of this study is to determine whether endometrial scratching increases live birth rates in women with unexplained infertility.MethodA multicentre randomized controlled trial will be conducted in Dutch academic and non-academic hospitals starting from November 2017. A total of 792 women with unexplained infertility and a good prognosis for spontaneous conception < 12 months (Hunault > 30%) will be included, of whom half will undergo endometrial scratching in the luteal phase of the natural cycle. The women in the control group will not undergo endometrial scratching. According to Dutch guidelines, both groups will subsequently perform timed intercourse for at least 6 months. The primary endpoint is cumulative live birth rate. Secondary endpoints are clinical and ongoing pregnancy rate; miscarriage rate; biochemical pregnancy loss; multiple pregnancy rate; time to pregnancy; progression to intrauterine insemination (IUI) or IVF; pregnancy complications; complications of endometrial scratching; costs and endometrial tissue parameters associated with reproductive success or failure. The follow-up duration is 12 months.DiscussionSeveral small studies show a possible beneficial effect of endometrial scratching in women with unexplained infertility trying to conceive naturally or through IUI. However, the quality of this evidence is very low, making it unclear whether these women will truly benefit from this procedure. The SCRaTCH-OFO trial aims to investigate the effect of endometrial scratching on live birth rate in women with unexplained infertility and a good prognosis for spontaneous conception < 12 months.Trial registrationNTR6687, registered August 31st, 2017.Protocol versionVersion 2.6, November 14th, 2018.

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“…Three latest studies which compared hysteroscopical groups with and without endometrial lesion, produced opposing results. Seval et al 14 stated significantly higher rates of implantation and rates of pregnancy with the LEI groups, before IVF whereas El-Khayat et al 13 and Shokeir et al 12 , examining the natural cycle and cycles with artificial insemination, did not find any justification to perform endometrial lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have tried to show that local endometrial injury (LEI) prior to IVF leads to an inflammatory response causing an increased endometrial receptivity and bigger IVF success rate [3][4][5] . In the majority of studies, LEI was made on the front or the back of uterus wall 6 , using Pippele biopsy catheter [7][8][9] , Novak biopsy catheter 10 or endometrial cell sampler 11 ; in smaller number of studies, LEI was made during hysteroscopy using grasping forceps 12,13 or monopolar electrode 14 .…”

Section: Introductionmentioning

confidence: 99%

The effects of local endometrial injury by hysteroscopy on in vitro fertilization outcome

et al. 2018

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Bacngraund/Aim. Regardless of embryos quality, an appropriate endometrial thickness and a successful embryo transfer (ET), implantation remains a difficulty for a favorable outcome of an in vitro fertilization (IVF). Numerous studies with the aim of increasing implantation rate and pregnancy rate suggest local endometrial injury (LEI) prior to the IVF procedure. Hysteroscopy is a method becoming more widely used both with patients after a failed IVF cycle and with patients before the first IVF, considering the large incidence of uterus cavum pathological states which have a negative impact on the favorable outcome. However, there is still no consensus reached over LEI, the way and time of its performing or its impact. The aim of this research was to determine the effect of hysteroscopically made local endometrial lesion on the IVF procedure outcome, both in the first and in the next IVF cycle and also to examine if the new method of LEI provoking using bipolare electrode has a favorable impact on post IVF pregnancy success. Methods. Total of 81 patients had hysteroscopy performed 30-50 days prior to IVF, 40 of which had LEI made during hysteroscopy (the LEI group) using bipolar electrode in a way not described in any available literature. Remaning his-teroscopically treated patients (n = 41) had no LEI (the non-LEI group). The control group included 151 patient who had IVF performed with no prior hysteroscopy and LEI. Results. The rate of clinical pregnancies after LEI was statistically more significant in comparison to the control group (52.50% vs 34.44%, p < 0.05) and it meant 2.1 time bigger chance to conceive (OR=2.10; 95% CI: 1.04-4.26; p < 0.05). We noticed differences in the implantation rate between the LEI group and the non-LEI group on one side and the control group on the other, in favor of the two groups subjected to hysteroscopy (23.89%, 25.47% vs 18.18%, respectively), but they were not of any statistical significance. Not significantly higher rate of pregnancy was present, after the first and the next IVF, both in the LEI and the non-LEI group when compared to the control one. Conclusion. New method of LEI provoking by bipolar electrode in the process of hysteroscopy is a simple and safe method allowing higher rate of clinical pregnancies and doubling the probabilty of the positive IVF outcome.

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Hysteroscopic‐guided local endometrial injury does not improve natural cycle pregnancy rate in women with unexplained infertility: Randomized controlled trial

Abstract: Local endometrial injury for natural cycle conception in women with UI is not justified. Further RCT are warranted to prove or disprove this.

Cited by 21 publications

References 14 publications

The effect of endometrial scratch on natural-cycle cryopreserved embryo transfer outcomes: a randomized controlled study

The effect of endometrial scratch on natural-cycle cryopreserved embryo transfer outcomes: a randomized controlled study

Does endometrial scratching increase the rate of spontaneous conception in couples with unexplained infertility and a good prognosis (Hunault > 30%)? Study protocol of the SCRaTCH-OFO trial: a randomized controlled trial

The effects of local endometrial injury by hysteroscopy on in vitro fertilization outcome

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