Impact of local endometrial injury on in vitro fertilization/intracytoplasmic sperm injection outcomes: A systematic review and meta‐analysis

Abstract

Aim: Recent studies have revealed positive effects of endometrial injury on clinical pregnancy rates, but with inconsistent results. The aim of this meta-analysis was to assess the efficacy of endometrial injury (biopsy and/or hysteroscopy) as a potential treatment measure for implantation failure in the in vitro fertilization population. Methods: We searched in PubMed for studies comparing the efficacy of endometrial injury versus no intervention in women with at least one implantation failure. A random-effects model was used to evaluate the clinical pregnancy rate (CPR) and the live birth rate (LBR). Results: Seventeen studies (11 randomized and 6 non-randomized studies) were included in this meta-analysis, including 1864 women in the intervention group and 2193 women in the control group. Overall, the CPR and LBR were significantly higher in the intervention group than in the control group (for CPR, n = 3997, 16 studies, P < 0.00001, risk ratio (RR) = 1.47, 95% confidence interval [CI] [1.24, 1.74]; for LBR, n = 2361, 11 studies, P = 0.003, RR = 1.41, 95% CI [1.12, 1.78]). However, after excluding the nonrandomized studies, there was no significant difference in CPR (P = 0.29 for endometrial biopsy, P = 0.05 for hysteroscopy) and LBR (P = 0.23 for endometrial biopsy, P = 0.39 for hysteroscopy) between the intervention group and the control group. Conclusion: There is still insufficient evidence to support the use of endometrial injury in women with implantation failure. Robust randomized controlled studies should be designed and performed before clinical implementation of endometrial injury.

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

“…The majority of EI trials have found that EI in luteal phase increased the IVF success rate . The statement above has also been proved by several recent meta‐analysis studies . However, in 2019, another two systematic reviews suggested that current evidence did not fully support performing EI with the purpose of improving success of a first ET attempt .…”

“…[2][3][4][5][6][7][8][9][10]26,27 The statement above has also been proved by several recent meta-analysis studies. 10,14 However, in 2019, another two systematic reviews suggested that current evidence did not fully support performing EI with the purpose of improving success of a first ET attempt. 15,16 Therefore, the clinical application of EI is still in controversial, especially for the frozen-thawed ET process due to the lack of evidence.…”

“…However, there is no consensus in the field up to date and the benefit of EI prior to embryo transfer is controversial. Specifically, some studies demonstrated that performing EI in luteal phase prior to in vitro fertilization (IVF)/ICSI improved implantation and clinical pregnancy rates, in the meanwhile, there are some studies denied such benefit of EI . It is important to point out that most previous studies focused on fresh embryo transfer.…”

“…Specifically, some studies demonstrated that performing EI in luteal phase prior to in vitro fertilization (IVF)/ICSI improved implantation and clinical pregnancy rates, [2][3][4][5][6][7][8][9][10] in the meanwhile, there are some studies denied such benefit of EI. [11][12][13][14][15][16] It is important to point out that most previous studies focused on fresh embryo transfer.…”

The impact of endometrial injury on reproductive outcomes: results of an updated meta‐analysis

“…Later, similar reviews were published. [9][10][11] Vitagliano et al showed improved reproductive outcomes in women with two or more previous failed cycles, with the greatest beneficial effect seen when double luteal EI was performed. 10 Van Hoogenhuijze et al found improved CPR but no improved LBR in women with at least two previous failed cycles, concluding that it is still unclear whether EI improves IVF outcomes.…”