Local endometrial injury in women with failed IVF undergoing a repeat cycle: A randomized controlled trial

Tk, Aleyamma; Singhal, Himanshu; Premkumar, Prasanna Samuel; Acharya, Mousumi; Kamath, Mohan S; George, Kuryan

doi:10.1016/j.ejogrb.2017.05.005

Cited by 34 publications

(28 citation statements)

References 17 publications

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“…Of note is the fact that all these interventions employing autologous PBMC administration are performed by inserting a catheter in the uterine cavity at least 24 hours prior to embryo transfer. Knowing that local endometrial injury by mechanical means may have an impact on endometrial receptivity—although new data have initiated a debate on the issue, we cannot exclude this possibility. However, current practice suggests local endometrial injury to be avoided during the transfer cycle since data show a worsening of reproductive outcomes in that case …”

Section: Discussionmentioning

confidence: 99%

“…During the last decade, several clinical trials have evaluated the efficacy of endometrial injury as a treatment option in case of RIF. Their results have been summarized in meta‐analyses suggesting a rather optimistic aspect regarding this treatment; nevertheless, recent data tend to question the initial enthusiasm . Despite the ongoing debate, endometrial injury has been widely incorporated in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Intrauterine CRH‐treated PBMC in repeated implantation failure

Makrigiannakis

Vrekoussis

Makrygiannakis

et al. 2019

Eur J Clin Investigation

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Background The intrauterine administration of activated autologous peripheral blood monocytes (PBMC) prior to embryo transfer seems to improve reproductive outcomes in women with repeated implantation failure (RIF). We have previously shown that the intrauterine administration of PBMC treated with corticotropin‐releasing hormone (CRH) prior to blastocyst transfer (day 5) improves significantly the clinical pregnancy rate of women with RIF. In the present crossover pilot study, we have investigated whether CRH‐PBMC treatment could be of benefit in case of fresh early cleavage stage embryo transfer (day 3) in women with RIF. Methods Twenty‐six (n = 26) women with at least three previous failed IVF attempts and no history of clinical pregnancy in the past were recruited in this study. Ovarian stimulation was performed following either the long or the short protocol. PBMC were collected during the oocyte retrieval, were treated with CRH, and transferred in the uterine cavity 2 days later. Good quality cleavage stage embryos were transferred at day 3, following oocyte retrieval. Results Following the intrauterine administration of CRH‐treated autologous PBMC, 15/26 clinical pregnancies occurred (57.69%). Compared to the null result of the same women prior to recruitment, this observation was considered significant (P < 10−2). Conclusion Our findings further support the role of the intrauterine administration of CRH‐treated PBMC as an effective approach when transferring cleavage stage embryos in women with RIF. Prospective randomized studies are needed to clarify whether such intervention could be of benefit in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intrauterine CRH‐treated PBMC in repeated implantation failure

Makrigiannakis

Vrekoussis

Makrygiannakis

et al. 2019

Eur J Clin Investigation

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“…In most of these studies, LEI in the cycle preceding the IVF-ET cycle increased significantly in terms of clinical pregnancy, implantation and/or live birth rates, while it was found ineffective in other studies. [10][11][12][13][14] In two meta-analyses, in which randomized and non-randomized trials were evaluated together, it was stated that LEI on women who had recurrent IVF failure increased the clinical pregnancy rates with respect to the control group. 4,5 In the review of 14 studies, LEI was found to be related with an increase in clinical pregnancy rates in women who had two or more ET, while having no effect on incidence of twin pregnancy, miscarriage or bleeding.…”

Section: Discussionmentioning

confidence: 99%

Is There any Impact of Local Endometrial Injury on Implantation and Clinical Pregnancy Rates in the First in Vitro Fertilization Cycles

Cüylan¹,

Demır²,

Dilbaz³

et al. 2019

JCOG

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mplantation is one of the most crucial steps for a successful in-vitro fertilization (IVF)-embryo transfer (ET). Implantation success depends on the quality of the embryo and endometrial receptivity. Even with a good quality embryo transfer, the rates of implantation may vary between 25-30% per transferred embryo. 1,2 Implantation occurs during the "implantation window", which is the period between the 19 th and 23 rd days of the menstrual cycle, when endometrial receptivity is at its peak, and includes a three-stage process of apposition, adhesion and invasion of the blastocyst to the endometrium.Recently, local endometrial injury (LEI) has been proposed as one of the methods that aim to increase the implantation rates in IVF-ET cycles. Initially, Barash et al. showed an increase in implantation and pregnancy rates in 134 women who had repeated endometrial biopsies as a method of LEI before IVF-ET cycles. 3 Likewise, other studies have also demonstrated an increase in pregnancy rates after LEI in women with recurrent IVF failure. 4,5 The first study investigating the effect of LEI on implantation and JCOG. 2019;29(4):129-35 129 A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To evaluate the impact of local endometrial injury (LEI), applied during the first in vitro fertilization (IVF)-embryo transfer (ET) cycle using office hysteroscopy, on implantation and pregnancy rates. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A total of 372 women under the age of 40, who had their first IVF-ET treatment cycle, with no ovulatory or intracavitary pathology were included in this study. LEI was created in the fundus, anterior and posterior endometrial walls during office hysteroscopy, which was performed prior to the IVF-ET cycle. Long luteal gonadotropin releasing hormone agonist protocol was used in all cycles and 273 patients underwent embryo transfer. Implantation and pregnancy rates were compared to the control group. R Re es su ul lt ts s: : Age, body mass index, baseline follicle stimulating hormone, luteinizing hormone, and estradiol levels, antral follicle counts, infertility etiologies, total oocyte counts, intra-cytoplasmic sperm injection percentages were similar, both in the study and the control groups. Clinical pregnancy rates (28.7% vs 26.1%, p>0.05), total pregnancy rates (43.1% vs 38%, p>0.05) and implantation rates (19% vs 12.9%, p>0.05) of the LEI injury group were higher than those of the control group, however the difference was not statistically significant. There was no statistically significant difference between the miscarriage rates. C Co on nc cl lu us si io on n: : Even if implantation and pregnancy rates improved slightly in LEI group, the study did not reveal a significant improvement for the implantation and pregnancy rates after the LEI, which was created during hysteroscopy before the first IVF-RT treatment cycle. K Ke ey yw wo or rd ds s: : Embryo transfer; implantation; in vitro fertilization; local endometrial injury; office hysteroscopy

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“…However, some studies failed to detect any benefit of the endometrial injury . Therefore, we conduct this meta‐analysis to assess the efficacy of endometrial injury (biopsy and/or hysteroscopy) as a potential treatment measure for implantation failure in the IVF population.…”

Section: Introductionmentioning

confidence: 99%

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

Gui

Yang

et al. 2018

J of Obstet and Gynaecol

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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.

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Local endometrial injury in women with failed IVF undergoing a repeat cycle: A randomized controlled trial

Cited by 34 publications

References 17 publications

Intrauterine CRH‐treated PBMC in repeated implantation failure

Intrauterine CRH‐treated PBMC in repeated implantation failure

Is There any Impact of Local Endometrial Injury on Implantation and Clinical Pregnancy Rates in the First in Vitro Fertilization Cycles

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

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