Single and double endometrial scratching (ES) in infertile women with strict criteria of recurrent implantation failure (RIF)

Abstract

Controversies surrounding the effect of ES on pregnancy outcome in women with RIF are mostly due to the poorly defined target population. We evaluated the effect of ES on clinical outcomes in women with strict criteria of RIF before IVF/ICSI. We also examined the effect of ES on the expression of markers of endometrial receptivity. Women with failed implantation after transfer of seven or more top quality day 3 embryos or three blastocysts underwent the scratch procedure on exact days of the cycle prior to IVF/ ICSI. Results were compared to no scratch control group. Using histopathology, immunohistochemistry, and scanning electron microscopy, we also examined the effect of injury on the endometrial receptivity in a separate series of observations with double ES. Cumulative pregnancy rate was significantly higher in the study group as compared to control (54.8% vs. 29.0%; p < .05). The effect of ES on the clinical outcome was seen during fresh ET, but not on the next FET cycles. ES improves impaired endometrial receptivity by partially normalizing the expression of estrogen and progesterone receptors (ERs, PRs) and pinopodes. We concluded that in a well-defined subpopulation of infertile women with RIF, ES significantly enhances pregnancy rates. ES has a specific impact on endometrial receptivity normalizing the expression of some markers.

Outcome of Different Endometrial Preparation Protocols Prior to Frozen-Thawed Embryo Transfer on Pregnancy Outcomes in Women with Repeated Implantation Failure

“…The potential beneficial effect of performing ES in patients with RIF may positively affect endometrial receptivity by normalizing marker expression in most but not all endometrial cells, thereby increasing ongoing pregnancy rates. 15 However, some scholars have pointed out that endometrial mechanical stimulation does not improve the clinical pregnancy rate in patients with RIF and found that ES did not improve implantation and pregnancy rates. 43 One potential reason for this could be that the endometrium had not sufficiently recovered because the interval between ES and embryo implantation was short.…”

“… 11–14 The potential mechanism underlying the procedure could involve improving impaired endometrial receptivity through the partial normalization of estrogen and progesterone receptor expression, as well as pinopode proliferation. 15 Decidualization of the endometrium could be initiated by ES, thus increasing the probability of implantation of a replaced embryo. 16 Furthermore, inflammatory and immune processes could be influenced by ES, leading to the promotion of embryo implantation.…”

Effectiveness of herb-partitioned moxibustion on the navel for pregnancy outcomes in patients with recurrent implantation failure undergoing in vitro fertilization and embryo transfer: a study protocol for a randomized controlled trial

“…In Western medicine, the main treatments for RIF are surgery and drugs. Surgical treatment includes hysteroscopic operation before transplantation to stimulate endometrial repair and growth by scraping the endometrium [ 12 – 14 ]. On the other hand, drug treatment mainly includes human chorionic gonadotropin [ 15 ], growth hormone [ 16 ], glucocorticoid [ 17 ], and oral letrozole [ 18 ].…”