Endometrial injury prior to assisted reproductive techniques for recurrent implantation failure: a systematic literature review

Panagiotopoulou, Nikoletta; Karavolos, Stamatios; Choudhary, Meenakshi

doi:10.1016/j.ejogrb.2015.06.026

Cited by 47 publications

(38 citation statements)

References 37 publications

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“…The same favorable results have been reported when oHS was performed within 50 days (13) or even within 6 months prior to a new ART (16). On the other hand, this impact is somehow questionable in light of the recent conflicting evidence (5,26). Further research is still needed to optimize instrumentation and timing.…”

Section: Discussionmentioning

confidence: 50%

Impact of office hysteroscopy in repeated implantation failure: Experience of a single center

Pabuçcu¹,

Yalçın²,

Bodur³

et al. 2016

J Turkish German Gynecol Assoc

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Objective: Repeated implantation failure (RIF) is a clinical entity affecting many couples undergoing assisted reproductive technology (ART).Various intrauterine pathologies contribute to RIF. Nevertheless, vaginal sonography and hysterosalpingography, which are the common diagnostic tools for the initial follow-up, have limited sensitivities. In this context, we aimed to evaluate the impact of office hysteroscopy (oHS) on live birth rates (LBRs) when performed prior to subsequent ART cycles in women with a history of RIF. Material and Methods:The database of an assisted reproduction center was retrospectively reviewed to detect eligible cases. A total of 363 women out of 2875 admissions were consecutively included in the analysis, of which 119 formed the oHS group and 244 formed the non-oHS group prior to a new ART cycle. Women in the oHS arm were examined during their early follicular phase via a vaginoscopic approach 1-6 months before the beginning of a new cycle. The standard in-vitro fertilization-intracytoplasmic sperm injection (IVF/ICSI) cycle was applied to all the women. Results:In the oHS group (n=119), 61 patients had intrauterine abnormalities, with an overall abnormality rate of 51.2%. Implantation, pregnancy, and LBRs of the groups were statistically similar. LBRs of the women with abnormal oHS findings (15/61, 24.5%), with normal oHS findings (14/58, 24.1%), and without oHS (39/244, 16%) were statistically similar (p=0.41). Conclusion:Unrecognized intrauterine pathologies can be easily detected and concurrently treated during oHS with high success rate. However, a beneficial impact depends on the extent of the pathology and thus, routine application to enhance reproductive outcomes is still not warranted. (J Turk Ger Gynecol Assoc 2016; 17: 197-200) Keywords: Endometrium, in-vitro AbstractSubjects who underwent the procedure formed the oHS group, whereas the remaining subjects formed the non-oHS group. All included patients were between 18 and 40 years of age and had follicle-stimulating hormone (FSH) levels of <15 IU/mL. The exclusion critertia were 1) poor ovarian response according to the Bologna criteria (8) or women with premature ovarian failure; 2) male subjects with severe oligozoospermia, oligoasthenozoospermia, or azoospermia; 3) preimplantation genetic screening and cryopreserved/thawed embryo transfer cycles; 4) women with confirmed endometriosis; 5) women with hypothalamic amenorrhea; and 6) women who underwent oHS more than 6 months prior to a new cycle.Office hysteroscopy procedure All patients were examined during their early follicular phase, 1-6 months before the start of a new ART cycle, via the vaginoscopic approach as previously described (9). No routine preoperative analgesia, antibiotics, sedation, or cervical preparation was used. Briefly, a rigid hysteroscope (continuous flow; 30° forward oblique view) with an outer diameter of 4 mm using 0.9% normal saline was used. Following adequate distension of the uterine cavity, systematic inspection was performed. Standard g...

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Section: Discussionmentioning

confidence: 50%

Impact of office hysteroscopy in repeated implantation failure: Experience of a single center

Pabuçcu¹,

Yalçın²,

Bodur³

et al. 2016

J Turkish German Gynecol Assoc

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“…For example, across Australia, New Zealand and the UK it is advised to patients undergoing IVF by 83% of the clinicians working in a fertility clinic [19]. Multiple studies have been performed to investigate the effect of endometrial scratching in women undergoing ART cycles, but the method of scratching, the population being scratched and the study quality varies widely [17, 18]. Due to this heterogeneity in design and variability in quality, it remains unclear for whom this extra treatment could be beneficial, and for whom it is redundant [18].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have been performed to investigate the effect of endometrial scratching in women undergoing ART cycles, but the method of scratching, the population being scratched and the study quality varies widely [17, 18]. Due to this heterogeneity in design and variability in quality, it remains unclear for whom this extra treatment could be beneficial, and for whom it is redundant [18]. This stresses the need for large randomized controlled trials in specific subpopulations and for an individual patient data analysis to reduce heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

“…Since then, multiple study groups have investigated the effect of endometrial scratching on implantation rate with differences in population, device used (a soft plastic endometrial biopsy catheter, Karman cannula or Novak curette), timing (luteal or follicular phase), and frequency [6–16]. Several hypotheses supporting the positive effect of scratching on pregnancy rates have been proposed but the exact mechanism remains unclear [17, 18]. A Cochrane review by Nastri et al suggests that for women undergoing ART, an endometrial scratch in the month prior to COH improves the chance of achieving a clinical pregnancy and live birth in women with two or more previously failed embryo transfers, but the evidence is of moderate quality at best [17].…”

Section: Introductionmentioning

confidence: 99%

“…A Cochrane review by Nastri et al suggests that for women undergoing ART, an endometrial scratch in the month prior to COH improves the chance of achieving a clinical pregnancy and live birth in women with two or more previously failed embryo transfers, but the evidence is of moderate quality at best [17]. Another review on endometrial injury in women undergoing ART could not perform a meta-analysis due to significant clinical heterogeneity, and could therefore not draw conclusions on the effectiveness of scratching [18]. This stresses the need for large randomized controlled trials on specific subgroups of subfertile couples.…”

Section: Introductionmentioning

confidence: 99%

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Endometrial scratching in women with implantation failure after a first IVF/ICSI cycle; does it lead to a higher live birth rate? The SCRaTCH study: a randomized controlled trial (NTR 5342)

et al. 2017

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BackgroundSuccess rates of assisted reproductive techniques (ART) are approximately 30%, with the most important limiting factor being embryo implantation. Mechanical endometrial injury, also called ‘scratching’, has been proposed to positively affect the chance of implantation after embryo transfer, but the currently available evidence is not yet conclusive. The primary aim of this study is to determine the effect of endometrial scratching prior to a second fresh in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle on live birth rates in women with a failed first IVF/ICSI cycle.MethodMulticenter randomized controlled trial in Dutch academic and non-academic hospitals. A total of 900 women will be included of whom half will undergo an endometrial scratch in the luteal phase of the cycle prior to controlled ovarian hyperstimulation using an endometrial biopsy catheter. The primary endpoint is the live birth rate after the 2nd fresh IVF/ICSI cycle. Secondary endpoints are costs, cumulative live birth rate (after the full 2nd IVF/ICSI cycle and over 12 months of follow-up); clinical and ongoing pregnancy rate; multiple pregnancy rate; miscarriage rate and endometrial tissue parameters associated with implantation failure.DiscussionMultiple studies have been performed to investigate the effect of endometrial scratching on live birth rates in women undergoing IVF/ICSI cycles. Due to heterogeneity in both the method and population being scratched, it remains unclear which group of women will benefit from the procedure. The SCRaTCH trial proposed here aims to investigate the effect of endometrial scratching prior to controlled ovarian hyperstimulation in a large group of women undergoing a second IVF/ICSI cycle.Trial registrationNTR 5342, registered July 31st, 2015.Protocol versionVersion 4.10, January 4th, 2017.

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Endometrial injury in women undergoing in vitro fertilisation (IVF)

Lensen

Armstrong

Gibreel

et al. 2021

Cochrane Database of Systematic Reviews

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Endometrial injury prior to assisted reproductive techniques for recurrent implantation failure: a systematic literature review

Cited by 47 publications

References 37 publications

Impact of office hysteroscopy in repeated implantation failure: Experience of a single center

Impact of office hysteroscopy in repeated implantation failure: Experience of a single center

Endometrial scratching in women with implantation failure after a first IVF/ICSI cycle; does it lead to a higher live birth rate? The SCRaTCH study: a randomized controlled trial (NTR 5342)

Endometrial injury in women undergoing in vitro fertilisation (IVF)

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