Endometrial scratching for subfertility: everyone's doing it

Lensen, Sarah; Sadler, Lynn; Farquhar, Cindy

doi:10.1093/humrep/dew053

Cited by 80 publications

(74 citation statements)

References 15 publications

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“…The effect of LEI still remains controversial and the subgroup of patients with RIF who would mostly benefit from LEI still needs to be identified. Despite these concerns it was found in recent survey that in women with RIF, 92% of clinicians would recommend LEI [8]. …”

Section: Introductionmentioning

confidence: 99%

Endometrial injury, the quality of embryos, and blastocyst transfer are the most important prognostic factors for in vitro fertilization success after previous repeated unsuccessful attempts

Reljič

Knez

Kovač

et al. 2017

J Assist Reprod Genet

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PurposeThe purpose of this study was to find out the most important prognostic factors for achieving a pregnancy after in vitro fertilization (IVF) in women with history of repeated unsuccessful IVF attempts.MethodsWe analyzed factors affecting pregnancy rate in a retrospective study including 429 IVF/ICSI cycles performed in women younger than 40 years with at least three previous consecutive failed IVF/ICSI attempts.ResultsClinical pregnancy was observed in 140/429 (32.6%) cycles. Clinical pregnancy rate (CPR) was significantly higher in cycles with LEI compared to cycles without LEI before embryo transfer (44.4 vs 26.54%, p = 0.007). The CPR was also higher in cycles with day 5 blastocyst- compared with day 3 cleavage-stage embryo transfers (45.51 vs 26.54%, p < 0.001). In multivariate logistic regression model, only transfer of at least one good quality embryo (OR = 4.32, 95% CI 2.41–7.73), local endometrial injury (OR = 1.73, 95% CI 1.02–2.92), and transfer on day 5 (OR = 3.02, 95% CI 1.53–5.94) remained important independent prognostic factors for clinical pregnancy.ConclusionsThese results suggest that hysteroscopy with local injury to the endometrium prior to ovarian stimulation for IVF/ICSI can improve implantation and pregnancy rates in women experiencing recurrent IVF failure. However, large studies are needed to confirm these findings.

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Section: Introductionmentioning

confidence: 99%

Endometrial injury, the quality of embryos, and blastocyst transfer are the most important prognostic factors for in vitro fertilization success after previous repeated unsuccessful attempts

Reljič

Knez

Kovač

et al. 2017

J Assist Reprod Genet

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“…As well, vascular endothelial growth factor (VEGF) is an angiogenic factor necessary for ovulation, implantation and placentation (36,37). Endometrial scratching have recently been used to induce such factors through inducing an artificial inflammation (38,39). All this evidence provides us with a multidimensional approach to pregnancy and reproduction complications.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Maternal KIR and Parental HLA-C Genes Diversity With Risk of Preeclampsia in Lorestan Province of Iran

Akbari¹,

Ahmadi²,

Shahsavar³

et al. 2018

International Journal of Women’s Health and Reproduction Scienc

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Introduction Preeclampsia is a pregnancy specific syndrome occurring in 3%-14% of all pregnancies worldwide based on recent reports (1). There are a variety of approaches to its pathogenesis. Among these approaches, immune system and its involved molecules are notable (2). The fascinating feature of immune system is that it does not normally reject the semi-allograft fetus. Two roles can be considered for immune system in implantation and pregnancy; the first one is impeding the formation of abnormal embryos, and the second one is maintenance of the fetomaternal interaction through immune tolerance signals. Natural killer-cells (NKs) are the most important cells in the immune tolerance. The NKs identify self-cells through their killer-cell immunoglobulin-like receptors (KIRs) expressed on their surface. These KIRs interact with the human leukocyte antigens (HLAs) expressed on surface of nuclear self-cells. KIR has 8 inhibitory (2DL1, 2DL2, 2DL3, 2DL4, 2DL5, 3DL1, 3DL2 and 3DL3) and 6 activating (2DS1, 2DS2, 2DS3, 2DS4, 2DS5 and 3DS1) genes. In human genome, both HLA and KIR have loci (not locus) and therefore they are inherited as haplotypes. As well, each gene of their loci can be polymorphic. Hence interactions of different KIRs with different HLAs lead to different outcomes. Therefore from an anthropological point of view, people of ethnicities have different KIR-HLA interactions (3-7). There are 2 classes of HLA, I and II, and class I can be classical or non-classical. HLA-G is a nonclassical HLA expressed on the semi-allograft embryonic cells. This HLA interacts with KIR2DL4 molecules and triggers the immune tolerance (8-13). NKs might have (or not) the marker CD16 which is a weapon for antibodydependent cell-mediated cytotoxicity (ADCC). Usually CD56 dim NKs are CD16 + ; therefor CD16 + CD56 dim NKs are called cytotoxic NKs. On the other hand, CD16-CD56 bright NKs are called immune-regulatory NKs (2, 14-16). About 90% of uterine NKs (UNKs) are immune-regulatory. Hence UNKs are not usually cytotoxic for embryo (2, 15). The fascinating point is that how the immune system is both killing and protective. In other words, this system is a bodyguard to protect the self and kill the non-self. Pregnancy is a semi-allograft transplantation. Thus there

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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].…”

Section: Discussionmentioning

confidence: 99%

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 scratching for subfertility: everyone's doing it

Abstract: N/A.

Cited by 80 publications

References 15 publications

Endometrial injury, the quality of embryos, and blastocyst transfer are the most important prognostic factors for in vitro fertilization success after previous repeated unsuccessful attempts

Endometrial injury, the quality of embryos, and blastocyst transfer are the most important prognostic factors for in vitro fertilization success after previous repeated unsuccessful attempts

Correlation of Maternal KIR and Parental HLA-C Genes Diversity With Risk of Preeclampsia in Lorestan Province of Iran

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)

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