Endometrial scratching to improve pregnancy rate in couples with unexplained subfertility: A randomized controlled trial

Gibreel, Ahmed; Badawy, Ahmed; El-Refai, Waleed; Eladawi, Noha

doi:10.1111/j.1447-0756.2012.02016.x

Cited by 74 publications

(80 citation statements)

References 30 publications

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“…Moreover, two meta-analyses of the results of the above-mentioned studies as well as a randomised clinical trial recently published strongly support the notion that local endometrial injury significantly improves clinical pregnancy and live birth rates in the subsequent IVF cycle (El-Toukhy et al 2012, Potdar et al 2012, Gibreel et al 2013. Furthermore, it has been recently shown that biopsy treatment has a positive effect on spontaneous pregnancies as well (Brinsden et al 2009).…”

Section: Introductionmentioning

confidence: 71%

Biopsy-induced inflammatory conditions improve endometrial receptivity: the mechanism of action

Gnainsky¹,

Granot²,

Aldo³

et al. 2015

Reproduction

139

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A decade ago, we first reported that endometrial biopsy significantly improves the success of pregnancy in IVF patients with recurrent implantation failure, an observation that was later confirmed by others. Recently, we have demonstrated that this treatment elevated the levels of endometrial pro-inflammatory cytokines and increased the abundance of macrophages (Mac) and dendritic cells (DCs). We therefore hypothesised that the biopsy-related successful pregnancy is secondary to an inflammatory response, and aimed at deciphering its mechanism of action. Supporting our hypothesis, we found that the pro-inflammatory TNFa stimulated primary endometrial stromal cells to express cytokines that attracted monocytes and induced their differentiation into DCs. These monocytederived DCs stimulated endometrial epithelial cells to express the adhesive molecule SPP1 (osteopontin (OPN)) and its receptors ITGB3 and CD44, whereas MUC16, which interferes with adhesion, was downregulated. Other implantation-associated genes, such as CHST2, CCL4 (MIP1B) and GROA, were upregulated by monocyte-derived Mac. These findings suggest that uterine receptivity is mediated by the expression of molecules associated with inflammation. Such an inflammatory milieu is not generated in some IVF patients with recurrent implantation failure in the absence of local injury provoked by the biopsy treatment.Reproduction (2015) 149 75-85

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Section: Introductionmentioning

confidence: 71%

Biopsy-induced inflammatory conditions improve endometrial receptivity: the mechanism of action

Gnainsky¹,

Granot²,

Aldo³

et al. 2015

Reproduction

139

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“…We previously reported, however, that BCL6 was elevated in 80% of women with UI (11), and our population reflects this diagnosis. The effect of endometrial scratching may have had benefit on implantation rates before IVF, although data on this topic are controversial (43,44), but since scratching was performed in all subjects this should not be a confounder.…”

Section: Discussionmentioning

confidence: 99%

Endometrial BCL6 testing for the prediction of in vitro fertilization outcomes: a cohort study

Almquist

Likes

Stone

et al. 2017

Fertility and Sterility

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Objective To evaluate endometrial BCL6 expression as a prognostic biomarker for In Vitro Fertilization (IVF) outcome in women with unexplained infertility (UI) prior to embryo transfer. Design Prospective cohort study. Setting University associated infertility clinic. Patients Women with UI for greater than 1 year. Interventions We studied women with UI who underwent testing for endometrial BCL6, in an LH-timed mid-luteal phase biopsy and completed an IVF cycle and embryo transfer. Main Outcome Measure(s) Clinical pregnancy rate (CPR) and live birth rate (LBR) per transfer was compared for women positive or negative for BCL6 expression. An abnormal BCL6 result was defined by an HSCORE (> 1.4). Results Women with normal and abnormal BCL6 and those who conceived or not had similar characteristics. Women with low levels of BCL6 expression had a significantly higher CPR (11/17; 64.7%; 95%CI: 41.3 to 82.6), compared to women with abnormal (high) BCL6 expression (9/52; 17.3%; 95%CI: 9.3 to 30.8). These results yield a relative risk (RR) of 0.267 (95%CI: 0.13 to 0.53; p = 0.0004) for those with normal BCL6 expression, an absolute benefit (AB) of 47.4% (95%CI: 22.5 to 72). LBR was also significantly higher in women with low BCL6 expression(10/17; 58.8; 95%CI: 36 to 78.4), compared to women with abnormal BCL6 expression (6/52; 11.5%; 95%CI: 5.4 to 23). The RR was 0.19 (95%CI: 0.08 to 0.45; p = 0.0002), yielding an AB of 47.3% (95%CI: 21.8 to 67.8). Conclusions Aberrant BCL6 expression (> 1.4 HSCORE) was strongly associated with poor reproductive outcomes in IVF cycles in women with UI.

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“…However, some well-designed studies have demonstrated effects on pregnancy rates in intrauterine insemination (IUI) or natural conception cycles. Gibreel et al examined this procedure in couples with unexplained infertility, and showed beneficial effect of endometrial scratching on pregnancy rates in women after natural conception [16]. Although Abdelhamid found a significant increment in pregnancy rates in IUI procedures when endometrial scratching was performed [17], some other randomized controlled studies failed to show significant differences between intervention and control groups in IUI cycles [4,18].…”

Section: Discussionmentioning

confidence: 98%

Does adding endometrial scratching to diagnostic hysteroscopy improve pregnancy rates in women with recurrent in-vitro fertilization failure?

Seval

Şükür

Özmen

et al. 2016

Gynecological Endocrinology

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Endometrial scratching to improve pregnancy rate in couples with unexplained subfertility: A randomized controlled trial

Abstract: Endometrial scratching may improve clinical pregnancy rates in couples with unexplained infertility. Adequately powered studies are mandated to confirm or refute the findings.

Cited by 74 publications

References 30 publications

Biopsy-induced inflammatory conditions improve endometrial receptivity: the mechanism of action

Biopsy-induced inflammatory conditions improve endometrial receptivity: the mechanism of action

Endometrial BCL6 testing for the prediction of in vitro fertilization outcomes: a cohort study

Does adding endometrial scratching to diagnostic hysteroscopy improve pregnancy rates in women with recurrent in-vitro fertilization failure?

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