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

Abstract

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