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Endometrial Injury May Increase the Pregnancy Rate in Patients Undergoing Intrauterine Insemination: An Interventional Randomized Clinical Trial

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Abstract

Objective

This study aimed to investigate the effect of endometrial injury using Pipelle catheter in the follicular phase (cycle day 5, 6, or 7) of the stimulation cycle on pregnancy rates in patients undergoing intrauterine insemination.

Methods

This prospective randomized controlled study was carried out in the Assisted Reproductive Technology Unit of Ain Shams University Maternity Hospital, Cairo, Egypt, from July 1, 2013 to August 31, 2015. Three hundred sixty women, 20 to 35 years of age, with patent fallopian tubes, mild male factor infertility, or unexplained infertility were recruited. Participants were allocated randomly into 2 groups: experimental arm and control arm. Women in the experimental arm underwent endometrial biopsy using a Pipelle catheter on day 5, 6, or 7 of the stimulation cycle combined with intrauterine insemination. Women in the control group underwent intrauterine insemination with no endometrial biopsy done. The primary outcomes were the clinical and chemical pregnancy rates.

Results

Data of 344 participants were statistically analyzed. The chemical pregnancy rate was 23.66% in the experimental arm and 10.85% in the control arm (P =.002). The clinical pregnancy rate was 18.93% in the experimental arm and 7.42% in the control arm (P =.003).

Conclusion

Endometrial injury using a Pipelle catheter in the stimulation cycle may improve pregnancy rates in women undergoing intrauterine insemination.

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References

  1. Human Fertilisation and Embryology Authority. Fertility Treat-ment in 2010; Trends and Figures; 2010. Web site. http://www.hfea.gov.uk. Published 2010. Updated 2015. Accessed January 2, 2014.

    Google Scholar 

  2. Pasch, LA, Gregorich, SE, Katz, PK, et al. Psychological distress and in vitro fertilization outcome. Fertil Steril. 2012;98(2): 459–464.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wang, H, Dey, SK Roadmap to embryo implantation: clues from mouse models. Nat Rev Genet. 2006;7(3):185–199.

    Article  PubMed  Google Scholar 

  4. Paria, BC, Huet-Hudson, YM, Dey, SK Blastocyst’s state of activ-ity determines the window of implantation in the receptive mouse uterus. Proc Natl Acad Sci U S A 1993;90(21):10159–10162.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ma, WG, Song, H, Das, SK, Paria, BC, Dey, SK Estrogen is a critical determinant that specifies the duration of the window of uterine receptivity for implantation. Proc Natl Acad Sci U S A 2003;100(5):2963–2968.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Fanchin, R, Ayoubi, JM Uterine dynamics: impact on the human reproduction process. Reprod Biomed Online. 2009;18(suppl 2): 57–62.

    Article  PubMed  Google Scholar 

  7. Mandelbaum, J, Junca, AM, Plachot, M The implantation window in humans after fresh or frozen-thawed embryo transfers. In: Mashiach, S, Ben-Rafael, Z, Laufer, N, Schenker, JG, eds. Advances in Assisted Reproductive Technologies. New York, NY: Plenum Press; 1990.

    Google Scholar 

  8. Davies, MC, Anderson, MC, Mason, BA, Jacobs, HS Oocyte donation: the role of endometrial receptivity. Hum Reprod. 1990;5(7): 862–869.

    Article  CAS  PubMed  Google Scholar 

  9. Nastri, CO, Gibreel, A, Raine-Fenning, N, et al. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Database Syst Rev. 2012;7:cd009517.

    Google Scholar 

  10. Li, R, Hao, G Local injury to the endometrium: its effect on implantation. Curr Opin Obstet Gynecol. 2009;21(3):236–239.

    Article  CAS  PubMed  Google Scholar 

  11. Zhou, L, Li, R, Wang, R, Huang, HX, Zhong, K Local injury to the endometrium in controlled ovarian hyperstimulation cycles improves implantation rates. Fertil Steril. 2008;89(5):1166–1176.

    Article  PubMed  Google Scholar 

  12. Siristatidis, C, Vrachnis, N, Vogiatzi, P, et al. Potential pathophy-siological mechanisms of the beneficial role of endometrial injury in in vitro fertilization outcome. Reprod Sci. 2014;21(8):955–965.

    Article  PubMed  Google Scholar 

  13. Gnainsky, Y, Granot, I, Aldo, PB, et al. Local injury of the endometrium induces an inflammatory response that promotes successful implantation. Fertil Steril. 2010;94(6):2030–2036.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Shohayeb, A, El-Khayat, W Does a single endometrial biopsy regimen (S-EBR) improve ICSI outcome in patients with repeated implantation failure? A randomised controlled trial. Eur J Obstet Gynecol Reprod Biol. 2012;164(2):176–179.

    Article  PubMed  Google Scholar 

  15. El-Toukhy, T, Sunkara, S, Khalaf, Y Local endometrial injury and IVF outcome: a systematic review and meta-analysis. Reprod Biomed Online. 2012;25(4):345–354.

    Article  PubMed  Google Scholar 

  16. Yeung, TW, Chai, J, Li, RH, Lee, VC, Ho, PC, Ng, EH The effect of endometrial injury on ongoing pregnancy rate in unselected sub-fertile women undergoing in vitro fertilization: a randomized controlled trial. Hum Reprod. 2014;29(11):2474–2481. doi:10.1093/humrep/deu213.

    Article  CAS  PubMed  Google Scholar 

  17. Nastri, CO, Lensen, SF, Gibreel, A, et al. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Database Syst Rev. 2015;3:cd009517.

    Google Scholar 

  18. Gibreel, A, Badawy, A, El-Refai, W, El- Adawi, N Endometrial scratching to improve pregnancy rate in couples with unexplained subfertility: a randomized controlled trial. J Obstet Gynaecol Res. 2013;39(3):680–684.

    Article  PubMed  Google Scholar 

  19. Parsanezhad, M, Dadras, N, Maharlouei, N, Neghahban, L, Kera-mati, P, Amini, M Pregnancy rate after endometrial injury in couples with unexplained infertility: a randomized clinical trial. Iran J Reprod Med. 2013;11(11):869–874.

    PubMed  PubMed Central  Google Scholar 

  20. El-Khayat, W, Elsadek, M, Saber, W Comparing the effect of office hysteroscopy with endometrial scratch versus office hys-teroscopy on intrauterine insemination outcome: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2015;194: 96–100.

    Article  PubMed  Google Scholar 

  21. Maged, AM, Al-Inany, H, Salama, KM, Souidan, II, Abo Ragab, HM, Elnassery, N Endometrial scratch injury induces higher pregnancy rate for women with unexplained infertility undergoing IUI with ovarian stimulation: a randomized controlled trial. Reprod Sci. 2016;23(2):239–243.

    Article  CAS  PubMed  Google Scholar 

  22. Zarei, A, Alborzi, S, Dadras, N, Azadi, G The effects of endometrial injury on intrauterine insemination outcome: a randomized clinical trial. Iran J Reprod Med. 2014;12(9):649–652.

    PubMed  PubMed Central  Google Scholar 

  23. National Institute for Clinical Excellence. CG156-Fertility: Assessment and Treatment for People with Fertility Problems. London, UK: NICE guidelines [CG156]; 2013.

    Google Scholar 

  24. ESHRE Capri Workshop Group, Aboulghar, M, Baird, DT, Collins, J, et al. Intrauterine insemination. Hum Reprod Update. 2009; 15(3):265–277.

    Article  Google Scholar 

  25. Jasovic, V, JasoviĆ-Siveska, E Success rate of intrauterine inse-mination in patients with unknown infertility. Vojnosanit Pregl. 2012;69(4):301–307.

    Article  PubMed  Google Scholar 

  26. De Brucker, M, Camus, M, Haentjens, P, Verheyen, G, Collins, J, Tournaye, H Assisted reproduction using donor spermatozoa in women aged 40 and above: the high road or the low road? Reprod Biomed Online. 2013;26(6):577–585.

    Article  PubMed  Google Scholar 

  27. Barash, A, Dekel, N, Fieldust, S, Segal, I, Schechtman, E, Granot, I Local injury to the endometrium doubles the incidence of suc-cessful pregnancies in patients undergoing in vitro fertilization. Fertil Steril. 2003;79(6):1317–1322.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Assisted Reproductive Technology (ART) Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University Hospitals, Ain Shams University Maternity Hospital, Ramses Street (Ahmed Lotfy Elsayed Street), Abbassia, Cairo, 11566, Egypt

    Ahmed M. Bahaa Eldin MD, Karim H. Abdelmaabud MD, Ahmed A. Tharwat MD, Tarek R. Aly MD, Ahmed E. Elbohoty MD & Azza A. Abdelrazik

  2. Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Mohamed Laban MD, Alaa S. Hassanin MD, Helmy M. Elsayed MD, Ahmed M. Ibrahim MD, Mohammed E. Ibrahim MD, Haitham M. Sabaa MD & Ibrahim Abdelhady

Authors
  1. Ahmed M. Bahaa Eldin MD
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  2. Karim H. Abdelmaabud MD
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  3. Mohamed Laban MD
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  4. Alaa S. Hassanin MD
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  5. Ahmed A. Tharwat MD
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  6. Tarek R. Aly MD
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  7. Ahmed E. Elbohoty MD
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  8. Helmy M. Elsayed MD
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  9. Ahmed M. Ibrahim MD
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  10. Mohammed E. Ibrahim MD
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  11. Haitham M. Sabaa MD
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  12. Azza A. Abdelrazik
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  13. Ibrahim Abdelhady
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Corresponding author

Correspondence to Ahmed M. Bahaa Eldin MD.

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Bahaa Eldin, A.M., Abdelmaabud, K.H., Laban, M. et al. Endometrial Injury May Increase the Pregnancy Rate in Patients Undergoing Intrauterine Insemination: An Interventional Randomized Clinical Trial. Reprod. Sci. 23, 1326–1331 (2016). https://doi.org/10.1177/1933719116638191

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