COULD A SIMPLE ENDOMETRIAL SCRATCH BOOST THE ODDS OF EMBRYO IMPLANTATION IN WOMEN WITH PREVIOUS INTRAUTERINE INSEMINATION FAILURE?
Safaa Ibrahim Mahmoud
Department of Obstetrics and Gynecology Faculty of Medicine Cairo University
Background: Implantation is considered as the rate-limiting step in success of assisted reproductive technology, and intrauterine insemination cycles. A successful implantation mainly depends on two basic factors including embryo quality and endometrial receptivity Endometrial scratch injury (ESI) has been recently proposed to enhance the implantation rate in IUI cycles by improving endometrial receptivity. Objective: The objective of this study was: to evaluate the effect of endometrial scratch conducted in the follicular phase of the same stimulation cycle on improving the pregnancy rate in cases with previous two or more intrauterine insemination (IUI) failure Design: Prospective randomized control study. Materials And Methods: Women attending infertility clinic in a tertiary care center and who have two or more repeated intrauterine insemination (IUI) failure were included in the study in 1:1 allocation ratio. A total of 233 patients were recruited and randomly allocated into two groups: Group A study group (n = 113) underwent endometrial scratching on D4–D7 (follicular phase) of the same stimulation and IUI cycle, Group B control group (n = 120) no endometrial scratch done, and all the patients underwent ovarian stimulation according to standard protocol followed by IUI Main outcome measures: The primary outcome is clinical pregnancy rate (CPR). Secondary outcomes included multiple pregnancies, ectopic pregnancies and miscarriage rates. Results: Clinical pregnancy rate was 27 (23.9%) in Group A and 14 (11.6%) in Group B. There was a significant difference in the results between both the groups (p = 0.02). There was no reported cases of ectopic pregnancy in both groups. 1 patient in group A had twin pregnancy. There was no significant difference in miscarriage rate between pregnant women in both groups. Two patients had first trimester abortions in the study group while in the control group one had one first trimester abortion. Conclusion: Endometrial scratching is a cost-effective and easy technique which improves significantly the clinical pregnancy rates in previous IUI failure cycles, but more trials are needed to be conducted using larger sample size to confirm the improved and significant outcome.