Endometrial pipelle scratching may decrease abortion rates rather than increasing pregnancy rates in intrauterine insemination cycles

Abstract

To assess the efficacy of endometrial pipelle scratching (EPS) preceding in- trauterine insemination (IUI) cycles. A total of 348 patients with unexplained infertility were enrolled into the study. 117 women with EPS were compared with 231 women without EPS and IUI. Livebirth and pregnancy rates and abor- tion rates were the primary outcomes. There were no difference in age, duration of infertility, basal hormone and total gonadotropin dose used throughout the cycle and endometrial thickness. In terms of pregnancy outcomes, pregnancy and livebirth rates in EPS group were17.1% and 15.7% respectively, while preg- nancy and livebirth rates in Non EPS group were 23.8% and 16% respectively. Spontaneous abortion rate in EPS group was significantly lower than Non EPS group (1.7% vs. 7.8%) which was statistically significant (p = 0.021). EPS did not improve pregnancy and livebirth rates. However, abortion rates were signifi- cantly lower in EPS patients. EPS may not have any impact on the embryonic implantation but may improve the proper development of implanted embryos by modulating the local factors. 

Keywords

• Endometrial Pipelle Scratching,intrauterine insemination,live birth,abortion

References

1. ReferencesAshrafi M, Tehraninejad ES, Haghiri M, Masomi M, Sadatmahalleh SJ, Arabipoor A. The effect of endometrial scratch injury on pregnancy outcome in women with previous intrauterine insemination failure: A randomized clinical trial. J Obstet Gynaecol Res 2017.
2. Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization. Fertil Steril 2003; 79: 1317-1322.
3. Carlos Simon and Jose Bellver Scratching beneath ‘The Scratching Case’: Systematic reviews and metaanalyses, the back door for evidencebased medicine. Human Reproduction, 2014 Vol.29, No.8 pp. 1618–1621
4. Diedrich K, Fauser BC, Devroey P, Griesinger G; Evian Annual Reproduction (EVAR) Workshop Group. The role of the endometrium and embryo in human implantation.Hum Reprod Update. 2007 Jul-Aug; 13(4):365-77
5. Dan Levin, Joseph Hasson, Aviad Cohen, Yuval Or, Baris Ata, Lilia Barzilay & Benny Almog. The effect of endometrial injury on implantationand clinical pregnancy rates. Gynecol Endocrinol, 2017; 33(10): 779–782Finn CA, Martin L.Endocrine control of the timing of endometrial sensitivity to a decidual stimulus Biol Reprod 1972; 7: 82-86
6. Gnainsky Y, Granot I, Aldo PB, Barash A, Or Y, Schechtman E, et al. Local injury of the endometrium induces an inflammatory response that promotes successful implantation. Fertil Steril 2010; 94: 2030-2036
7. Goel T, Mahey R, Bhatla N, Kalaivani M, Pant S, Kriplani A. Pregnancy after endometrial scratching in infertile couples undergoing ovulation induction and intrauterine insemination cycles-a randomized controlled trial. J Assist Reprod Genet. 2017; 34(8):1051-1058.
8. Gupta M, R. Mahey, T, Goel, G. Kachhawa, A. Kriplani. To evaluate the pregnancy rate after endometrial scratching in couples with unexplained infertility inovulatıon induction and IUI cycles Fertility and Sterility 2015; p-689

9. Jacqui Wise .Endometrial Scratching improves IVF pregnancy rate.BMJ 2013: 347;6007
10. Jeffrey M. Goldberg M.D Endometrial scratching to increase pregnancy rates with intrauterine insemination.Fertility and Sterility Vol 109 No.1 January 2018 :2
11. Karimzade MA, Oskouian H, Ahmadi S, Oskouian L. Local injury to the endometrium on the day of oocyte retrieval has a negative impact on implantation in assisted reproductive cycles: a randomized controlled trial. Arch Gynecol Obstet 2010; 281: 499-503.
12. Kriplani A, Goel T, Mahey R, Garima K, Sharma JB, Bhatla N. Pregnancy Rate after Endometrıal Scratching ınCouples wıth Unexplained Infertility ın ovulation Induction and IUI Cycles- a Randomised controlled Trial.Fertility and Sterility 2016: 19; 588
13. Lensen S, Sadler L, and Farquhar C. Endometrial scratching for subfertility: everyone’s doing it. Hum Reprod 2016; 31:1241–4.
14. Lensen SF, Manders M, Nastri CO, Gibreel A, Martins WP, Templer GE, et al. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database Syst Rev 2016:CD011424.
15. Lensen S, Martins W , Carolina Nastri 2, Lynn Sadler1 and Cindy Farquhar. Pipelle for Pregnancy (PIP): study protocols for three randomised controlled trials Trials, 2016: 17:216
16. Luco SM, Agbo C, Behr B, Dahan MH The evaluation of pre and post processing semen analysis parameters at the time of intrauterine insemination in couples diagnosed with male factor infertility and pregnancy rates based on stimulation agent. A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2014 Aug; 179:159-62
17. Nastri CO, Lensen SF, Gibreel A, Raine-Fenning N, Ferriani RA, Bhattacharya S, et al. Endometrial injury in women undergoing assisted reproductive techniques.Cochrane Database Syst Rev 2015:CD009517.
18. Papillon-Smith J, Baker SE, Agbo C, Dahan MH. Pregnancy rates with intrauterine insemination: comparing 1999 and 2010 World Health Organization semen analysis norms. Reprod Biomed Online. 2015 Apr;30(4):392-400
19. Radhakrishnan G. Evaluatıon of endometrıal scratchıng on ıntrauterıne ınsemınatıon outcome and endometrial receptivity. Fertility and Sterility 2015: 20; P-184
20. Senocak G.C., O.E. Yapca, B. Borekci. Comparison of pregnancy rates between patients with and without local endometrial scratching before intrauterine insemination J Gynecol Obstet Hum Reprod 2017: 687–690
21. Vitagliano A, Noventa, M, Saccone G, and Gizzo S, Giovannni S.Endometrial scratch injury before intrauterine insemination: is it time to re-evaluate its value? Evidence from a systematic review and meta-analysis of randomized controlled trials. Fertility and Sterility 2018: 109; 1.
22. Veltman-Verhulst SM, Hughes E, Ayeleke RO, Cohlen BJ. Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev 2016:CD001838.
23. 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 Vol 2014, 12. No. 9. pp: 647-652
24. 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: 1166-1176