Pregnancy rate after endometrial injury in couples with unexplained infertility: A randomized clinical trial

Mohammad Ebrahim Parsanezhad, Nasrin Dadras, Najmeh Maharlouei, Leila Neghahban, Peghah Keramati, Madihe Amini, Mohammad Ebrahim Parsanezhad, Nasrin Dadras, Najmeh Maharlouei, Leila Neghahban, Peghah Keramati, Madihe Amini

Abstract

Background: Unexplained infertility is still a challenging issue as to its causes, appropriate management and treatment. Evidence implicates early embryopathy or implantation failure as likely causes.

Objective: This study aims to investigate the effect of local endometrial injury on pregnancy rate in selected unexplained infertile patients.

Materials and methods: This was a randomized clinical trial conducted in Shiraz University Infertility Clinic of Ghadir Hospital. A total of 217 women with unexplained infertility aged 23-35 years old were randomly divided into two study groups through block randomization. After superovulation by clomiphene-citrate and gonadotropins and when the dominant follicles reached 18-20 mm, patients were randomly assigned to undergo endometrial local injury at posterior uterine wall by piplle endometrial sampling (n=114) or mock pipette biopsy (n=103) during pre-ovulatory days (when spontaneous urinary LH surge was detected). Then all the patients were instructed to follow a regularly timed intercourse.

Results: The pregnancy rate was significantly higher in the endometrial injury group compared to the control group [17/114 (14.9%) vs. 6/103 (5.8%) (OR: 2.83 95% CI: 1.07-7.49, p=0.03]. The abortion rate was comparable between two groups (17.64% vs. 14.28%; p=0.701).

Conclusion: Local mechanical injury of the endometrium can enhance the uterine receptivity and facilitates the embryo implantation. This simple, easy, and cost effective procedure is worth considering in selective unexplained infertility patients who implantation failure is the likely causes of infertility before complex treatments. This procedure may help reduce psychological tensions and high expenses imposed through such interventions. Registration ID in IRCT: IRCT2012082510657N1.

Keywords: Endometrial injury; Female; Infertility; Pregnancy.

Figures

Figure 1
Figure 1
Consort statement flow diagram

References

    1. Gnoth C, Godehardt E, Frank-Herrmann P, Friol K, Tigges J, Freundl G. Definition and prevalence of subfertility and infertility. Hum Reprod. 2005;20:1144–1147.
    1. Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss. Fertil Steril . 2008;90:S60.
    1. Marc A, Fritz Speroff L. Clinical gynecologic endocrinology and infertility. 8th Ed. Lippincott Williams & Wilkins, , a Wolters Kluwer business; 2011.
    1. Crosignani PG, Collins J, Cooke ID, Diczfalusy E, Rubin B. Recommendations of the ESHRE workshop on 'Unexplained Infertility'. Hum Reprod. 1993;8:977–980.
    1. Macklon NS, Geraedts JP, Fauser BC. Conception to ongoing pregnancy: the 'black box' of early pregnancy loss. Hum Reprod Update . 2002;8:333–343.
    1. Finn CA, Martin L. Endocrine control of the timing of endometrial sensitivity to a decidual stimulus. Biol Reprod . 1972;7:82–86.
    1. 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.
    1. 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.
    1. 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.
    1. Collins JA, Burrows EA, Wilan AR. The prognosis for live birth among untreated infertile couples. Fertil Steril . 1995;64:22–28.
    1. Guzick DS, Sullivan MW, Adamson GD, Cedars MI, Falk RJ, Peterson EP, et al. Efficacy of treatment for unexplained infertility. Fertil Steril . 1998;70:207–213.
    1. Practice Committee of the American Society for Reproductive Medicine. Effectiveness and treatment for unexplained infertility. Fertil Steril . 2006;86 :S111–114.
    1. Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update . 2010;16:231–245.
    1. 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.
    1. Sherer DM, Abulafia O. Angiogenesis during implantation, and placental and early embryonic development. Placenta . 2001;22:1–13.
    1. Mirkin S, Nikas G, Hsiu JG, Diaz J, Oehninger S. Gene expression profiles and structural/functional features of the peri-implantation endometrium in natural and gonadotropin-stimulated cycles. J Clin Endocrinol Metab. 2004;89:5742–5752.
    1. Ray A, Shah A, Gudi A, Homburg R. Unexplained infertility: an update and review of practice. Reprod Biomed Online . 2012;24:591–602.
    1. Jonathan S, Berek B. Novak's Gynecology. 15th Ed. Lippincott Williams and Wilkins, a Wolters Kluwer business; 2012.
    1. Kosmas IP, Tatsioni A, Fatemi HM, Kolibianakis EM, Tournaye H, Devroey P. Human chorionic gonadotropin administration vs. luteinizing monitoring forintrauterine insemination timing, after administration of clomiphene citrate: a meta-analysis. Fertil Steril . 2007;87:607–612.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅