The Role of Endometrial Scratching to Improve the Pregnancy Rate Among Infertile Couples

Background: Different technologies have been used in order to improve the endometrial condition as well as the quality of embryos; however, still the implantation process could fail. Endometrial Scratching (ES) has been proposed by many studies and revealed conflicting results. Objective: The study Aims to investigate the effect of ES on improving the Clinical Pregnancy Rate (CPR) and Live Birth Rate (LBR). Methodology: This is a retrospective study was carried out at Libyan National Fertility Centre. 188 Infertile women were included in the study in two different groups. 95 patients who underwent ES and 93 as control group. Cases with male factor infertility, history of surgical sterilization, premature ovarian failure, endometriosis and other hormonal disturbance (thyroid /prolactin) had been excluded from the study. Results: The CPR was positively affected by scratching procedure among infertile women after perform ES (p value 0.022). The secondary infertile patients have got significant benefit after performing ES by improving the CPR (P value 0.045). The ES has improved the CPR on patients with previous history of failed Intra-Cytoplasmic Semen Injection ICSI (P value 0.043). However, there was no statistically significant difference to the effect of ES on LBR. Conclusion: The study found that the ES has a positive role to improve the implantation among specific group of infertile couples. It is recommended to perform ES for couples with secondary infertility and previously failed ICSI cycle.

Intentional endometrial injury enhances angiogenesis through increased production and activation of MMP-9 by TNF-α and MMP-3 in a mouse model

There have been reports of improved pregnancy rates after performing intentional endometrial injuries, also known as endometrial scratching, in patients with recurrent implantation failure. In our previous study on intentional endometrial injury, we found an increased expression of matrix metalloproteinase (MMP)-3 following induced injuries to the mice endometrium. In the current study, we further examine whether the rise in MMP-3 could contribute to increased angiogenesis. Female C57B1/6 mice were obtained at 12 weeks of age, and intentional endometrial injuries were induced mechanically in the left uterine horns. Using the appropriate media, uterine-washes were performed on the injured and uninjured (control) horns of the harvested uteri. The uterine tissues were further processed for tissue lysates, histopathology and immunohistochemistry. The results show that intentional endometrial injuries caused an increase in secreted LPA in the injured horns, which were detected in the uterine-washes. In addition, LPA induced increased production of TNF-α in human endometrial epithelial cells (hEEpCs). Furthermore, TNF-α appeared to induce differential and cell-specific upregulation of the MMPs: MMP-3 was upregulated in the epithelial (hEEpCs), while MMP-9 was upregulated in the endothelial cells (human endometrial endothelial cells; hEEnCs). The upregulation of MMP-3 appeared to be necessary for the activation of MMP-9, whose active form stimulated the formation of vessel-like structure by the hEEnCs. The results of this study suggest that there may be enhanced angiogenesis following intentional endometrial injuries, which is mediated in part by TNF-α-induced and MMP-3-activated MMP-9 production.

TO ANALYSE THE EFFECT OF ENDOMETRIAL SCRATCHING ON PREGNANCY RATES IN PREVIOUSLY FAILED IUI CYCLES

Background: To analyse the effect of endometrial scratching on pregnancy rates in previously failed IUI cycles Methods: Randomized control study conducted on Couples attending the Infertility Clinic, Obstetrics & Gynaecology Department, SMS Medical College, Jaipur and requiring repeat IUI were recruited for the study from Feb 2019 to November 2020. Results: women in which IUI failed two times positive results after scratching was present in 16.15% cases followed by 6.92% positive results in women who had three times IUI failed and women who had only one-time IUI failed positive results was present in 4.62% cases. In controls we found positive results with 5.38% in women having one-time IUI failed followed by 3.85% in women where two time IUI failed and only in 2.31% women positive results found having three time IUI failed. Conclusion: In conclusion this study demonstrates 2.5-3 fold increase in pregnancy rates after scratch, endometrial scratching can be a preferred option in patients with previous failed IUI cycles before opting for expensive IVF treatment. Keywords: IUI, IVF, Inferetility