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

Endometrial scratch injury may improve clinical pregnancy rates and ongoing pregnancy rates in intrauterine insemination stimulated cycles without increasing the risk of multiple pregnancy, ectopic pregnancy, or miscarriage.

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Volume 109, Issue 1, Pages 84–96.e4

Authors:

Amerigo Vitagliano, M.D., Marco Noventa, M.D., Gabriele Saccone, M.D., Salvatore Gizzo, M.D., Salvatore Giovannni Vitale, M.D., Antonio Simone Laganà, M.D., Pietro Salvatore Litta, M.D., Carlo Saccardi, M.D., Giovanni Battista Nardelli, M.D., Attilio Di Spiezio Sardo, M.D.

Abstract:

Objective

To assess the impact of endometrial scratch injury (ESI) on the outcomes of intrauterine insemination (IUI) stimulated cycles.

Design

Systematic review and meta-analysis.

Setting

Not applicable.

Patient(s)

Infertile women undergoing one or more IUI stimulated cycles.

Intervention(s)

Randomized controlled trials (RCTs) were identified by searching electronic databases. We included RCTs comparing ESI (i.e., intervention group) during the course of IUI stimulated cycle (C-ESI) or during the menstrual cycle preceding IUI treatment (P-ESI) with controls (no endometrial scratch). The summary measures were reported as odds ratio (OR) with 95% confidence-interval (CI).

Main Outcome Measure(s)

Clinical pregnancy rate, ongoing pregnancy rate, multiple pregnancy rate, ectopic pregnancy rate, miscarriage rate.

Result(s)

Eight trials were included in the meta-analysis, comprising a total of 1,871 IUI cycles. Endometrial scratch injury was associated with a higher clinical pregnancy rate (OR 2.27) and ongoing pregnancy rate (OR 2.04) in comparison with the controls. No higher risk of multiple pregnancy (OR 1.09), miscarriage (OR 0.80), or ectopic pregnancy (OR 0.82) was observed in patients receiving ESI. Subgroup analysis based on ESI timing showed higher clinical pregnancy rate (OR 2.57) and ongoing pregnancy rate (OR 2.27) in patients receiving C-ESI and no advantage in patients receiving P-ESI.

Conclusion(s)

Available data suggest that ESI performed once, preferably during the follicular phase of the same cycle of IUI with flexible aspiration catheters, may improve clinical pregnancy and ongoing pregnancy rates in IUI cycles. Endometrial scratch injury does not appear to increase the risk of multiple pregnancy, miscarriage, or ectopic pregnancy.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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