Bio-psychological Medicine - BJSTR Journal

Abstract

#Implantation is the rate limiting step for success during In Vitro Fertilization (IVF). Lot of advances have been done for improving the success rate in IVF, like use of #Preimplantation GenetingScreening (PGS) for ensuring euploid embryo transfers besides freeze all cycles for improving embryo-endometrial synchrony, still for fresh cycles implantation remains a question mark. Endometrial Scratching (ES) or endometrial injury, trauma or biopsy is a fast phenomenon i.e minimally invasive outdoor procedure that causes minimal discomfort. Hysteroscopy can be used to perform it or one can use a lot of soft and rigid endometrial biopsy devices. Since it is commonly performed in the luteal phase, disruption of any early pregnancy is the only big risk associated with this method. Mechanism of action for increasing endometrial receptivity with ES are i) it facilitates endometrial #decidualization ii) Because of injury there is healing which=>activation of an immune response, with cytokines, interleukins, growth factors, macrophages and natural killer cells iii) It causes slowing of endometrial maturation to improve synchrony [1]. Though these hypothesis remain untested till date some reasoning is given regarding how ES benefits.In 2015 there was a Cochrane analysis done on 14 Randomized Control Trials (RCT’s) which had 2128 IVF patients and it was concluded that ES done in the preceding #luteal phase or early follicular phase of a fresh cycle improved the clinical pregnancy rates significantly (relative risk 1.34, 95% CI-1.21-1.61; P=0.02) in 13 studies [1]. In the only study where ES was done on the day of retrieval was stopped early as it showed a marked reduction in pregnancy rates. However, the results might have been secondary to greater degree of endometrial injury caused by a novak curette. In toto many studies had a high risk of bias along with no uniformity in terms of patient selection, stimulation protocol along with timing of ES, and thus effectivity of ES was just based on moderate evidence.

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Potential Role of Endometrial Scratching in Improving Pregnancy Rates Following Intra Uterine Insemination - A Short Commentary by Kulvinder Kochar Kaur in BJSTR