The Effect of Day 6 Endometrial Injury of the Same ICSI Cycle on the Pregnancy Rate (Randomized Controlled Trial)

Abstract

Among the various potential causes of implantation failure, uterine factors (e.g., thin endometrium, poor endometrial receptivity, and immunologicalincompatibility)have received the most attention in recent years. Management of repeated implantation failure despite transfer of good-quality embryos still remains a dilemma for ART specialists. Scrapping of endometrium in the same ICSI cycle has been shown to improve the pregnancy rate in recent studies. It has been shown that endometrial receptivity could be modulated by a multitude of signaling molecules, including prostaglandins, growth factors, cytokines, chemokines, integrins, leukemia inhibitory factor, and E-cadherin. Whereas dysregulation of some of these factors could be associated with repeated implantation failure, key molecular mechanisms that underlie the regulation of endometrial receptivity remain to be elucidated. This hypothesis has been supported--directly or indirectly-in a number of clinical settings. An endometrial biopsy-induced injury could produce just such a local inflammatory and angiogenic environment between the endometrium and the conceptus, which, in turn, facilitates embryo implantation and subsequent pregnancy in earlier studies. However, due to substantial variations in patient selection, timing, number and extent of endometrial injury applied, and techniques in earlier studies, the merits of endometrial biopsy injury on clinical outcomes in IVF clinics remain controversial.