The role of Induced Endometrial Scratching by Using Hystroscope on Changing the Pregnancy Rate in Couples with Unexplained Infertility

Abstract

The objective of this randomized controlled trial was to test the effect of endometrial injury on pregnancy rate on day (21-26) of spontaneous menestual cycle in women with unexplained infertility aged between 20-35 years. An endometrial biopsy induced injury could produce a local inflammatory reactions and angiogenic environment between the endometrium and the conceptus which, in turn, facilitates embryo implantation and subsequent pregnancy in earlier studies. The study was conducted at the infertility out-patient clinic of Ain Shams University Maternity Hospital during the period from October 2013 to October 2014. In this randomized controlled study, 245 subjects were enrolled in the trial and 212patients were completed the study, they divided into 3 groups hystroscopic, sound and control group: Group (A) (hystroscopic group) consists of 75 patients received endometrial injury on day 21-26 by the hystroscope. Group (B) (sound group) consists of 75 patients without endometrial injury by introduction of sound only on day 21-26.  93 Group (C) (control group) consists of 75 patients without any intervention. All patients from the two groups (A & B) were received combiened oral contraceptive pills that contain norgestimate 0.25mg, ethinyl oestradiol 0.35mg (Cilest®, Janssen,Cairo, Egypt) at the third day of the same cycle of intervention for twenty one days and were followed for six months for incidence of pregnancy. In group (A) a single induced endometrial injury at the luteal phase on day (21-26) of the cycle was done by using the hystroscope. In group (B) the uterine sound was introduced into the uterine cavity without endometrial injury at the same time in group (C) patients had no any intervention and were followed for six months Couples were advised to practice sexual intercourse according to their convenience for the next 6 months. As regarding the demographic data of the patients in the present study, there were no statistical significant differences between women in the interventional group (hystroscope & sound) and control group as regard the mean age, BMI, duration of infertility, FSH, LH, E2 and incidence of pregnancy (P>0.05), also no demographic differences between women who got pregnant in the hystroscopic, sound and control group except regarding the mean age and the duration of the infertility (P< 0.05).