Objective: To examine the timing of endometrial scratch in a patient’, s menstrual cycle and whether there is an association with subsequent implantation. Materials and methods: This study is a retrospective chart review on women, aged 18-45, seen in a reproductive endocrine clinic seeking conception. Timing of endometrial scratch was defined as proliferative (cycle day 1-9), periovulatory (CD11-16), or secretory (CD19+). All periovulatory biopsies were performed at time of oocyte retrieval in women freezing all oocytes/embryos for future use. Primary outcome of interest was positive beta-hCG within ninety days of the endometrial scratch. Results: Sixty-nine cases of endometrial scratch met the inclusion criteria. There were no statistically significant differences in baseline demographic characteristics between those who received endometrial injury in the three phases. There was no significant difference in frequency of positive beta-hCG within 90 days of endometrial scratch between the patients who received an endometrial scratch in the three phases (proliferative 65. 6%, periovulatory 69. 6%, secretory 64. 3%,p = 0. 9332). Conclusion: In contrast to prior studies which showed up to 65% decrease in implantation rate after endometrial scratch performed at time of oocyte retrieval, this study shows no significant difference in implantation when the injury is performed at the time of oocyte retrieval as compared to other phases of the menstrual cycle. Possible explanation may be that we did not perform a scratch if fresh embryo transfer was planned. As endometrial injury is associated with patient discomfort, performing the scratch while under conscious sedation for oocyte retrieval may be desirable in cycles where fresh embryo transfer is not planned. Future studies are needed to assess the validity of these findings.

Background: Unexplained infertility is still a challenging issue as to its causes, appropriate management and treatment. Evidence implicates early embryopathy or implantation failure as likely causes.Objective: This study aims to investigate the effect of local endometrial injury on pregnancy rate in selected unexplained infertile patients.Materials and Methods: This was a randomized clinical trial conducted in Shiraz University Infertility Clinic of Ghadir Hospital. A total of 217 women with unexplained infertility aged 23-35 years old were randomly divided into two study groups through block randomization. After superovulation by clomiphene-citrate and gonadotropins and when the dominant follicles reached 18-20 mm, patients were randomly assigned to undergo endometrial local injury at posterior uterine wall by piplle endometrial sampling (n=114) or mock pipette biopsy (n=103) during pre-ovulatory days (when spontaneous urinary LH surge was detected). Then all the patients were instructed to follow a regularly timed intercourse.Results: The pregnancy rate was significantly higher in the endometrial injury group compared to the control group [17.114 (14.9%) vs. 6.103 (5.8%) (OR: 2.83 95% CI: 1.07-7.49, p=0.03]. The abortion rate was comparable between two groups (17.64% vs. 14.28%; p=0.701).Conclusion: Local mechanical injury of the endometrium can enhance the uterine receptivity and facilitates the embryo implantation. This simple, easy, and cost effective procedure is worth considering in selective unexplained infertility patients who implantation failure is the likely causes of infertility before complex treatments. This procedure may help reduce psychological tensions and high expenses imposed through such interventions.

Background: Implantation is considered as the rate-limiting step in success of assisted reproduction techniques, and intrauterine insemination cycles. It might be affected by ovarian superovulation and endometrial local scratching.Objective: This study aims to investigate the effect of local endometrial injury on the outcome of IUI cycles.Materials and Methods: In this randomized clinical trial 144 women with unexplained infertility, mild male factor, and mild endometriosis randomly divided into two study groups through block randomization. The patients were randomly assigned to undergo endometrial biopsy between days 6-8 of the previous menstrual cycle before IUI (n=72, IUI cycles =126) or receive no interventions (n=72, IUI cycles=105).Results: The pregnancy rate per patient was 17 (23.6%) and 14 (19.4%) in endometrial biopsy and control groups, respectively (p=0.686). The pregnancy rate per cycle was 17/126 (13.5%) and 14/105 (13.3%) in endometrial biopsy and control groups, respectively (p=0.389). The abortion rate was comparable between the two groups (6.9% vs. 9.7%; p=0.764). The ongoing pregnancy rate was found to be comparable between the two study groups, as well (16.7% vs. 9.7%; p=0.325). Endometrial thickness (p=0.609) was comparable between the groups; however E2 was significantly lower in the endometrial biopsy group (p<0.001). Conclusion: Application of local endometrial injury in the cycle before the IUI cycles is not associated with increased pregnancy rate per patient and per cycle, decreased abortion, and increased endometrial thickness.

Background: Implantation remains a limiting step in IVF/ICSI. Endometrial injury isa promising procedure aiming at improving the implantation and pregnancy rates after IVF/ICSI.Objective: The aim of this study was to evaluate the effect of endometrial injury induced in precedingcycle on IVF/ICSI outcome.Materials and Methods: Four hundred patients undergoing their first IVF/ICSI cycle in two IVF units in Minia, Egypt were randomly selected to undergo either endometrial injury in luteal phase of preceding cycle (intervention group) or no treatment (control group). Primary outcome was the implantation and live birth rates While the secondary outcome was clinical pregnancy, miscarriage, multiple pregnancy rates, pain and bleeding during and after procedure.Results: Implantation and live birth rates were significantly higher in intervention compared with control group (22.4% vs.18.7%, p=0.02 and 67% vs.28%, p=0.03), respectively. There was also a significant reduction in miscarriage rate in intervention group (4.8% vs.19.7%, respectively, p<0.001).Conclusion: Endometrial injury in preceding cycle improves the implantation rate and live birth rate and reduces the miscarriage rate per clinical pregnancy in patients undergoing their first IVF/ICSI cycle.