Endometrial injury in women undergoing assisted reproductive techniques

Nastri, Carolina O, Lensen, Sarah F, Gibreel, Ahmed, Raine-Fenning, Nick, Ferriani, Rui A, Bhattacharya, Siladitya ORCID: https://orcid.org/0000-0002-4588-356X and Martins, Wellington P 2015. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Library (3) , CD009517. 10.1002/14651858.CD009517.pub3

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Abstract

Review question To assess the safety and efficacy of performing an endometrial injury (such as endometrial biopsy) on reproductive outcomes in women undergoing ART. Background Couples who have trouble getting pregnant may seek fertility treatments to help them conceive. These treatments are known as assisted reproductive techniques (ART), such as in vitro fertilisation (IVF). In ART, eggs are collected from the woman and are combined with semen in the laboratory to create embryos. Embryos are transferred back into the womb in the hope that they will establish a pregnancy. Implantation is the process by which an embryo is embedded in the lining of the womb; it is the first step toward establishing a successful pregnancy. It has been suggested that the chances of implantation are increased by intentional endometrial scratching, such as by endometrial biopsy or curettage, before replacement of the embryo. Study characteristics Cochrane authors included 14 clinical trials (2128 women) evaluating the effects of endometrial injury on outcomes of ART. Thirteen of these trials studied endometrial injury during the menstrual cycle before embryo transfer. One trial studied endometrial injury on the day of oocyte retrieval, which is just a few days before the day the embryo is transferred into the womb. Whether participants had undergone previous embryo transfers varied among the included studies. The evidence is current to January 2015. Key results The included studies suggest that endometrial injury performed sometime during the month before the start of ovarian stimulation as part of ART improves the chances that a woman will achieve live birth and clinical pregnancy. Moderate‐quality evidence suggests that if 26% of women achieve live birth without endometrial injury, between 28% and 48% will achieve live birth with this intervention. Contrary to this, endometrial injury performed on the day the eggs are picked up reduces the chances of pregnancy. We are still uncertain about the effect of endometrial injury on adverse events such as miscarriage, multiple pregnancy or vaginal bleeding. However, the endometrial injury procedure does appear to cause some pain, although this is short lived. Quality of the evidence Evidence that endometrial injury performed in the cycle before ART increases the probability of live birth and clinical pregnancy is of moderate quality. For all other outcomes the evidence is of low or very low quality. The quality of the evidence is reduced because insufficient participants were included in the studies, and because a large proportion of the included studies have important limitations in the methods that they used.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Wiley: 12 months - No Online Open
ISSN:	1465-1858
Date of First Compliant Deposit:	28 August 2018
Date of Acceptance:	22 March 2015
Last Modified:	24 Oct 2022 07:14
URI:	https://orca.cardiff.ac.uk/id/eprint/114426

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