The effects of endometrial injury on intrauterine insemination outcome: A randomized clinical trial.

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.

Vagifem is superior to vaginal Premarin in induction of endometrial thickness in the frozen-thawed cycle patients with refractory endometria: A randomized clinical trial.

BACKGROUND: Embryo transfer to a developed endometrium is an important prognostic factor in frozen-thawed embryo transfer cycle outcome. Vaginal estrogen, such as Vagifem vaginal tablets and Premarin vaginal cream, is a regimen used for the patients with refractive endometria. OBJECTIVE: Our objective was to compare the effects of Vagifem and Premarin on the endometrial thickness of the patients with refractive endometria. MATERIALS AND METHODS: In this randomized clinical trial, 30 patients with refractive endometria in frozen-thawed embryo transfer cycles received Vagifem vaginal tablets and 30 women received Premarin vaginal cream. Endometrial thickness was measured on the 14th day of drug administration. RESULTS: Comparing the endometrial thicknesses of the two groups showed that the endometria of the Vagifem group was significantly thicker than that of the Premarin group (5.93±0.38 vs. 6.74±0.32; p<0.001). CONCLUSION: Vagifem is superior to Premarin in induction of endometrial thickness in frozen-thawed embryo transfer cycles in the patients with refractive endometria.

The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas.

OBJECTIVE: To evaluate the effects of laparoscopic cystectomy on ovarian reserve in patients with endometriomas. DESIGN: Prospective study. SETTING: Private and university hospitals. PATIENT(S): A total of 193 patients with endometriomas undergoing laparoscopic cyctectomy. INTERVENTION(S): Serum levels of antimüllerian hormone (AMH), FSH, and E2, as well as antral follicle count (AFC) were measured preoperatively and 1 week, 3 and 9 months postoperatively for AMH, and 3 months for other values. MAIN OUTCOME MEASURE(S): Ovarian reserve based on the comparison of AMH alterations. The secondary end points are changes in FSH, E2, and AFC. RESULT(S): Serum AMH level decreased significantly from the baseline (3.86 ± 3.58 ng/mL) to 1 week (1.66 ± 1.92 ng/mL), 3 months (2.06 ± 2.5 ng/mL), and 9 months (1.77 ± 1.76 ng/mL) postoperatively. Those patients with bilateral endometriomas had significantly lower levels of AMH, 1 week, 3 and 9 months after operation. Also, patients older than 38 years had lower postoperative AMH levels. The FSH levels increased significantly from baseline to 3 months postoperatively. The AFC level increased significantly from baseline to 3 months after operation. CONCLUSION(S): The AMH level decreased and the FSH level increased after laparoscopic cystectomy for endometriomas, especially in older patients and those with bilateral cysts.

Pregnancy rate after endometrial injury in couples with unexplained infertility: A randomized clinical trial.

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. Registration ID in IRCT: IRCT2012082510657N1.