Improving reproductive outcomes of intrauterine insemination: Does endometrial scratch injury help? A randomised controlled trial
| Autor: | Pratibha Singh, Navdeep Kaur Ghuman, Sunil Raikar, Garima Yadav, Meenakshi Gothwal |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Pregnancy Rate medicine.medical_treatment Clinical pregnancy Fertilization in Vitro Insemination law.invention Miscarriage 03 medical and health sciences Endometrium 0302 clinical medicine Randomized controlled trial Ovulation Induction law Pregnancy Follicular phase medicine Humans 030212 general & internal medicine Prospective Studies Insemination Artificial 030219 obstetrics & reproductive medicine Obstetrics business.industry Obstetrics and Gynecology medicine.disease Reproductive Medicine Endometrial scratch Relative risk Ovulation induction Female business |
| Zdroj: | European journal of obstetrics, gynecology, and reproductive biology. 253 |
| ISSN: | 1872-7654 |
| Popis: | Objective(s) Current evidence suggests that endometrial injury improves clinical pregnancy rate while having no effect on miscarriages in women undergoing IVF/ICSI. However, there is no substantial evidence to advocate the use of endometrial injury to benefit the outcomes of IUI treatment. Additionally, there is no clear consensus about the ideal timing, underlying mechanism and optimum intensity of endometrial injury required. The study examines the effect of intentional endometrial injury/scratch in the early proliferative phase of stimulated cycle on reproductive outcomes (clinical and ongoing pregnancy rates and miscarriage occurrence) of intra-uterine insemination treatment (IUI). Study design, size, duration This prospective, randomized control interventional study was conducted in a tertiary level teaching institution from April 2018 to February 2020. 150 eligible couples requiring IUI treatment who agreed to participate were randomly allocated on 1:1 basis to either control or intervention group. The trial participants received up to 3 cycles ovulation induction with clomiphene citrate and intra-uterine insemination. In addition, women in intervention group were subjected to endometrial scratch injury on day 6-7 of their stimulated cycle. 154 cycles in control arm and 128 cycles in intervention group were analyzed for clinical pregnancy, miscarriages and pain experienced by the women during endometrial scratch injury using the statistical package SPSS (version 21). Result Similar cumulative clinical pregnancy rates (12.5% Vs 13.6%, RR 1.21, 95% CI 0.44-3.37, p = 0.713), biochemical pregnancy rates (17.1% vs 22.9%, RR 1.43, CI 0.59-3.47, p = 0.421) and ongoing pregnancy rates (10.93% Vs 11.47%, RR 1.05, CI 0.35-3.21, p = 924) were observed in control and intervention arms. Likewise, the relative risk of miscarriage occurrence in the intervention arm was 1.32 (95% CI 0.39-4.32, p = 1.000) which was not statistically different from control group. Mean pain score of 6.93 on numerical pain rating scale was experienced by women whilst having endometrial scratch injury. Conclusions There is insufficient evidence to defend the use of endometrial scratch injury in intra-uterine insemination treatment, as it is moderately painful and have uncertain beneficial influence on reproductive outcomes. |
| Databáze: | OpenAIRE |
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