Effectiveness of Endometrial Scratch in Enhancement of Endometrial Receptivity Marker and Pregnancy Outcome in Intra Cytoplasmic Sperm Injection Cycles

The goal of our trial was to determine whether endometrial injury in luteal phase of the preceding cycle to IVF cycles would improve pregnancy rates through its effect on vascular endothelial growth factor level and endometrial thickness. This prospective study was undertaken in the Higher Institute of Infertility diagnosis and Assisted Reproductive Techniques/Al-Nahrain University. All women had undergone Intra Cytoplasmic Sperm Injection cycles. Endometrial scratching had been done for the females in the intervention group with a pipelle catheter in luteal phase prior to ICSI cycle. Blood sample was taken before scratch. All patients undergo controlled ovarian hyper stimulation, oocyte retrieval and embryo transfer. At this day, another blood sample was taken for the measurement of the level of VEGF and ultrasound used to measure endometrial thickness. Two weeks later clinical pregnancy rate were evaluated after luteal support. The patients in scratch group had higher pregnancy rate (14/23) 60.9% than non-scratched group (11/33) 33.3% although not significant (p value 0.057). Also these tests revealed that there were significant differences in vascular endothelial growth factor level P value (>0.00) in scratch group which is higher than before the procedure (279.86±126.0, 134.55±64.07). Furthermore, the VEGF level in scratch group (279.86±126.0) is significantly higher than control group (208.35±72.25) as p value was (0.020). The endometrial thickness of the scratch group (1.0±0.13) was significantly higher than non-scratched (0.92±0.12) as p value (0.03). It is safe and simple to use endometrial injury induced by pipelle biopsy as an outpatient procedure which is associated with significant improvement in implantation, by providing a favorable environment which enhance endometrium and sub endometrium vascularization of the uterus. Also it improves endometrial thickness.