Role of Endometrial Scratch in Enhancing Pregnancy Rate of ICSI Cycle Through Its Effect on TNF-α


AbstractBackground:The overall success rate of assisted reproductive techniques is onlyabout 30% due to certain limiting factors. Endometrial scratching could induceinflammatory response which manifested by the up-regulation of different cytokinesand chemokines with subsequent accumulation of immune cells in the injuredsite. One of the most important cytokine in this regard is TNF-α which wasfound to induce tissue remodeling by stimulating the production of many otherpro-inflammatory cytokines.Objectives:To investigate the role of endometrial injury during the luteal phasebefore ICSI cycles in the enhancement of pregnancy outcomes.Materials and Methods:This prospective study was undertaken in the High Instituteof Infertility diagnosis and Assisted Reproductive Techniques / Al-NahrainUniversity. All women were undergone ICSI cycles. Women in the intervensiongroup underwent endometrial scratching with a Pipelle catheter in luteal phasepreceding cycle. Blood sample was taken before scratch. All patients undergocontrolled ovarian hyperstimulation, oocyte retrieval and embryo transfer, anotherblood sample was taken at day of embryo transfer to measure level of TNF-α.Clinical pregnancy rate then evaluation after luteal support of two weeks.Results:The patients in scratch group has higher pregnancy rate (14/23) 60.9%than non intervention group (11/33) 33.3% although not significant (p value0.057).The results showed that the TNF-α after scratch (54.53±10.2) was significantlyhigher than before scratch (39.26±14.74) in the same group, as p value was( <0.001). In addition the TNF-α was significantly higher in scratch group(54.53±10.2) than control (25.91±9.08) as p value was (< 0.001) .Conclusion:Induced endometrial local injury is an easy, simple and cost-effectivetechnique that can be used to improve the uterine receptivity and enhanceembryo transplantation.