Effect of endometrial scratching in luteal phase versus follicular phase on iui outcome

Background and Aim : Blastocyst implantation in uterine endometrium is a dynamic process under theinfluence of hormonal factors and endometrial tissue features . The endometrium has the ability to acceptblastocyst over a period of time, which is referred to as the implantation interval. During this period, theuterus is under the influence of immune cells, cytokines, growth hormones and chemokines to acceptblastocyst. One of the ways to increase implantation success rate is to cause endometrial physical injured.Following endometrial uterine injury, inflammatory cytokines are released into the tissue and commencerepairing process and increase the capacity for uterine endometrial implantation. In addition, endometrialinjury induces decidualization, which protects the implantation. In Assisted Reproductive Techniques(ART), due to the use of ovulation induction hormones, the rate of implantation has been reduced, whichtheoretically using endometrial uterine injury can improve the rate of implantation in these techniques.Previous studies have shown that endometrial injury in vitro fertilization (IVF) increases the rate ofimplantation, pregnancy and live birth in infertile women. Due to different endometrial characteristics intwo luteal and follicular phases, the results of endometrial injury are different in these two phases. Previousstudies of uterine injury have been conducted in a single phase and few studies have compared the resultsof these two phases (6). Considering the lack of previous studies in this regard, the main aim of this studywas to compare the effect of endometrial scratching on Intrauterine insemination(IUI) success in twofollicular and luteal phases in infertile women treated with IUI.Methods : The present study was a double-blind randomized clinical trial study performed on 75 patientsin Isfahan s Shahid Beheshti Hospital between 2018 and 2019.The target population of the study is womenwith primary or secondary infertility without a specific cause or women who have mild infertility husbandsand who are candidates for controlled ovarian stimulation(COS)+IUI induction.Results : Mean age, BMI and infertility duration of the patients were 31.43 ± 3.60 years, 23.43 ± 2.89 and41.4 ± 1.61 years, respectively, and the fertility type was 52% of the secondary and 48% of the primary.The results showed that the three groups did not differ significantly in terms of age, BMI, duration ofmenopause and fertility type (P-value <0.05).Numerical indices of basal levels of FSH, LH, TSH, PRLwere reported in Table 3 and the results showed that there was no significant difference between the threegroups (P <0.05).The results of Chi-square test were of significant difference between the variable CPR (PValue=0.001), CR (P-Value=0.003) and OP (P-Value=0.006) in the three groups, which resulted in thehighest percentage of positive initial clinical pregnancy rate (CPR) (52%), CR (56%) and OP (52%) infollicular group. Fisher s exact test did not show a significant difference between the three groups in termsof Abortion and EP (P-value > 0.05)Conclusion : The results of this study showed that uterine scratching in both luteal and follicular phasesresulted in increased IUI success, but this was more effective in follicular phase.

کلیدواژه ها:

Blastocyst implantation ، endometrium ، Chi-square test