Evaluation of endometrial scratching on intrauterine insemination outcome and endometrial receptivity

Abstract

Objective: Evaluation of endometrial scratching on pregnancy rates after IUI and comparing levels and distribution of IL-6 (inflammatory molecule) and E-Cadherin (adhesion molecule) by immunohistochemistry. Study design: Randomized case control study. Setting: Tertiary care hospital of Delhi, India. Material and methods: 240 women (120 in each group) with previous failed IUI cycles were enrolled. Study group patients were subjected to endometrial scratch by “Pipelle” on postovulatory day 6–8 in the preceding cycle. IUI was performed after controlled ovarian stimulation with gonadotropins. 20 patients of study group in whom IUI was cancelled underwent repeat scratch on postovulatory day 6–8. Levels and distribution of IL-6 and E-Cadherin were evaluated by Immunohistochemistry before and after the scratch. Main outcome: Comparison of pregnancy rates in women undergoing IUI after endometrial scratching with women undergoing IUI alone. Results and conclusion: There were 19 (19%) clinical pregnancies in the study group and 8 (7.6%) in the control group. There was a significant difference in between both the groups (p = 0.022). Number of pregnancies in unexplained infertility patients was 22.66% in study and 9.5% in control group (p = 0.0291). There was significant increase in score for IL-6 and E-Cadherin in both glands and stroma after scratching. Endometrial scratch is a simple, practical, cost effective and outpatient procedure which may increase pregnancy rates in previous failed IUI cycles. Increased intensity of staining; shift of major part of staining from gland or stroma in pre scratch samples to both glands and stroma in post scratch samples; and increased stromal decidualization point towards increased endometrial receptivity. Keywords: Endometrial scratching, IUI, Pregnancy rates, IL-6, E-Cadherin