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. 2020 Sep 17;19(4):334-349.
doi: 10.1002/rmb2.12348. eCollection 2020 Oct.

The impact of endometrial injury on reproductive outcomes: results of an updated meta-analysis

Chen Nahshon  1 , Lena Sagi-Dain  1 , Martha Dirnfeld  1
Affiliations

The impact of endometrial injury on reproductive outcomes: results of an updated meta-analysis

Chen Nahshon et al. Reprod Med Biol. .

Abstract

Background: It is still unclear whether endometrial injury (EI) has a beneficial effect on reproductive outcomes, and if so, the optimal procedure characteristics are not clear. All previous papers concluded that more research is needed, and as additional studies were recently published, the insights on EI have changed significantly.

Methods: Searches were conducted in MEDLINE, Embase, Web of Science, and Cochrane Library, to identify randomized controlled trials examining the EI effect on IVF outcomes in women at least one previous failed cycle.

Results: 2015 references were identified through database searching. Ultimately, 17 studies were included, involving 3016 patients. Clinical pregnancy rate (CPR) (RR = 1.19, [95% CI 1.06-1.32], P = .003) and live birth rate (LBR) (RR = 1.18, [95%CI 1.04-1.34], P = .009) were significantly improved after EI. Number of previous failed cycles, maternal age, and hysteroscopy were found to be relevant confounders. Higher CPR and LBR were found when EI was performed twice, while performing EI once did not significantly improve reproductive rates.

Conclusion: According to the present meta-analysis, EI may be offered to younger patients with few previous failed cycles and should be additionally studied in an RCT comparing different timing and more than one EI before treatment.

Keywords: endometrial biopsy; endometrial injury; endometrial scratching; repeated implantation failure; reproductive outcomes.

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Conflict of interest statement

Chen Nahshon, Lena Sagi‐Dain and Martha Dirnfeld declare that they have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of database searching
FIGURE 2
FIGURE 2
Risk of bias assessment
FIGURE 3
FIGURE 3
Clinical pregnancy rate—Forest plots. A, Clinical pregnancy rate, B, Clinical pregnancy rate—at least two previous failed cycles, C, Clinical pregnancy rate—age ≤ 30 years old, D, Clinical pregnancy rate—age > 30 years old, E, Clinical pregnancy rate—studies without hysteroscopy
FIGURE 4
FIGURE 4
Subgroup analysis by the number of times of Endometrial injuries—Forest plots. A, Clinical pregnancy rate—once. B, Clinical pregnancy rate—twice. C, Live birth rate—once. D, Live birth rate—twice
FIGURE 5
FIGURE 5
Live birth rate—Forest plots. A, Live birth rate. B, Live birth rate—at least two previous failed cycles. C, Live birth rate—age ≤ 30 years old. D, Live birth rate—age > 30 years old. E, Live birth rate—studies without hysteroscopy
FIGURE 6
FIGURE 6
Miscarriage rate—Forest plot
FIGURE 7
FIGURE 7
Multiple pregnancy rate—Forest plot
See this image and copyright information in PMC

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