Site-specific endometrial injury improves implantation and pregnancy in patients with repeated implantation failures
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RESEARCH
Open Access
Site-specific endometrial injury improves implantation and pregnancy in patients with repeated implantation failures Shang Yu Huang†, Chin-Jung Wang†, Yung-Kuei Soong, Hsin-Shih Wang, Mei Li Wang, Chieh Yu Lin and Chia Lin Chang*
Abstract Background: To test whether a site-specific hysteroscopic biopsy-induced injury in the endometrium during the controlled ovarian hyperstimulation cycle improves subsequent embryo implantation in patients with repeated implantation failure, a total of 30 patients who have had good responses to controlled ovulation stimulation but have failed to achieve pregnancy after two or more transfers of good-quality embryos were recruited in this prospective study. Methods: A single, site-specific hysteroscopic biopsy-induced injury was generated on the posterior endometrium at midline 10-15 mm from the fundus during the D4-D7 period of the ongoing controlled ovarian hyperstimulation cycle in six patients. Results: Patients received endometrial biopsy protocol achieved a pregnancy rate of 100%. By contrast, only 46% of patients with similar clinical characteristics (N = 24) achieved pregnancy without the hysteroscopic biopsyinduced endometrium injury (p < 0.05). Conclusions: Our proof-of-concept study demonstrates that a site-specific hysteroscopic endometrium injury performed during the ongoing in vitro fertilization (IVF) cycle, instead of injuries received during prior cycles, significantly improves clinical outcomes in patients with repeated implantation failure. Keywords: hysteroscopy, endometrium biopsy, IVF, repeated implantation failure, pregnancy
Background In assisted reproductive technology, procedures for culturing and transferring embryos have been continually improved over the last two decades. Yet the clinical pregnancy rate has not substantially improved over the last ten years (currently only 32.4~33.0% per IVF transfer as reported by ESHRE in 2010)[1], and many patients have suffered repeated implantation failure even in the most successful in vitro fertilization (IVF) clinics. Although no practical solutions for repeated implantation failure have emerged, an improved ability to control
* Correspondence: [email protected] † Contributed equally Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan
the endometrial environment for implantation promises to have a significant, positive impact on IVF outcomes. Among the various potential causes of repeated implantation failure, uterine factors (e.g., thin endometrium, poor endometrial receptivity, and immunological incompatibility) have received the most attention in recent years [2]. It has been shown that endometrial receptivity could be modulated by a multitude of signaling molecules, including prostaglandins [3], growth factors, cytokines, chemokines, integrins, leukemia inhibitory factor [4,5], Wnt family ligands [6], and Ecadherin [7]. Whereas dysregulation of some of these factors could be ass
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