In women undergoing assisted reproductive techniques (ART), intentional endometrial injury performed in the month prior to the embryo transfer cycle can increase the likelihood of clinical pregnancy and live birth, according to results of a new study.1
Intentionally injuring the endometrium through endometrial biopsy or curettage before embryo transfer has been reported previously to increase the odds of implantation and aid embryonic development, subsequently improving the chances of a live birth.2,3 The hypothesis behind this practice is that injury to the endometrium triggers a large secretion of growth factors and cytokines in the process of wound healing, which may help implantation.2 However, the effectiveness and safety of this practice remains unknown.
Using 5 randomized controlled trials that compared intentional endometrial injury prior to embryo transfer in women undergoing ART with no intervention or with a mock procedure that did not cause endometrial injury, researchers assessed the efficacy and safety of the practice. A total of 591 women were included. In a subgroup analysis, outcomes were compared for injury in the previous cycle and injury on the day of oocyte retrieval.
In the previous-cycle subgroup, the procedure for intentional injury was performed within 1 month before the start of ovulation induction. The intervention more than doubled the chances of a clinical pregnancy (4 trials; OR, 2.61) and a live birth (2 trials; OR, 2.46).1 There were no reports of pain or bleeding in any of the 4 trials. Imprecise reporting of the odds of miscarriage per clinical pregnancy prevented the authors from developing any meaningful conclusion about the relationship between intentional endometrial injury and miscarriage.
In the day-of-oocyte-retrieval subgroup, endometrial injury occurred a few days before the embryo was transferred to the uterus. The odds of clinical pregnancy (1 trial; OR, 0.30) and ongoing pregnancy were significantly reduced (1 trial; OR, 0.28).1 As with the trials used in the previous-cycle subgroup, the trial for the day-of subgroup did not report adverse effects related to the practice.
To better understand the safety of endometrial injury, future studies should assess whether the practice is associated with adverse effects, such as pain and bleeding, and how the practice relates to multiple pregnancy or miscarriage.
Pertinent Points:
- Endometrial injury performed in the month before starting ovulation induction improves the rates of clinical pregnancy and live birth in women undergoing assisted reproductive techniques.
- Performing endometrial injury on the day of oocyte retrieval significantly reduces the rates of clinical pregnancy and ongoing pregnancy.
B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi
This case study shows a 26 week gestation with a cystic mass close to the sacrum.
CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.
Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).
Normal 35 week pregnancy
An approx. 12 week fetus, first ultrasound of this pregnancy.
4D image of 29 weeks pregnancy, multiple anomalies: Clinch hand, omphalocoele, single atrium
Is this lesion a fibroid or adenomyosis? Patient is a young (38n yr. old) married female with a history of dysmenorrhea and polymenorrhoea.
The patient was a 38 year old G4 P3, 20w4d. I was doing an anatomic survey today. While I was looking at a long axis view of the fetal heart with color Doppler, the baby developed hiccups, and with each contraction of the fetal thorax (which was quite obvious) I could see an explosion of blue color representing blood going through the foramen ovale from right to left.
This is a confirmed case of scar ectopic pregnancy. Yesterday, I carried out this exam in an emergency room, without much time to perform an adequate sonogram, the patient did not feel good with “cramps” but no signs of bleeding.
Normal aspect of the ossification centers of the fetal sternum at 33 weeks. Size of the ossification centers decreases in a cranio-caudal sense.
Leiomyoma that has undergone fatty degeneration.
Sagittal image from a transvaginal sonogram in a patient with bleeding after a spontaneous abortion. The endometrium (between cursors) was thick and heterogeneous, measuring 8.5 mm in thickness (Fig1). Color doppler image in same patient shows focal flow (Fig. 2 - arrow) within the heterogeneous endometrium.
Images of "Bulky Uterus"
Cystic spaces in the sub-endometrial myometrium of the fundus.
Complete Invasive Mole
A 29-year-old gravida 10, para 3 (1 term gestation, 1 preterm gestation of twins, 1 stillbirth at 5 months, 2 spontaneous abortions, and 4 elective abortions) presented to the clinic at about 5 weeks’ gestation with abdominal pain and vaginal bleeding. She described the pain as sporadic, mostly on the left side, exacerbated by movement, and resolving with rest, and the bleeding as initially intermittent but then heavier “like a period.”
Implantation in the scar of a previous Cesarean is thought to be the rarest of ectopic pregnancies. With the increasing numbers of Cesareans performed, scar implantation may become more frequent as well. We present an illustrative case.
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome affects at least 1 in 4500 female births.1 The syndrome consists of vaginal aplasia with other müllerian duct abnormalities. The characteristic feature of MRKH syndrome is congenital absence or underdevelopment of the upper vagina and uterus; it is rarely associated with unilateral renal agenesis, ectopia, or horseshoe kidney.
Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the endometrium, occurring in the age group of 40-50 years.
