Dataset Information

Endometrial injury in women undergoing in vitro fertilisation (IVF).

ABSTRACT:

SUBMITTER: Lensen SF

PROVIDER: S-EPMC8190981 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Endometrial injury in women undergoing in vitro fertilisation (IVF).

Lensen Sarah F SF Armstrong Sarah S Gibreel Ahmed A Nastri Carolina O CO Raine-Fenning Nick N Martins Wellington P WP

The Cochrane database of systematic reviews 20210610

<h4>Background</h4>Implantation of an embryo within the endometrial cavity is a critical step in the process of in vitro fertilisation (IVF). Previous research has suggested that endometrial injury (also known as endometrial scratching), defined as intentional damage to the endometrium, can increase the chance of pregnancy in women undergoing IVF.<h4>Objectives</h4>To assess the effectiveness and safety of endometrial injury performed before embryo transfer in women undergoing in vitro fertilisa ...[more]

PMID: 34110001

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Project description:BackgroundIn IVF/ICSI treatment, the process of embryo implantation is the success rate-limiting step. Endometrial scratching has been suggested to improve this process, but it is unclear if this procedure increases the chance of implantation and live birth (LB) and, if so, for whom, and how the scratch should be performed.Objective and rationaleThis individual participant data meta-analysis (IPD-MA) aims to answer the question of whether endometrial scratching in women undergoing IVF/ICSI influences the chance of a LB, and whether this effect is different in specific subgroups of women. After its incidental discovery in 2000, endometrial scratching has been suggested to improve embryo implantation. Numerous randomized controlled trials (RCTs) have been conducted, showing contradicting results. Conventional meta-analyses were limited by high within- and between-study heterogeneity, small study samples, and a high risk of bias for many of the trials. Also, the data integrity of several trials have been questioned. Thus, despite numerous RCTs and a multitude of conventional meta-analyses, no conclusion on the clinical effectiveness of endometrial scratching could be drawn. An IPD-MA approach is able to overcome many of these problems because it allows for increased uniformity of outcome definitions, can filter out studies with data integrity concerns, enables a more precise estimation of the true treatment effect thanks to adjustment for participant characteristics and not having to make the assumptions necessary in conventional meta-analyses, and because it allows for subgroup analysis.Search methodsA systematic literature search identified RCTs on endometrial scratching in women undergoing IVF/ICSI. Authors of eligible studies were invited to share original data for this IPD-MA. Studies were assessed for risk of bias (RoB) and integrity checks were performed. The primary outcome was LB, with a one-stage intention to treat (ITT) as the primary analysis. Secondary analyses included as treated (AT), and the subset of women that underwent an embryo transfer (AT+ET). Treatment-covariate interaction for specific participant characteristics was analyzed in AT+ET.OutcomesOut of 37 published and 15 unpublished RCTs (7690 participants), 15 RCTs (14 published, one unpublished) shared data. After data integrity checks, we included 13 RCTs (12 published, one unpublished) representing 4112 participants. RoB was evaluated as 'low' for 10/13 RCTs. The one-stage ITT analysis for scratch versus no scratch/sham showed an improvement of LB rates (odds ratio (OR) 1.29 [95% CI 1.02-1.64]). AT, AT+ET, and low-RoB-sensitivity analyses yielded similar results (OR 1.22 [95% CI 0.96-1.54]; OR 1.25 [95% CI 0.99-1.57]; OR 1.26 [95% CI 1.03-1.55], respectively). Treatment-covariate interaction analysis showed no evidence of interaction with age, number of previous failed embryo transfers, treatment type, or infertility cause.Wider implicationsThis is the first meta-analysis based on IPD of more than 4000 participants, and it demonstrates that endometrial scratching may improve LB rates in women undergoing IVF/ICSI. Subgroup analysis for age, number of previous failed embryo transfers, treatment type, and infertility cause could not identify subgroups in which endometrial scratching performed better or worse. The timing of endometrial scratching may play a role in its effectiveness. The use of endometrial scratching in clinical practice should be considered with caution, meaning that patients should be properly counseled on the level of evidence and the uncertainties.

Project description:BackgroundThe positive effects of dehydroepiandrosterone (DHEA) on oocyte and embryo quality improvement are often concerned. While the results on DHEA-induced endometrial improvement are controversial.ObjectiveTo evaluate whether DHEA intervention improved endometrial function and reproductive outcomes during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles and to thus provide clinical recommendations.Data sourcesPubMed, Cochrane Library, EMBASE and Web of Science from database inception to 31 July 2024, without language restrictions. The references of conference proceedings and websites on clinical trials were manually checked.Study designSystematic review and meta-analysis.Study eligibility criteriaParallel-controlled randomized controlled trials (RCTs) design; women underwent IVF/ICSI, patients in the experimental group received adminstration with DHEA, whereas the control group received with or without placebo; and the outcomes included reproductive or endometrial function.Study appraisal and synthesis methodsRCTs evaluating the effects of DHEA on IVF/ICSI outcomes were included. Risk of bias and quality of evidence (QoE) were assessed according to the Cochrane Collaboration's tool and the Grading of Recommendations Assessment, Development and Evaluation system. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were assessed by random-effects or fixed-effects models. Subgroup and meta-regression analyses were used to find sources of heterogeneity. Trial sequential analysis was used to judge the stability of the outcomes. Trial sequential analysis was used in order to control for random errors.ResultsA total of 16 trials included 1973 women. DHEA treatment significantly increased endometrial thickness (MD = 0.93, CI: 0.27 to 1.60; low QoE), which helped improve clinical pregnancy rate (CPR) (OR = 1.34, 95% CI: 1.08 to 1.67; low QoE). DHEA administration also increased the quality of oocyte and embryo [including the number of oocytes retrieved (MD = 0.73, CI: 0.36 to 1.10; low QoE), oocytes fertilized (MD = 0.48, CI: 0.10 to 0.87; low QoE), transferred embryos (MD = 0.27, CI: 0.09 to 0.46; very low QoE), and high-quality embryos (MD = 0.65, CI: 0.27 to 1.03; low QoE)]. Subgroup and meta-regression analyses revealed that heterogeneity might be related to disease type, ovarian stimulation protocol, and addition time of DHEA treatment. There was insufficient evidence to reach a conclusion regarding the live birth rate/ongoing pregnancy rate, miscarriage rate, and MII oocyte number of DHEA. And no severe adverse effects were observed with DHEA administration. Due to the apparent improvemen in the CPR, women with thin endometrium might benefit from DHEA cotreament.ConclusionsDue to the limited sample size and methodological problems, the QoE was low to very low; hence, the results should be interpreted with caution. The effectiveness of DHEA requires more research before it can be considered for clinical practice.Prospero registrationCRD42023428885.

Dataset Information

Endometrial injury in women undergoing in vitro fertilisation (IVF).

Publications

Endometrial injury in women undergoing in vitro fertilisation (IVF).

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