title: Endometrial injury prior to assisted reproductive techniques for recurrent implantation failure: a systematic literature review.
abstract: Endometrial injury to improve implantation for women undergoing assisted reproductive techniques has attracted a lot of attention recently and has rapidly become incorporated into clinical practice. The aim of this study is, thus, to assess the effectiveness and safety of endometrial injury performed in the cycle preceding assisted reproductive techniques in women with recurrent implantation failure. Electronic database searches, including MEDLINE, EMBASE, CENTRAL and grey literature, up to 30th May 2015 were conducted with no restrictions. Randomized controlled trials comparing endometrial injury versus placebo or no treatment in the cycle preceding assisted reproductive techniques in women with recurrent implantation failure were selected. The primary outcome was live birth rate. Secondary outcomes were clinical pregnancy, implantation, miscarriage and procedure-related complication rates. Of the 1115 publications identified, 4 met the inclusion criteria. Meta-analysis was not possible due to significant clinical heterogeneity among the included studies. Patients' characteristics differed, as did the intervention used with endometrial injury being performed at different phases of the preceding menstrual cycle. Moreover, the effect of endometrial injury on live birth and clinical pregnancy rates were inconsistent among the included studies. In summary, there is currently insufficient evidence to support the use of endometrial injury in women with recurrent implantation failure undergoing assisted reproductive techniques while the procedure-associated complication rate has not been assessed. Clinical implementation should, thus, be deferred until robust evidence becomes available.
authors.affiliation: Newcastle Fertility Centre at Life, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne and Wear, UK. Electronic address: n.panagiotopoulou@oxfordalumni.org.
authors.forename: Nikoletta
authors.initials: N
authors.lastname: Panagiotopoulou
authors.affiliation: Aberdeen Centre for Reproductive Medicine, Aberdeen Maternity Hospital, NHS Grampian, Aberdeen, UK.
authors.forename: Stamatios
authors.initials: S
authors.lastname: Karavolos
authors.affiliation: Newcastle Fertility Centre at Life, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne and Wear, UK.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Choudhary
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D010064:Embryo Implantation; D020964:Embryo Loss / Q000517:prevention & control*; D004624:Embryo Transfer; D004717:Endometrium / Q000601:surgery*; D005260:Female; D006801:Humans; D050498:Live Birth; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention
keywords: Assisted reproductive techniques; Endometrial injury; Recurrent implantation failure