title: A randomized trial of local endometrial injury during ovulation induction cycles.
abstract: OBJECTIVE
  To investigate the effect of endometrial injury on pregnancy outcomes among infertile women taking clomifene citrate.
  
  
  METHODS
  A prospective randomized trial was undertaken at an Egyptian hospital between January 26, 2015, and July 17, 2016. Eligible women (≥1 year primary/secondary/unexplained infertility, aged 20-35 years, day-2 follicle-stimulating hormone <12 IU/L, normal prolactin/thyroid function/uterine cavity, ≥1 patent tube, male partner with normal semen count and motility, 3 cycles of clomifene citrate without success) were randomly allocated (1:1) using computer-generated numbers into intervention (received endometrial injury on cycle day 15-24) or control groups (sham procedure). Women began ovulation induction on days 3-5 of the following cycle. Participants and investigators were not masked to group assignment. The primary outcomes were clinical pregnancy, spontaneous abortion, and multiple pregnancy rates. Women who completed follow-up were included in analyses.
  
  
  RESULTS
  The intervention group included 52 women and the control group 53 women. The clinical pregnancy rate was significantly higher in the intervention group (37% [n=19]) than in the control group (13% [n=7]; P=0.006). No differences between the intervention and control groups were noted for spontaneous abortion rate (11% [2/19] vs 29% [2/7]; P=0.287) or multiple pregnancy rate (11% [2/19] vs 14% [1/7]; P=0.790). No adverse effects were reported.
  
  
  CONCLUSIONS
  Endometrial injury before ovulation induction could improve chances of pregnancy and its outcomes. CLINICALTRIALS.GOV: NCT02345837.
authors.affiliation: Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt.
authors.forename: Medhat E E
authors.initials: MEE
authors.lastname: Helmy
authors.affiliation: Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Maher
authors.affiliation: Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt.
authors.forename: Nabih I
authors.initials: NI
authors.lastname: Elkhouly
authors.affiliation: Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ramzy
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use*; D004717:Endometrium / Q000293:injuries* / Q000601:surgery; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D008183:Luteal Phase / Q000502:physiology; D010060:Ovulation / Q000502:physiology; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene
keywords: Endometrial injury; Infertility treatment; Ovulation induction; Pipelle biopsy sampling; Pregnancy outcomes