Evaluation of endometrial scratching on intrauterine insemination outcome and endometrial receptivity.

Objective: Evaluation of endometrial scratching on pregnancy rates after IUI and comparing levels and distribution of IL-6 (inflammatory molecule) and E-Cadherin (adhesion molecule) by immunohistochemistry. Study design: Randomized case control study. Study design: Randomized case control study. Setting: Tertiary care hospital of Delhi, India. Material and methods: 240 women (120 in each group) with previous failed IUI cycles were enrolled. Study group patients were subjected to endometrial scratch by ''Pipelle" on postovulatory day 6-8 in the preceding cycle. IUI was performed after controlled ovarian stimulation with gonadotropins. 20 patients of study group in whom IUI was cancelled underwent repeat scratch on postovulatory day 6-8. Levels and distribution of IL-6 and E-Cadherin were evaluated by Immunohistochemistry before and after the scratch. Main outcome: Comparison of pregnancy rates in women undergoing IUI after endometrial scratching with women undergoing IUI alone. Results and conclusion: There were 19 (19%) clinical pregnancies in the study group and 8 (7.6%) in the control group. There was a significant difference in between both the groups (p = 0.022). Number of pregnancies in unexplained infertility patients was 22.66% in study and 9.5% in control group (p = 0.0291). There was significant increase in score for IL-6 and E-Cadherin in both glands and stroma after scratching. Endometrial scratch is a simple, practical, cost effective and outpatient procedure which may increase pregnancy rates in previous failed IUI cycles. Increased intensity of staining; shift of major part of staining from gland or stroma in pre scratch samples to both glands and stroma in post scratch samples; and increased stromal decidualization point towards increased endometrial receptivity. [ABSTRACT FROM AUTHOR]