Endometrial Injury and Sub Endometrial Doppler Study to Predict Uterine Receptivity in Women with Unexplained Infertility: A Randomized Controlled Trial

Abstract

Objectives: The aim of this work was to compare the effectiveness and safety of endometrial scratching at different times of the menstrual cycle on cumulative pregnancy rate and also to assess and clarify its relationship and effect on sub-endometrial vasculature blood flow by Doppler ultrasound, in cases of unexplained infertility attempting to conceive spontaneously (without ovulation induction). Study Design: A prospective randomized clinical control study. Patients and Methods: A total of 252 eligible participants were included in the study and randomly allocated using block randomization into three groups: Group A (n = 84): endometrial scratching was performed during the pre-ovulatory days and Group B (n = 84): endometrial scratching has been done at day 7 of the cycle. Group C (control group): includes 84 cases without endometrial scratching. The Doppler ultrasound will be done. The pulsatility index (PI) and resistance index (RI) of endometrial and sub endometrial arteries were calculated. All women were followed up to 3 months. Results: Cumulative pregnancy rate is 21.42% and 28.57% in the study groups A and B respectively which is higher than group C (control group) (4.76%) but with statistically insignificant P-value = 0.254. There is statistically significant difference in RI & PI between the studied groups and the control group on day 13 (P value < 0.001). There is statistically significant difference in PI between day 13 and day 6 for the same group in both groups (A&B) (P value < 0.003), while there is no statistically significant difference in Group C (P value = 0.156). Conclusion: Endometrial scratching is a cost-effective and easy technique which may improve clinical pregnancy rates and endometrial blood flow in women with unexplained infertility.