Abstract
Author(s): Asim F Alwohaibi*, Hend El-Hossary and Mahmoud Amr Nadim
Background/Aim: Previous Implantation Failure (IF) remains a major challenge in assisted reproduction. Mechanical endometrial injury has been proposed to improve receptivity, though the ideal target population is debated. This retrospective study evaluated targeted hysteroscopic endometrial scratching in specific IF subgroups.
Patients and Methods: The study included 152 IF patients in a private IVF center from June 2021 to June 2022, split into an intervention group (n=76) undergoing targeted scratching and a matched control group (n=76). During the follicular phase of the prior unmedicated cycle, the sharp edge of an inverted 30-degree rigid hysteroscope created localized linear scratches before starting a fixed GnRH antagonist protocol with day 5 ET. We compared baseline characteristics, stimulation parameters, and reproductive outcomes. Statistical analyses included subgroup evaluations and multivariable logistic regression using SPSS 28.0.
Results: No significant differences in baseline demographics or stimulation parameters (p > 0.05). The scratching group showed higher clinical pregnancy (46.1% vs. 27.6%, p=0.019) and ongoing pregnancy rates (40.8% vs. 23.7%, p=0.024). Subgroup analysis revealed significant ongoing pregnancy benefits only in women under 35 (50.0% vs. 27.3%, p=0.028) and those with 2-3 prior failed cycles (48.1% vs. 28.0%, p=0.038). No significant improvements were seen in women over 35 or with 4 or more failures. Multivariable analysis confirmed endometrial scratching (aOR 2.45, p=0.025), age under 35 (aOR 2.15, p=0.036), and 2-3 prior failures (aOR 1.95, p=0.042) as independent predictors of ongoing pregnancy.
Conclusion: Targeted hysteroscopic endometrial scratching enhances pregnancy rates in patients with previous IF, especially in women under 35 with moderate prior failures.