الفهرس 
The Art of IVFOnly 14 pages are availabe for public view
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Abstract
The objective of this pilot randomized control trial was to test the effect of endometrial injury on day 21 of preceding cycle to ICSI cycle and endometrial injury on day 7 of the same ICSI cycle on pregnancy rate in patients undergoing ICSI.
Although earlier studies aiming to understand the effect of hysteroscopic endometrium biopsy on implantation have been methodologically diverse, a common denominator appears to have been the presence of local injuries prior to an IVF cycle, because local inflammatory and angiogenesis reactions are indispensable for a successful implantation, an endometrial biopsy-induced injury could produce just such a local inflammatory and angiogenic environment between the endometrium and the conceptus, which, in turn, facilitates embryo implantation and subsequent pregnancy in earlier studies .
However, due to substantial variations in patient selection, timing, number and extent of endometrial injury applied, and techniques in earlier studies, the merits of endometrial biopsy injury on clinical outcomes in IVF clinics remain controversial.
This Pilot randomized case control study included 60 patients were prepared to do ICSI and they divided into: designed 3 groups:
Group (A) consists of 20patients as control group.
Group (B) consists of 20 patients received endometrial injury on day 21 in preceding cycle to ICSI cycle.
Group (C) consists of 20 patients received endometrial injury on day 7 of the ICSI cycle.
All patients receive the long induction protocol: Depends on Age, weight, GnRH was given three weeks after the beginning of the preceding cycle to ICSI cycle to do down regulation of the pituitary gland is achieved as confirmed by very low level of E2.
The GnRH is usually started in leuteal phase or early in follicular phase. hMG therapy is started after down regulation 3 ampoules/day in average weight women between 25-35 years old. Down regulation of pituitary gonadotrophic function, this will allow prevention of premature LH surge, until oocyte maturity can be reached.
A single induced endometrial injury was done on the posterior endometrium mostly at midline 10-15 mm from the fundus by using Cook catheter containing special metal like hock tipped instrument introduced from inside to outer sheath, then without using local anesthetic agent, that catheter would be introduced inside vagina, cervix and uterus, then it would be protruded from the sheathe and endometrial simple injury (scratch) would be done, then reintroduce metal instruments inside the outer sheath of Cook catheter and get out from the uterus , cervix and vagina.
The present study found the rate of biochemical pregnancy was significantly higher in women subjected to endometrial injury compared with those who were not [68.4 % Vs. 25.0% respectively; P-value = 0.018] in women less than or equal 30 years old.
The rate of Clinical pregnancy was significantly higher in women subjected to endometrial injury compared with those who were not [63.2 % Vs. 16.7 % respectively P-value = 0.011] in women less than or equal 30 years old.
In women older than 30 years old of age there was no statistically significant difference between women with or without endometrial injury.