Iranian Society of Gynecology Oncology


Mehr Fertility Research Center, Guilan University of Medical Sciences, Rasht, Iran


Background and Objective: Repeated implantation failure (RIF) is still remain an ongoing challenge. RIF may be contributed to the embryo or the endometrium, which any abnormalities of each two may result implantation failure. The aim of present study was to report the effect of endometrial injury (EI) during frozen embryo transfer (FET) on pregnancy outcome in RIF patients.
Material and methods: In this retrospective case series, since 2018 to 2020, 20 patients with a history of RIF who underwent EI during FET cycle were evaluated.
Results: Chemical, clinical and ongoing pregnancy and live birth was achieved in 8 (40%), 7 (35%), 6 (30%) and 6 (30%) patients, respectively.
Conclusion: The present study shows that using EI in FET cycle is a feasible, safe and efficient method in improving clinical outcomes. More researches are needed to find out the real effect of EI during FET in RIF patients.



  1. 1. Busnelli A, Somigliana E, Cirillo F, Baggiani A, Levi-Setti PE. Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysis. Sci Rep. 2021;11(1):1-31. 2. Mehrafza M, Raoufi A, Hosseinzadeh E, Pourseify Gh, Zare Yousefi T, Shakery T , Tamimi A. The Effect of Intrauterine Infusion of Plasma Enriched Platelet on Live Birth Rate in Patients with Implantation Failure. J OBSTET GYNECOL CANCER RES. 2022;Article in press. 3. Vitagliano A, Sardo ADS, Saccone G, Valenti G, Sapia F, Kamath MS, et al. Endometrial scratch injury for women with one or more previous failed embryo transfers: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2018;110(4):687-702. e2. 4. Maged AM, Rashwan H, AbdelAziz S, Ramadan W, Mostafa WA, Metwally AA, et al. Randomized controlled trial of the effect of endometrial injury on implantation and clinical pregnancy rates during the first ICSI cycle. Int J Gynaecol Obstet. 2018;140(2):211-6. 5. Yang J-H, Chen C-D, Chou C-H, Wen W-F, Tsao P-N, Lee H, et al. Intentional endometrial injury increases embryo implantation potentials through enhanced endometrial angiogenesis. Biol Reprod. 2019;100(2):381-9. 6. Tang Z, Hong M, He F, Huang D, Dai Z, Xuan H, et al. Effect of endometrial injury during menstruation on clinical outcomes in frozen–thawed embryo transfer cycles: A randomized control trial. J Obstet Gynaecol Res. 2020;46(3):451-8. 7. Yu X, Gao C, Dai C, Yang F, Deng X. Endometrial injury increases expression of hypoxia-inducible factor and angiogenesis in the endometrium of women with recurrent implantation failure. Reprod Biomed Online. 2019;38(5):761-7. 8. Wang Z, Liu Y, Liu J, Kong N, Jiang Y, Jiang R, et al. ATF3 deficiency impairs the proliferative–secretory phase transition and decidualization in RIF patients. Cell Death Dis. 2021;12(4):1-15. 9. El-Toukhy T, Sunkara S, Khalaf Y. Local endometrial injury and IVF outcome: a systematic review and meta-analysis. Reprod Biomed Online. 2012;25(4):345-54. 10. Okada H, Tsuzuki T, Murata H. Decidualization of the human endometrium. Reprod Med Biol. 2018;17(3):220-7. 11. Sherer D, Abulafia O. Angiogenesis during implantation, and placental and early embryonic development. Placenta. 2001;22(1):1-13. 12. Zhou L, Li R, Wang R, Huang H-x, Zhong K. Local injury to the endometrium in controlled ovarian hyperstimulation cycles improves implantation rates. Fertil Steril. 2008;89(5):1166-76. 13. Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization. Fertil Steril. 2003;79(6):1317-22. 14. Karimzade MA, Oskouian H, Ahmadi S, Oskouian L. Local injury to the endometrium on the day of oocyte retrieval has a negative impact on implantation in assisted reproductive cycles: a randomized controlled trial. Arch Gynecol Obstet. 2010;281(3):499-503. 15. Van Hoogenhuijze N, Kasius J, Broekmans F, Bosteels J, Torrance H. Endometrial scratching prior to IVF; does it help and for whom? A systematic review and meta-analysis. Hum Reprod Open. 2019;2019(1):hoy025. 16. Kanazawa E, Nakashima A, Yonemoto K, Otsuka M, Yoshioka N, Kuramoto T, et al. Injury to the endometrium prior to the frozen–thawed embryo transfer cycle improves pregnancy rates in patients with repeated implantation failure. J Obstet Gynaecol Res. 2017;43(1):128-34.