Response to: Impact of luteal phase hysteroscopy and concurrent endometrial biopsy on subsequent IVF cycle outcome

Abstract

We would like to thank Dr. Shokeir for his interest in our manuscript presenting improved outcome in women who had luteal phase hysteroscopy and concurrent endometrial biopsy in the cycle prior to starting ovarian stimulation for IVF [1]. In fact, the initial data about this issue came from the women with recurrent implantation failure [2]. The results in 2062 women with recurrent implantation failure suggested that inducing injury in the cycle preceding IVF was 70 % more likely to result in a clinical pregnancy compared to no intervention [2]. Furthermore, regards to the type of endometrial injury, this meta-analysis revealed that clinical pregnancy rates were twice as high with biopsy/scratch as compared to hysteroscopy [2]. It is hypothesized that local injury to endometrium prior to IVF initiated changes in the immune system and gene expression leading to a more favorable endometrium for implantation in the next cycle. Nevertheless, the exact mechanism(s) and the optimal timing and the type of intervention (hysteroscopy or endometrial biopsy/scratch) still need to be clarified [3]. Unlike the meta-analysis mentioned, a recent randomized study proposed that endometrial aspiration in the mid-luteal phase in the cycle preceding ovarian stimulation for IVF did not improve the ongoing pregnancy rate in unselected subfertile women undergoing their first IVF treatment [4]. Further randomized studies investigating all the aspects of local endometrial injury and treatment outcome in patients undergoing first IVF cycle are needed.