Infertility Clinical Trial
Official title:
Effect of Endometrial Biopsy on in Vitro Fertilization Pregnancy Rates - a Randomized, Multicenter Study
Animal and clinical studies have suggested that local tissue trauma can promote the process
of an embryo implanting in the uterine cavity. The clinical studies have been performed in
patients with a history of previously failed treatments using in vitro fertilization; a
process of stimulating many eggs from a women and removing them from the body, to allow
fertilisation with sperm to occur in a laboratory setting. The embryos are then replaced into
the uterine cavity.
This study questions whether endometrial biopsy (placing a small straw like catheter through
the cervix and into the uterine cavity to take a sample of tissue via suction into the bore
of the catheter), within 5-10 days of starting a cycle of in vitro fertilization, will
improve pregnancy outcome for patients in the first or second cycle of treatment. The
hypothesis is that endometrial biopsy will improve pregnancy outcome.
The study is a randomized multicentre study involving 3 Canadian fertility centres.
Although the data are preliminary, there are studies suggesting that mild endometrial trauma
in the cycle preceding IVF increases pregnancy rates, at least in women with recurrent
implantation failure. Whether endometrial biopsy could promote implantation and improve
pregnancy rates in the larger population of women undergoing IVF has yet to be explored. The
present study will address this question and examine the impact of endometrial biopsies on
IVF outcomes in the context of a randomized controlled trial.
The optimal timing of the endometrial biopsy in the cycle preceding IVF has not been
determined, but the majority of the studies have included a biopsy in the mid-luteal phase of
the preceding cycle. In order to allow an adjuvant therapy to IVF that would be considered
tolerable to a subject, and applicable to a large infertile women population, it was
determined that a single endometrial biopsy, performed approximately 1 week prior to the
start of controlled ovarian hyperstimulation (COH) in an IVF cycle, would be the simplest,
most flexible, and generalizable intervention to study its effects on pregnancy rates. All
other components of the IVF treatment will remain constant with approximately 8-12 days of
ovarian stimulation, human chorionic gonadotrophin (HCG) trigger being administered in that
time frame and oocyte retrieval occuring 36 hours later from trigger. The embryo transfer
will take place either day 3 or day 5 after oocyte retrieval.
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