Impact of intrauterine injection of human chorionic gonadotropin Vs intrauterine infusion of autologous platelet rich plasma Vs endometrial scratch on pregnancy rates as management of unexplained recurrent implantation failure (A prospective comparative study)

Abstract

Background: Infertility is one of the most common problems among couples worldwide. In vitro fertilization (IVF) is the gold standard treatment for causes of infertility, including tubal obstruction, severe male factor, poor ovarian reserve, and unexplained infertility of long duration. Implantation is an essential physiological phenomenon for pregnancy and IVF success. It is referred to the attachment of the embryo to the endometrial luminal surface of the uterus. The aim of this study is Assessment and evaluation the effect of intrauterine injection of human chorionic gonadotropin before embryo transfer of IVF cycle versus intrauterine infusion of autologous platelet rich plasma versus the endometrial scratch on the clinical pregnancy rates as a management of the cases with unexplained RIF.Methods: A prospective comparative study was done in Tanta university hospital and private fertility centers.Group A (30 cases): the cases in this group had been subjected to instillation of the endometrial cavity with HCG. Intra-caviar instillation of HGG was mediated immediately before ET in a dose of HGG (≤ 500 international unit).Group B (30 cases): the cases were subjected to endometrial scratch or injury.Group C (30 cases): the participants in this group were treated by intrauterine infusion of autologous platelet rich plasma (PRP). Results: there was no statistically significant difference between the three studied groups regarding the basic hormonal profile (FSH, LH, E2, TSH, Prolactin and AMH). there was no statistically significant difference between the three studied groups regarding (Number of oocyte retrieval, Number of oocytes fertilized, Number of embryo transfer and Duration of stimulation (days). there was no statistically significant difference among the three studied groups according to the biochemical, clinical, ongoing pregnancy and miscarriage rates. The clinical pregnancy rates in group C using PRP was little higher than group A and B. there was no negligible difference in the miscarriage rate across the three groups. Due to the small sample size, there was no statistically differences, the study needed more time and data to draw firm conclusionsConclusions: RIF is a highly fertility obstacle so larger studies with great experience in handling and preparation are recommended to reach an evidence based solid conclusion regarding the use of these different modalities in RIF.