Endometrial Injury Techniques in Assisted Reproductive Technology

Endometrial injury encompasses a range of deliberate, localised disruptions to the uterine lining performed prior to embryo transfer in assisted reproductive technology (ART). Techniques such as Pipelle sampling, hysteroscopic biopsy and catheter-based scratching seek to modulate the endometrial microenvironment, enhance receptivity and ultimately improve implantation and live birth rates. Proposed mechanisms include induction of a controlled inflammatory response, remodelling of the extracellular matrix and activation of resident stem and progenitor cells. Procedure timing varies from the cycle preceding ovarian stimulation to the luteal phase of the transfer cycle. Clinical outcomes have been mixed, reflecting differences in patient selection, injury method, timing and number of interventions. Nonetheless, certain subgroups—particularly women with recurrent implantation failure—have shown a more consistent benefit, prompting ongoing investigations into underlying biological changes and optimised protocols.

Research from Nature Portfolio

Recent studies have explored the cellular impact of local endometrial injury in patients with repeated implantation failure. One investigation assessed consecutive mid-luteal phase biopsies and demonstrated that a single local injury alters the decidualisation capacity of perivascular endometrial mesenchymal stem cells (eMSCs) without changing their abundance. This modulation of decidual responses in eMSCs may contribute to a more supportive stromal environment for trophoblast invasion and explains, in part, observed improvements in implantation rates among women who have previously failed to achieve pregnancy despite good-quality embryos.

Endometrial Injury Techniques in Assisted Reproductive Technology publication trend

The graph below shows the total number of articles in endometrial injury techniques in assisted reproductive technology across all publications each year (not limited to Nature Index journals).

Technical terms

Endometrial injury: A targeted mechanical disruption of the uterine lining intended to improve endometrial receptivity before embryo transfer.

Endometrial mesenchymal stem cells (eMSCs): Resident stromal progenitors that contribute to cyclical regeneration and decidualisation of the endometrium.

Decidualisation: The process by which endometrial stromal cells transform into specialised secretory decidual cells in response to hormonal cues.

Recurrent implantation failure (RIF): The absence of a clinical pregnancy after transfer of good-quality embryos in multiple consecutive ART cycles.

Pipelle biopsy: A minimally invasive sampling technique using a thin suction catheter to obtain endometrial tissue for diagnostic or therapeutic purposes.

References

1. Endometrial scratching in women undergoing IVF/ICSI: an individual participant data meta-analysis. Human Reproduction Update (2023).
2. Closer to the Reality—Proteome Changes Evoked by Endometrial Scratching in Fertile Females. International Journal of Molecular Sciences (2023).
3. Subtle changes in perivascular endometrial mesenchymal stem cells after local endometrial injury in recurrent implantation failure. Scientific Reports (2023).
4. The role of endometrial scratching prior to in vitro fertilization: an updated systematic review and meta-analysis. Reproductive Biology and Endocrinology (2023).