Background: The main aim of the study, is to compare the effect of sildenafil therapy and endometrial scratch injury as methods for improving endometrial receptivity on the outcome of ICSI cycle.
Patients and methods: This was a prospective randomized controlled study which was done in private based ICSI centers, where a total of 150 patients were included. These were divided into 3 groups; Control group(n=50), endometrial scratch injury group(n=50) ,and sildenafil group(n=50). Endometrial scratch injury was done on 21th day of the spontaneous cycle before ICSI-ET treatment using a pipelle endometrium sampler. received sildenafil citrate( 25mg tablets 3 times daily intravaginally) staring from the first day of FSH stimulation. Beta-HCG titter was done for detection of pregnancy.
Results: There was a statistically significant difference regarding the pregnancy rate between the control group and those who received endometrial scratch( Pvalue 0.0405) with a pregnancy rate of 56% (N=28) in comparison to the control group with 46% (N=23). On the other hand, there was no significant difference regarding the sildenafil group P value 0.067 with pregnancy rate of 48% (N=24). In the control group, all the pregnant patients showed positive fetal pulsations, while in the endometrial scratch group 92.8% showed positive fetal pulsations (N=26), and in the sildenafil group 95.8% showed positive fetal pulsations (N=23).
Conclusion: Endometrial scratch injury was a safe and cheap method to improve pregnancy rate in ICSI cycles, however using it routinely needs more studies comparing it to other methods of improving endometrial receptivity.