The effect of endometrial scratching process on pregnancy results to be done in the follicular phase of the same intrauterine insemination CYCLES

Aim : The aim of in this thesis was to investigate the effect of endometrial scratching (ES)on pregnancy rates performed in the midproliferative phase of the same cycle in ovulation induction cycles with letrozole and gonadotropin in infertile patients treated with intrauterine insemination following ovulation induction (OI) due to infertility. Material and Method: Between December 2022 and May 2023, a total of 57 patients who applied to Balıkesir University Faculty of Medicine, Obstetrics and Gynecology outpatient clinic due to infertility, who underwent intrauterine insemination after ovulation induction with letrozole or ganodotropin, and who underwent or not endometrial scratching in the midproliferative period, were included in this retrospective study. Pregnancy rates of patients who underwent and did not undergo endometrial scratching on the 8th or 9th day of menstruation in gonadotropin and letrozole cycles were compared with the information obtained from electronic file data. After IUI, all patients were prescribed progesterone (Progestan 200mg soft capsule 2x1 vaginal) and sexual intercourse was recommended at least 3 times every other day. Beta-human chorionic gonadotropin (β-HCG) levels in the blood of these patients were measured 15 days after the IUI procedure. In addition, demographic data such as age and body mass index of patients were recorded. And semen analysis of spouses, HSG, gravide-parities, previous operation history, known disease, basal (tested on the 2nd or 3rd day of menstruation) follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) values, the dose and duration of the agent used in ovulation induction, the endometrial thickness of the patients who underwent endometrial scratching on the day of the scratching, and the endometrial thickness of all patients before IUI were recorded from electronic file data. Findings: Groups 1 and 2 were analyzed among themselves, with groups 3 and 4 among themselves. Pregnancy rates between groups 1 and 2 were 13.3% and 11.8%, respectively, but this increase was not statistically significant (p=0.8952). The endometrial thickness of group 1 on the ES day was 6.1 ±1.1 millimeters (mm), and viii the endometrial thickness on the HCG day was 6.8±1.0 mm. Pregnancy rates between groups 3 and 4 were 20.0% and 26.7%, respectively, and this difference was not statistically significant (p=0.7079). The endometrial thickness of group 3 on the ES day was 8.5±1.6 mm, and the endometrial thickness on the HCG day was 9.4±2.1 mm. An increase in endometrial thickness after ES was detected in both letrozole and gonadotropin study groups. Conclusion: Compared with controls, ES use is associated with an increased pregnancy rate in IUI cycles with Letrozole, but this increase was not statistically significant. Also, use of ES on Day 8 or 9 in both Letrozole and Gonadotropin cycles is associated with increased endometrial thickness. Keywords: intrauterine insemination, endometrial scratching, pregnancy, ovulation induction