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IMR Press / CEOG / Volume 49 / Issue 1 / DOI: 10.31083/j.ceog4901027
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Open Access Systematic Review
The impact of endometrial mechanical stimulation in women with normal hysteroscopic findings undergoing IVF/ICSI: a meta-analysis
Li-Jun Lin1,2,3,†Jia Liu1,†Liang-Zhi Xu1,2,3Hui Chen1,2,3,*
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1 Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
2 Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
3 Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, 610041 Chengdu, Sichuan, China

These authors contributed equally.

Clin. Exp. Obstet. Gynecol. 2022, 49(1), 27; https://doi.org/10.31083/j.ceog4901027
Submitted: 19 April 2021 | Revised: 17 May 2021 | Accepted: 26 May 2021 | Published: 19 January 2022
This is an open access article under the CC BY 4.0 license.
Abstract

Background: To investigate whether hysteroscopic endometrial mechanical stimulation improves pregnancy outcomes in patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods: We conducted a systematic search in electronic databases including PubMed, Embase, Cochrane Library, Web of Science from their inception to Feb 20th, 2021, as well as a manual search. All publications on the impact of hysteroscopic endometrial mechanical stimulation on IVF/ICSI outcomes were retrieved. Two reviewers independently screened the retrieved studies using stringent inclusion and exclusion criteria; data were subsequently extracted, and risk of bias was assessed. Meta-analysis of the selected studies was performed using Revman 5.3. Results: Eight studies involving 1494 patients were eligible for inclusion, including 5 randomized controlled trials and 3 prospective non-randomized simultaneous controlled experimental studies. We found that compared with the control group, hysteroscopic endometrial mechanical stimulation effectively increased live birth rate [risk ratio (RR) = 2.15, 95% confidence interval (CI) (1.78, 2.60), p $<$ 0.00001] and clinical pregnancy rate [RR = 1.95, 95% CI (1.28, 2.98), p = 0.002], and also decreased abortion rate [RR = 0.54, 95% CI (0.35, 0.86), p = 0.009]. Subgroup analyses revealed that, hysteroscopic endometrial mechanical stimulation administered in the luteal phase in patients undergoing their first IVF/ICSI cycle was associated with significantly higher live birth rate and clinical pregnancy rate, as well as a significantly lower abortion rate. Discussion: Endometrial mechanical stimulation may improve live birth rate, clinical pregnancy rate and reduce abortion rate in patients with normal hysteroscopic findings who are undergoing IVF/ICSI. The benefits may be even greater if this therapy is given in the luteal phase and in patients who are in their first IVF/ICSI cycle. However, due to the limited quantity and quality of the included studies and variable stimulation methods, these findings should be interpreted with caution, and more high-quality studies are needed to confirm this conclusion.

Keywords
Hysteroscopy
Endometrial mechanical stimulation
IVF
ICSI
Meta analysis
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