الفهرس 
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Abstract
The present pilot randomized clinical trial was performed in Obstetric & Gynecology department at Menoufia University hospital. The study was conducted on 25-35 years old women who suffered from unexplained infertility with history of failed IUI cycles. In order to find the etiology of infertility, all the patients underwent standard infertility work up that proved to be normal ie, normal semen analyses, normal ovulation and bilateral patent tubes.
The study protocol was approved by Ethics & Research Committee (ERC), Faculty of Medicine, Menoufia University. In addition, written informed consents were obtained from all the study participants.
A total of 60 women were screened regarding eligibility for the study. These patients underwent IUI. The patients were randomly divided into 3 groups through block randomization.
Control group A: (n=20, IUI only cycles), no intervention before the IUI cycles.
Study Groups: (n=40 IUI cycles with LEI by Pipelle), according to LEI timing subdivided to:
Study group B: 20 underwent LEI at day 21 before the IUI cycle.
Study group C: 20 underwent LEI on day 7 of the same IUI cycle.
LEI was done on posterior wall of the uterus. The patients were requested to use non-hormonal means of contraception during this cycle.
All the patients received CC +/- FSH. Transvaginal sonography was also performed and according to the size and number of the stimulated
follicles, FSH was continued until at least one more than 18mm dominant follicle was seen. Then ovulatory dose of hCG, were injected IM.
After 32 hours of hCG injection, IUI was performed by husband Semen prepared through swim-up method.
β-hCG was checked if the patient experienced one week missed period. Moreover, pregnancy was documented by transvaginal ultrasound at 2 weeks of gestation.
Clinical pregnancy was positive in 2 (10%) women in control group compared with 6 (30%) women in day 21 group and 4 (20%) women in day 7 group respectively. There was no statistically significant difference among 3 groups in clinical pregnancy rate. Rate of pregnancy was significantly higher in women subjected to endometrial injury compared with those who were not in women ≤ 30 years old. However in women older than 30 years old of age there was no statistically significant difference between women with or without endometrial injury.
This study proved that induced endometrial injury response may facilitate the preparation of the endometrium for implantation. So in women undergoing IUI, LEI can be done on day 21 of the preceding cycle or day 7 of the same cycle to improve pregnancy outcomes. The results look to be better when LEI done before IUI cycle.
Further studies are needed to evaluate the effect and timing of endometrial trauma on pregnancy rate at IUI cycle.