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Effect of Endometrial Biopsy on in Vitro Fertilization Pregnancy Rates - a Multicenter Study (EndoBx-IVF)

This study has been terminated.
(Suboptimal subject recruitment)
Information provided by (Responsible Party):
Jon Havelock, Pacific Centre for Reproductive Medicine Identifier:
First received: April 12, 2013
Last updated: April 7, 2017
Last verified: April 2017

Animal and clinical studies have suggested that local tissue trauma can promote the process of an embryo implanting in the uterine cavity. The clinical studies have been performed in patients with a history of previously failed treatments using in vitro fertilization; a process of stimulating many eggs from a women and removing them from the body, to allow fertilisation with sperm to occur in a laboratory setting. The embryos are then replaced into the uterine cavity.

This study questions whether endometrial biopsy (placing a small straw like catheter through the cervix and into the uterine cavity to take a sample of tissue via suction into the bore of the catheter), within 5-10 days of starting a cycle of in vitro fertilization, will improve pregnancy outcome for patients in the first or second cycle of treatment. The hypothesis is that endometrial biopsy will improve pregnancy outcome.

The study is a randomized multicentre study involving 3 Canadian fertility centres.

Condition Intervention
Infertility Pregnancy Device: Endometrial Biopsy

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Effect of Endometrial Biopsy on in Vitro Fertilization Pregnancy Rates - a Randomized, Multicenter Study

Resource links provided by NLM:

Further study details as provided by Jon Havelock, Pacific Centre for Reproductive Medicine:

Primary Outcome Measures:
  • Clinical Pregnancy Rate [ Time Frame: Five weeks gestation, as dated from the egg retrieval ]
    Clinical pregnancy rate, defined as transvaginal ultrasound documentation of fetal heartbeat at five weeks gestation.

Secondary Outcome Measures:
  • Implantation Rate [ Time Frame: Five weeks gestation, as dated from the egg retrieval ]
    The number of gestational sacs seen at ultrasound, divided by the total number of embryos transferred

  • Live Birth Delivery Rate [ Time Frame: Within twelve months of the cycle start date ]
    Live birth delivery rate will be the number of live birth deliveries expressed per 100 initiated cycles, aspiration cycles or embryo transfer cycles, for which the denominator (initiated, aspirated or embryo transfer cycles) will be specified. Live birth delivery will include deliveries that resulted in at least one live birth. The delivery of a singleton, twin or other multiple births will be registered as one delivery.

  • Fertilization Rate [ Time Frame: 24 hours after egg retrieval ]
    Fertilization rate will be the number of zygotes resulting from insemination by IVF or injection by intracytoplasmic sperm injection, expressed as a ratio to the total number of oocytes inseminated or injected.

  • Normal Fertilization Rate [ Time Frame: 24 Hours from egg retrieval ]
    Normal fertilization rate will be the number of normal zygotes resulting from insemination by IVF or injection by ICSI, expressed as a ratio to the total number of oocytes inseminated or injected.

  • Endometrial Thickness [ Time Frame: Day of administration of human chorionic gonadotropin (8-12 days into ovarian stimulation) ]
    As assessed by transvaginal ultrasound, the maximum dimension of the endometrial cavity echo in an antero-posterior plane.

  • Endometrial Pattern [ Time Frame: Day of administration of human chorionic gonadotropin (8-12 days into ovarian stimulation) ]
    The endometrial pattern will be categorised as either trilaminar (triple stipe pattern) or hyperechoic (diffusely echogenic)at the time of transvaginal ultrasound assessment.

  • Percentage of subjects with embryos cryopreserved [ Time Frame: At the latest, day 6 after egg retrieval ]
    Total number of participants with embryos in excess, that met criteria for cryopreservation

  • The number of embryos cryopreserved per subject [ Time Frame: At the latest, day 6 after egg retrieval ]
    The number of embryos each individual participant had in excess, meeting criteria for cryopreservation

Enrollment: 52
Study Start Date: January 2013
Study Completion Date: April 2016
Primary Completion Date: January 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Endometrial Biopsy
Endometrial biopsy performed within 5-10 days prior to starting controlled ovarian stimulation, as part of in vitro fertilization treatment.
Device: Endometrial Biopsy
An endometrial biopsy is performed using a sampling device known as a pipelle catheter which is introduced into the uterine cavity. The inner core is withdrawn creating suctional pressure into the hollow bore of the cavity, which allows acquisition of endometrial tissue upon rotation in the cavity. This is removed and the tissue sent for pathologic examination.
Other Names:
  • Endometrial pipelle biopsy
  • Endometrial sampling
No Intervention: Without Biopsy
Those proceeding with in vitro fertilization routinely, without an endometrial biopsy.

Detailed Description:

Although the data are preliminary, there are studies suggesting that mild endometrial trauma in the cycle preceding IVF increases pregnancy rates, at least in women with recurrent implantation failure. Whether endometrial biopsy could promote implantation and improve pregnancy rates in the larger population of women undergoing IVF has yet to be explored. The present study will address this question and examine the impact of endometrial biopsies on IVF outcomes in the context of a randomized controlled trial.

The optimal timing of the endometrial biopsy in the cycle preceding IVF has not been determined, but the majority of the studies have included a biopsy in the mid-luteal phase of the preceding cycle. In order to allow an adjuvant therapy to IVF that would be considered tolerable to a subject, and applicable to a large infertile women population, it was determined that a single endometrial biopsy, performed approximately 1 week prior to the start of controlled ovarian hyperstimulation (COH) in an IVF cycle, would be the simplest, most flexible, and generalizable intervention to study its effects on pregnancy rates. All other components of the IVF treatment will remain constant with approximately 8-12 days of ovarian stimulation, human chorionic gonadotrophin (HCG) trigger being administered in that time frame and oocyte retrieval occuring 36 hours later from trigger. The embryo transfer will take place either day 3 or day 5 after oocyte retrieval.


Ages Eligible for Study:   18 Years to 39 Years   (Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

Women undergoing first or second IVF cycle, with or without ICSI

  • Age 18-39
  • BMI 18-35 kg/m2
  • Uterine cavity evaluation (hysterosalpingogram, sonohysterogram, hysteroscopy) in the preceding 24 months
  • Early follicular phase (Day 2 or Day 3) serum FSH, evaluated in the preceding 6 months

ONE of the following:

  • Non- oral contraceptive pill (non-OCP) subjects: Documented LH surge 9-11 days prior to enrollment
  • Current OCP subjects: OCP use for ≥ 10 days
  • Use of long GnRH agonist or GnRH antagonist protocol
  • Subject able to give informed consent

Exclusion Criteria:

  • Prior enrolment in this study
  • Any prior early follicular phase serum FSH level ≥12 IU/L
  • Previous poor ovarian response, defined as prior IVF cycle cancelled for poor response, or ≤4 oocytes retrieved
  • IVF for pre-implantation genetic diagnosis (PGD) or fertility preservation
  • Diabetes mellitus or uncontrolled thyroid disease
  • Abnormal uterine cavity, such as unresected submucosal fibroids, uterine septum, Mullerian anomaly such as bicornuate or unicornuate uterus or intrauterine adhesions
  • Hydrosalpinx that has not been removed or surgically ligated
  • Any contraindication to endometrial biopsy
  • Office hysteroscopy or other uterine procedure planned or performed during cycle preceding IVF stimulation
  • Use of surgically retrieved sperm
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01983423

Canada, British Columbia
Pacific Centre for Reproductive Medicine
Vancouver, British Columbia, Canada, V5G 4X7
Canada, Ontario
Mt. Sinai Hospital Centre for Fertility and Reproductive Health
Toronto, Ontario, Canada, M5T 2Z5
Sponsors and Collaborators
Jon Havelock
Principal Investigator: Jon C Havelock, MD Pacific Centre for Reproductive Medicine and University of British Columbia
  More Information

Katz VL. Diagnostic procedures. Imaging, endometrial sampling, endoscopy: indications and contraindications, complications. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology . 5th ed. Philadelphia, Pa: Mosby; 2007.

Responsible Party: Jon Havelock, Principal investigator, Pacific Centre for Reproductive Medicine Identifier: NCT01983423     History of Changes
Other Study ID Numbers: EndoBx- IVF
Study First Received: April 12, 2013
Last Updated: April 7, 2017

Keywords provided by Jon Havelock, Pacific Centre for Reproductive Medicine:
Endometrial Biopsy
Endometrial Sampling
In Vitro Fertilization

Additional relevant MeSH terms:
Genital Diseases, Male
Genital Diseases, Female processed this record on September 20, 2017