***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To explore the possibility that endometrial injury modulates the expression of specific genes that may increase uterine receptivity . DESIGN Controlled clinical study . SETTING Clinical IVF unit and academic research center . PATIENT(S ) IVF patients with 28- to 30-day menstrual cycles . INTERVENTION(S ) Endometrial biopsies from two groups of patients were collected on days 20 - 21 of their spontaneous menstrual cycle . The experimental , but not the control , group underwent biopsies on days 11 - 13 and 21 - 24 of their preceding cycle . MAIN OUTCOME MEASURE(S ) Global endometrial gene expression and specific analysis of uroplakin Ib ( UPIb ) mRNA level throughout the menstrual cycle . RESULT ( S ) Local injury modulated the expression of a wide variety of genes . One of the prominently up-regulated genes was the bladder transmembranal protein , UPIb , whose expression by the endometrium is shown here for the first time . Endometrial UPIb mRNA increases after biopsy in the same cycle wct 2with an additional elevation in the following cycle . Immunohistochemical analysis localized the UPIb protein to the gl and ular-epithelial cells . Genes encoding other membrane proteins such as adipose differentiation-related protein and mucin 1 , transmembrane , were also up-regulated . CONCLUSION ( S ) The biopsy-induced increase in the expression of UPIb and other genes encoding membrane proteins supports the possible importance of the membrane structure and stability during implantation . The specific role of UPIb in uterine receptivity should be eluci date OBJECTIVE To evaluate hysteroscopic findings and estimate the effect of hysteroscopy  on achieving a pregnancy in women with a history of 2 implantation failures after in vitro fertilization ( IVF ) . DESIGN Prospect i ve observational and matched case control study . DESIGN CLASSIFICATION II-2 . SETTING Private assisted reproduction units . PATIENTS A total of 1475 patients with a history of 2 consecutive implantation failures after IVF who had a hysteroscopy were studied ; there were 414 matched pairs of women with a similar history who either had or did not have a hysteroscopy . INTERVENTIONS Hysteroscopy ( diagnostic or operative ) , IVF/intracytoplasmic sperm injection cycle . MEASUREMENTS AND MAIN RESULTS Hysteroscopic findings , clinical pregnancy rate ( CPR ) , and ongoing pregnancy rate ( OPR ) were measured . In all , 36.6 % of the study population had abnormal hysteroscopic findings and 22.2 % had unsuspected findings ; women with abnormal hysteroscopic findings showed significantly increased CPR and increased OPR in a new IVF cycle compared with those with a normal hysteroscopy result . Women who had a hysteroscopy showed significantly increased CPR and OPR compared with matched control subjects who did not have the procedure . Hysteroscopy and appropriate therapy significantly increased the chances of achieving a subsequent clinical and ongoing pregnancy . CONCLUSION Women with 2 implantation failures after IVF had a remarkably high possibility for unsuspected abnormalities seen at hysteroscopy . Hysteroscopy could serve as a positive prognostic factor for achieving a subsequent pregnancy BACKGROUND : Management of repeated implantation failure despite transfer of good- quality embryos still remains a dilemma for ART specialists . Scrapping of endometrium in the nontransfer cycle has been shown to improve the pregnancy rate in the subsequent IVF/ET cycle in recent studies . AIM : The objective of this r and omized controlled trial ( RCT ) was to determine whether endometrial injury caused by Pipelle sampling in the nontransfer cycle could improve the probability of pregnancy in the subsequent IVF cycle in patients who had previous failed IVF outcome . SETTING : Tertiary assisted conception center . DESIGN : R and omized controlled study . MATERIAL S AND METHODS : 100 eligible patients with previous failed IVF despite transfer of good- quality embryos were r and omly allocated to the intervention group and control groups . In the intervention group , Pipelle endometrial sampling was done twice : One in the follicular phase and again in the luteal phase in the cycle preceding the embryo transfer cycle . OUTCOME MEASURE : The primary outcome measure was live birth rate . The secondary outcome measures were implantation and clinical pregnancy rates . RESULTS : The live birth rate was significantly higher in the intervention group compared to control group ( 22.4 % and 9.8 % P = 0.04 ) . The clinical pregnancy rate in the intervention group was 32.7 % , while that in the control group was 13.7 % , which was also statistically significant ( P = 0.01 ) . The implantation rate was significantly higher in the intervention group as compared to controls ( 13.07 % vs 7.1 % P = 0.04 ) . CONCLUSIONS : Endometrial injury in nontransfer cycle improves the live birth rate , clinical pregnancy and implantation rates in the subsequent IVF-ET cycle in patients with previous unsuccessful IVF cycles Background To test whether a site-specific hysteroscopic biopsy-induced injury in the endometrium during the controlled ovarian hyperstimulation cycle improves subsequent embryo implantation in patients with repeated implantation failure , a total of 30 patients who have had good responses to controlled ovulation stimulation but have failed to achieve pregnancy after two or more transfers of good- quality embryos were recruited in this prospect i ve study . Methods A single , site-specific hysteroscopic biopsy-induced injury was generated on the posterior endometrium at midline 10 - 15 mm from the fundus during the D4-D7 period of the ongoing controlled ovarian hyperstimulation cycle in six patients . Results Patients received  endometrial biopsy protocol achieved a pregnancy rate of 100 % . By contrast , only 46 % of patients with similar clinical characteristics ( N = 24 ) achieved pregnancy without the hysteroscopic biopsy-induced endometrium injury ( p < 0.05 ) . Conclusions Our proof-of-concept study demonstrates that a site-specific hysteroscopic endometrium injury performed during the ongoing in vitro fertilization ( IVF ) cycle , instead of injuries received during prior cycles , significantly improves clinical outcomes in patients with repeated implantation failure BACKGROUND In this prospect i ve r and omized blinded clinical trial , we examined gene expression profiles of the human endometrium during the early and mid-luteal phases of the natural cycle . METHODS An  endometrial biopsy  was performed on day 16 ( LH + 3 ) or on day 21 ( LH + 8) , followed by RNA extraction and microarray analysis using an Affymetrix HG-U95A microchip . Data analysis was carried out using pairwise multiple group comparison with the significance analysis of microarrays ( SAM ) software . RESULTS With a false discovery rate of 0 , the analysis revealed that 107 genes were significantly and differently expressed ( > or = 2-fold ) during the early versus the mid-luteal phase of the cycle . Forty-five of these genes have not been previously linked to endometrial receptivity . Validation of the microarray data was accomplished using semiquantitative RT-PCR . We demonstrated the presence of estrogen and progesterone response elements ( ERE and PRE ) by analysis of the 5'-flanking regions of a subset of differentially regulated genes . CONCLUSIONS Using a strict bioinformatics approach of microarray data , we demonstrated significant changes in c and i date genes during the transition of the early to the mid-luteal phase of the human endometrium that may have functional significance for the opening and maintenance of the window of implantation OBJECTIVE To study whether an injury-induced inflammation might be the mechanism underlying the favorable effect of endometrial biopsy on the implantation rate in in vitro fertilization ( IVF ) patients . DESIGN Controlled clinical study . SETTING A medical center IVF unit and a research institute . PATIENT(S ) Women undergoing IVF who had previous failed treatment cycles . INTERVENTION(S ) Endometrial sample s were collected from two groups of patients on day 21 of their spontaneous menstrual cycle . The experimental , but not the control group underwent prior biopsy treatment on days 8 or/ and 11 to 13 of that same cycle . MAIN OUTCOME MEASURE(S ) Abundance of immune cells , cytokines/chemokines level , correlation between these parameters and pregnancy outcome . RESULT ( S ) A statistically significantly higher amount of macrophages/dendritic cells ( HLA-DR+ CD11c+ cells ) and elevated proinflammatory cytokines , tumor necrosis factor-α ( TNF-α ) , growth-regulated oncogene-α ( GRO-α ) , interleukin-15 ( IL-15 ) , and macrophage inflammatory protein 1B ( MIP-1B ) , were detected in day-21 endometrial sample s of the experimental group . A direct stimulatory effect of TNF-α on MIP-1B , GRO-α , and IL-15 messenger RNA ( mRNA ) expression was demonstrated . A positive correlation was found between the levels of macrophages/dendritic cells , MIP-1B expression , and TNF-α expression and the pregnancy outcome . CONCLUSION ( S ) A biopsy-induced inflammatory response may facilitate the preparation of the endometrium for implantation . Increased MIP-1B expression could possibly serve for prediction of implantation competence The study was conducted to evaluate if the diagnosis and treatment of intrauterine lesions with office hysteroscopy is of value in improving the pregnancy outcome in patients with recurrent in-vitro fertilization and embryo transfer failure . Four hundred and twenty-one patients who had undergone two or more failed IVF-embryo transfer cycles were prospect ively r and omized into two groups . Group I ( n = 211 ) did not have office hysteroscopic evaluation , Group II ( n = 210 ) had office hysteroscopy . The patients who had normal hysteroscopic findings were included in Group IIa ( n = 154 ) and patients who had abnormal hysteroscopic findings were included in Group IIb ( n = 56 ) . Intrauterine lesions diagnosed were operated during the office procedure . Fifty-six ( 26 % ) patients in Group II had intrauterine pathologies and the treatment was performed at the same time . No difference existed in the mean number of oocyte retrieved , fertilization rate , number of embryos transferred or first trimester abortion rates among the patients in groups . Clinical pregnancy rates in Group I , Group IIa and Group IIb were 21.6 % , 32.5 % and 30.4 % respectively . There was a significant difference in the clinical pregnancy rates between patients in Group I and Group IIa ( 21.6 % and 32.5 % , P = 0.044 , respectively ) and Group I and Group IIb ( 21.6 % and 30.4 % , P = 0.044 , respectively ) . There was no significant difference in the clinical pregnancy rate of patients in Groups IIa and IIb . Patients with normal hysterosalpingography but recurrent IVF-embryo transfer failure should be evaluated prior to commencing IVF-embryo transfer cycle to improve the clinical pregnancy rate Objective : The aim of the study was to evaluate if the diagnosis and treatment of uterine cavity abnormalities by hysteroscopy in patients undergoing IVF programme is of any value in improving clinical pregnancy outcome . Methods : 520 patients participated in this prospect i ve r and omized study and were classified into two groups . Group I ( n = 265 ) without office hysteroscopy . Group II ( n = 255 ) had office hysteroscopy and was sub classified into Group II a and Group II b. Group II a ( n = 160 ) had normal hysteroscopic findings whereas Group II b ( n = 95 ) had abnormal office hysteroscopy findings , which were corrected at the same time . Result : There was no difference in the mean number of oocytes retrieved , fertilization rate , and number of embryos transferred among the patients in different groups . Statistically significant difference was observed in terms of clinical pregnancy rates between Group I and Group II a ( 26.2 and 44.44 % , P < 0.05 ) , and Group I and Group II b ( 26.2 and 39.55 % , P < 0.05 ) , respectively . Conclusion : Patients with recurrent IVF embryo transfer failures after normal hysterosalpingography findings should also be reevaluated using hysteroscopy prior to further commencing IVF-embryo transfer cycles in order to enhance the clinical pregnancy rates OBJECTIVE To study the incidence of unsuspected endouterine abnormalities in patients for whom IVF-ET repeatedly fails . DESIGN Prospect i ve study . SETTING Infertility Unit of the Department of Obstetrics and Gynecology , Arcispedale Santa Maria Nuova , Reggio Emilia , Italy . PATIENT(S ) One hundred patients for whom two IVF-ET cycles failed in which > or = 2 good- quality embryos were transferred . INTERVENTION(S ) In-office diagnostic hysteroscopy and endometrial biopsy . MAIN OUTCOME MEASURE(S ) Relation between IVF-ET failure and unsuspected endouterine abnormalities . RESULT ( S ) In 18 patients , hysteroscopy showed an important unsuspected endouterine abnormality . Fifteen of these patients did not become pregnant after IVF-ET , and 3 became pregnant but had a spontaneous abortion . Histologic examination of the endometrium revealed chronic endometritis in 1 patient and tuberculous endometritis in another . CON 
    Output:
    
The evidence is strongly in favour of inducing local endometrial injury in the preceding cycle of ovarian stimulation to improve pregnancy outcomes in women with unexplained RIF .
Studies have shown that inducing injury to the lining of the womb in the cycle before starting ovarian stimulation for IVF can help improve the chances of achieving pregnancy .
Injury can be induced by either scratching the lining of the womb using a biopsy tube or by telescopic investigation of the womb using a camera .
This study suggests that in women with RIF , inducing local injury to the womb lining in the cycle prior to starting ovarian stimulation for IVF can improve pregnancy outcomes .