A Randomized Trial of Endometrial Scratching before In Vitro Fertilization

Abstract

BACKGROUNDEndometrial scratching (with the use of a pipelle biopsy) is a technique proposed to facilitate embryo implantation and increase the probability of pregnancy in women undergoing in vitro fertilization (IVF). METHODSWe conducted a pragmatic, multicenter, open-label, randomized, controlled trial. Eligible women were undergoing IVF (fresh-embryo or frozen-embryo transfer), with no recent exposure to disruptive intrauterine instrumentation (e.g., hysteroscopy). Participants were randomly assigned in a 1:1 ratio to either endometrial scratching (by pipelle biopsy between day 3 of the cycle preceding the embryotransfer cycle and day 3 of the embryo-transfer cycle) or no intervention. The primary outcome was live birth. RESULTSA total of 1364 women underwent randomization. The frequency of live birth was 180 of 690 women (26.1%) in the endometrial-scratch group and 176 of 674 women (26.1%) in the control group (adjusted odds ratio, 1.00; 95% confidence interval, 0.78 to 1.27). There were no significant between-group differences in the rates of ongoing pregnancy, clinical pregnancy, multiple pregnancy, ectopic pregnancy, or miscarriage. The median score for pain from endometrial scratching (on a scale of 0 to 10, with higher scores indicating worse pain) was 3.5 (interquartile range, 1.9 to 6.0). CONCLUSIONSEndometrial scratching did not result in a higher rate of live birth than no intervention among women undergoing IVF.

Therapeutic endometrial scratching and implantation after in vitro fertilization: a multicenter randomized controlled trial

“…However, subgroup analyses indicate an increase in the clinical pregnancy rate in women with three or more previous implantation failures. These results are consistent with previous research that reported that women with RIF in particular may benefit from endometrial scratching (5,(8)(9)(10)12), while no significant improvement could be demonstrated in unselected subfertile women (11,13,15).…”

“…This led to the first published study on 134 patients, which showed a twofold increase in live birth rate (48.9% vs 22.5 %) (5). Subsequently, a number of studies have indicated a potential clinical value of this intervention (4,6,7), particularly in repeated implantation failure (RIF) patients (5,(8)(9)(10), while others failed to detect a benefit in patients, mainly in those undergoing their first or second IVF attempt (11)(12)(13)(14)(15). In contrast, a randomized controlled trial (RCT) showed that endometrial scratching carried out on the day of oocyte pickup resulted in a reduction of approximately two-thirds in the implantation rate in comparison with the control group (16).…”

“…Only a few studies (4,6,11,15) reported live birth rates, and only one study reported prenatal and birth data on the children born (15). Furthermore, only two studies had adequate power to draw reliable conclusions (11,15).…”

Effect of endometrial injury during menstruation on clinical outcomes in frozen–thawed embryo transfer cycles: A randomized control trial

“…In is important to point out that in 2019, Lensen et al conducted a pragmatic, multicenter, open-label, randomized, controlled trail including 1364 patients, which showed that performing EI between day 3 of the cycle preceding the IVF cycle and day 3 of the IVF cycle did not result in a higher rate of live birth compared to control group for patients treated with IVF. 36 The incompatibility between their results and our study probably originates from aspects such as differences in population selection (such as ethics, ages, medical history), study design and duration of ET after EI. More studies are needed to further test such ideas.…”

Endometrial receptivity and implantation in women with previous failed embryo transfers: to scratch or not to scratch?

“…On the other hand, a large RCT of 1,362 women published by Lensen et al (4) showed the same live-birth rates (26.1%) in the scratch and control groups, and failed to find a positive effect from scratching 1 month preceding ovarian stimulation in a subgroup analysis of women with R2 RIFs. The investigators therefore concluded that we should stop offering endometrial scratching to patients due to a lack of overall benefit.…”