Endometrial scratch in women undergoing first-time IVF treatment: a systematic review and meta-analysis of randomized controlled trials

Abstract

The endometrial scratch (ES) procedure is an IVF 'add-on' that is sometimes provided prior to the first IVF cycle. A 2019 systematic review concluded that there was insufficient evidence regarding whether the ES has a significant effect on pregnancy outcomes (including live birth rate, LBR) when undertaken prior to the first IVF cycle. Further evidence has been published following this review, including the Endometrial Scratch Trial (ISRCTN23800982). The objective of this review was to synthesise and critically appraise the evidence for the clinical effectiveness and safety of the ES procedure in women undergoing their first IVF cycle. Databases searched include MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov. Eligible RCTs included women undergoing IVF for the first time that reported the effectiveness and/or safety of the ES procedure. Twelve studies were included. Meta-analysis showed no evidence of a significant effect of the ES on LBRs (10 trials, odds ratio [OR] of 1.17, 95% confidence interval [CI], 0.76 to 1.79), and other pregnancy outcomes. This review confirms that there is a lack of evidence that ES improves pregnancy outcomes, including LBR, for women undergoing their first IVF cycle. Clinicians are recommended not to perform this procedure in individuals undergoing their first cycle of IVF.

Endometrial scratch injury in infertile women undergoing in vitro fertilization cycles: a systematic review and meta-analysis

“…One study was conducted in five countries, 14 and another study was conducted in two countries. 20 The remaining 39 studies were conducted in one country (7 in Iran, 21,23–28 5 in Egypt, 4,16,19,29,30 4 in China, 22,31–33 3 in India, 34–36 3 in Turkey, 37–39 2 in the United kingdom, 13,40 2 in Hong Kong, 41,42 2 in Denmark, 15,43 2 in the USA, 44,45 and 1 each in Brazil, 46 Belgium, 47 France, 17 Israel, 48 Italy, 49 The Netherlands, 12 Poland, 50 and Spain). 51 The timing of ESI was not the same in all studies.…”

“…All studies were in the English language. Eleven RCTs were multicenter studies (1/32 centers, 12 1/16 centers, 13 1/13 centers, 14 1/4 centers, 15 3/3 centers, [16][17][18] and 4/2 centers [19][20][21][22] ), while the remaining 30 studies were in a single center. One study was conducted in five countries, 14 and another study was conducted in two countries.…”

Effectiveness of endometrial scratching in infertility treatment with assisted reproductive technologies

“…Дальнейшие наблюдения показали противоречивые результаты. Однако многие работы, не выявившие преимуществ локального повреждения слизистой оболочки матки, выполнялись в неселективной популяции либо у женщин, проходивших первый цикл ВРТ [9,10,17,32,34,45], а также имели высокий риск ошибки. В недавнем исследовании проводилась оценка методологических проблем в 25 РКИ, посвященных влиянию скретчинга эндометрия на результаты программ ЭКО [46].…”

Endometrial scratching: less invasive methods should be tried first

“…Endometrial scratching: less invasive methods should be tried first Jan Tesarik 1, * I read with interest the article by Metwally et al (2022) and the related editorial by Palomba and Macklon (2022), both calling into question the usefulness of performing endometrial scratching to enhance endometrial thickness and pregnancy rates in patients undergoing IVF. Based on a systematic review and meta-analysis of randomized controlled trials, Metwally et al (2002) conclude that there is a lack of evidence that endometrial scratching improves pregnancy outcomes for women undergoing a first IVF cycle.…”