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

Abstract

Objective This study aimed to evaluate the effect of endometrial scratch injury (ESI) in infertile women undergoing in vitro fertilization (IVF). Methods We screened MEDLINE, CENTRAL, EMBASE, Web of Science, and the Cochrane Central Register from inception to April 2023 using keywords related to endometrial scratch, implantation, infertility, and IVF. We included 41 randomized, controlled trials of ESI in IVF cycles (9084 women). The primary outcomes were the clinical pregnancy, ongoing pregnancy, and live birth rates. Results The clinical pregnancy rate was reported in all 41 studies. The odds ratio (OR) for the clinical pregnancy rate had an effect estimate of 1.34 with a 95% confidence interval (CI) of 1.14 to 1.58. The live birth rate was reported in 32 studies with 8129 participants. The OR for the live birth rate had an effect estimate of 1.30 with a 95% CI of 1.06 to 1.60. The multiple pregnancy rate was reported in 21 studies with 5736 participants. The OR for the multiple pregnancy rate had an effect estimate of 1.35 with a 95% CI of 1.07 to 1.71. Conclusion ESI increases the clinical pregnancy, ongoing pregnancy, live birth, multiple pregnancy, and implantation rates in women undergoing IVF cycles.

Comparison of Two Types of Endometrial Scratch before Embryo Transfer and Patient-Reported Pain Scores: A Prospective Randomized Pilot Study

“…Findings from this study suggest that patients who underwent endometrial scratch using the Shepard catheter have significantly lower pain scores compared to those who underwent the Pipelle. Low to moderate pain and discomfort are commonly reported by patients who received the Pipelle for endometrial biopsy (7,8,10). However, to our knowledge, no prior studies have assessed pain scores and ART outcomes using the Shepard catheter compared to the standard Pipelle.…”

“…In a systematic review of 12 studies involving 3,382 participants undergoing their first cycle of IVF, endometrial scratch had no significant effect on clinical pregnancy rates, and any minimal observed effects on implantation rates was deemed unreliable (9). However, a recent meta-analysis of 41 randomized control trials found that endometrial scratch improved implantation and clinical pregnancy rates in patients undergoing IVF when conducted during the follicular or luteal phase (8). Consequently, our study highlights the importance of optimizing endometrial scratch procedures to reduce patient discomfort, a valuable clinical consideration when the efficacy of specific techniques appears limited.…”

“…Endometrial scratch, a procedure that involves intentional disruption of the endometrium prior to embryo transfer, may increase endometrial receptivity and implantation (4)(5)(6). However, while some studies suggest that endometrial scratch prior to embryo transfer may improve implantation rates and clinical pregnancy rates, patients report experiencing moderate pain and discomfort during the endometrial scratch procedure (6)(7)(8)(9)(10) Endometrial scratch is associated with significantly higher pain scores compared to patients who did not receive endometrial scratch during ART (11). In a multicenter randomized control trial of 1,364 patients, the median pain score reported by patients who underwent endometrial scratch was 3.5 out of 10 on a visual analogue scale (IQR=1.9-6.0) (Lensen, 2019).…”