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.