BACKGROUND AND PURPOSE:

• Success of IVF ranges between 25 to 30%/cycle
• Endometrial scratching
  • Endometrial biopsy (or ‘scratch’) to induce inflammatory reaction
  • Postulated that inflammatory reaction may improve implantation rates by inducing immunologic mechanisms
• Lensen et al. (N Eng J Med., 2019) sought to determine whether endometrial scratching prior to in vitro fertilization (IVF) increased probability of pregnancy

METHODS:

• Pragmatic, multicenter, open-label, randomized, controlled trial (RCT)
  • Pipelle for Pregnancy (PIP) trial
• Participants
  • Women undergoing IVF (fresh and frozen embryo)
  • Protocol determined by local clinical practice
  • No recent exposure to disruptive intrauterine instrumentation
• Patients received either
  • Endometrial scratching (pipelle) biopsy between day 3 of the cycle preceding the embryo-transfer cycle and day 3 of the IVF cycle
  • No intervention
• Primary outcome: Live birth
• Secondary outcomes included
  • Ongoing pregnancy (at 12 weeks) | Clinical pregnancy | Multiple gestation | Ectopic Pregnancy | Biochemical Pregnancy | Miscarriage, Stillbirth and termination | Procedure pain (on a scale of 0 to 10 with higher scores indicating worse pain) | Bleeding post procedure | Maternal and newborn outcomes

RESULTS:

• 1,364 women were included
• Frequency of live birth
  • Endometrial-scratch group: 180 of 690 women (26.1%)
  • Control group: 176 of 674 women (26.1%)
  • adjusted odds ratio (OR) 1.00 (95% CI, 0.78 to 1.27)
  • Number of previous failed implantations (≥2 failures) did not alter results
• There were no significant between-group differences for the following rates
  • Ongoing pregnancy
  • Clinical pregnancy
  • Multiple pregnancy
  • Ectopic pregnancy
  • Miscarriage
• The median score for pain for endometrial scratching
  • 3.5 (interquartile range, 1.9 to 6.0)
• Further analysis did not identify any subgroup populations who could potentially benefit from endometrial scratching
• There were 14 adverse reactions
  • During procedure: Excessive pain (5) | Faint or dizzy (7) | Excessive bleeding (2)
  • No adverse events, including infection, noted post-procedure

CONCLUSION:

• Authors recognize limitation related to lack of blinding
• However, results indicate that endometrial scratching does not increase the rate of live births among women undergoing IVF but is associated with mild pain and small rate of adverse events

Learn More – Primary Sources:

A Randomized Trial of Endometrial Scratching before In Vitro Fertilization.

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