Endometrial scratch has no effect on live birth rate for first time IVF patients

Endometrial scratch, an IVF add-on treatment, has no effect on live birth rate for women undergoing a first IVF or intracytoplasmic sperm injection (ICSI) cycle, study shows. Endometrial scratch involves 'injuring' the lining of the uterus in the hope of improving embryo implantation and subsequent live birth rate.

The data from a large-scale randomised controlled clinical trial involving more than 1000 women at 16 UK centres was presented at the 2020 virtual meeting of the European Society for Human Reproduction and Embryology.

Women in the study were under 37, having their first cycle of IVF and were expected to be good responders. The scratch was performed in the mid-luteal phase of their menstrual cycle prior to IVF.

Results showed no difference in live birth rate between women having the endometrial scratch (38.6 percent) and women having IVF with no scratch (37.1 percent). The study also found no difference between the two treatment groups in terms of clinical pregnancy rate, embryo implantation rate and obstetric complications.

Chief investigator Mostafa Metwally from Sheffield Teaching Hospitals and the University of Sheffield, UK said: 'In first time IVF patients, we should not be doing endometrial scratch. There's no evidence that endometrial scratch in this group of women – first time IVF patients – will increase live birth rate. We have to draw the line here: we have shown no effect and I think we need to stop offering it on a routine clinical basis.'

Metwally stated that the strength of the research lies in its homogeneous study population, which leaves results less open to bias. 'Our study is the largest and most conclusive study in women having first time IVF treatment, and the findings conclusively indicate that the practice of performing scratch in this group should stop,' he said.

Professor Yacoub Khalaf, Professor of reproductive medicine and surgery, King's College, London, told BioNews: 'This large and well-designed multi-centre UK study confirms that the widely practised procedure of scratching the lining of the uterus is of no value in improving the success of IVF. I have no doubt every penny of the taxpayers' money spent on this research is worthwhile, as its results, add strength to the evidence from previous studies, and empowers assisted reproduction specialists to stop offering this procedure to prospective IVF patients as it adds no value and it only adds to the costs of treatment.

'The results of this study would benefit IVF patients world-wide by hopefully removing, once and for all, this so-called add-on from a long list that should be subjected to research as rigorous as this study so that only evidence-based interventions are used in patients' treatment. We are very proud that our centre contributed to this important study that now should earn endometrial scratching a red colour on the Human Fertilisation and Embryology Authority's traffic light system as scratching has proved ineffective.'