#VisualAbstract: A Randomized Trial of Endometrial Scratching before In Vitro Fertilization

1. This multicenter randomized control study showed that there were no significant differences in live birth rates between women undergoing in vitro fertilization (IVF) who had endometrial scratching performed prior to embryo transfer and women who had no intervention.

2. The scratch procedure was associated with mild pain and a small number of adverse events including intense pain, dizziness, nausea and bleeding.

Evidence Rating Level: 1 (Excellent)

Study Rundown: In vitro fertilization has gained momentum as a viable option for couples with infertility concerns. However, despite modern advancements in the procedure, success rates for IVF remain modest. Endometrial scratching with a pipelle has been proposed as a method to increase the success rate of IVF, however more data is needed to understand the effects of this procedure on live birth rates. In the Pipelle for Pregnancy (PIP) study, researchers examined the comparative effects of endometrial scratching versus no intervention on IVF live birth rates. The primary outcome was the live birth rate per woman in each study arm. Overall, researchers did not note any difference in live-birth rates between women who underwent endometrial scratching versus women who had no intervention. They also noted that women who had previously failed an IVF trial did not derive any marginal benefit from the procedure.

This large randomized trial concluded that there may not be much benefit derived from this procedure prior to embryo transfer, and the robust subgroup analysis showing no specific patient populations benefiting from the procedure further supports this conclusion. Notable limitations include lack of recording of pain scores during procedures in the control group and infeasibility to blind study participants.

Click to read the study in NEJM

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