To scratch or not to scratch?

Image of two women talking at a desk

Fertility specialists constantly look for ways to improve the chance of pregnancy for people who use IVF and other assisted reproductive techniques (ART) to have a baby. In the last few years a number of so called adjuvant therapies, meaning procedures which are added to a particular treatment to try to improve its outcome, have been developed by fertility clinics and are offered to  patients.

One such adjuvant therapy is the so called endometrial scratching. In this procedure the fertility specialist uses an instrument to ‘scratch’ the lining in the uterus in the month before the woman has IVF treatment. The thinking behind this is that the healing process will improve the lining in the uterus in the following month and make it easier for the embryo to implant and thereby improve the chance of pregnancy. While some studies have found this, a recent randomised controlled trial found that it actually reduces the chance. Randomised controlled trials are considered the most accurate method for finding out if having a new treatment is better or worse than not having it. This is because these trials involve one group of people who are given the new treatment and a control group who doesn’t and they can then be compared.

In this trial the researchers had planned to include 358 women, half of whom were to have the endometrial scratching in the month before they had IVF treatment and the other half to have IVF without having the endometrial scratching.  But by the time they had recruited 191 women, they stopped the trial because when they looked at the data for the 132 women who had reached the embryo transfer stage, they could see that the endometrial scratching group had a significantly lower pregnancy rate than the control group.

All the women in this study were having their first or second IVF cycle and the researchers concluded that, while endometrial scratching was not helpful for them, more research is needed to find out if it might help women who have had several unsuccessful IVF cycles. So, before you agree to have endometrial scratching as part of your IVF treatment, ask your doctor these five questions:

                                                

 Source: Frantz S, et al. Decrease in pregnancy rate after endometrial scratch in women undergoing a first or second in vitro fertilization. A multicenter randomized controlled trial. Human Reproduction 2018:dey334-dey