Scratching the surface of improved IVF success

A procedure called endometrial scratching significantly improves the clinical pregnancy rate – including the numbers of babies born – when performed just once in women who are undergoing assisted reproductive treatment, a study has found.

Results from the clinical trial, undertaken by a team of Brazilian scientists in collaboration with Dr Nick Raine-Fenning of the Nottingham University Research and Treatment Unit (NURTURE), demonstrate a significant benefit to the timing of endometrial scratching, reporting an increase in the clinical pregnancy rate of women undergoing IVF and ICSI treatment to 49 percent, compared with the current average (29 percent).

The study, being presented at the ISUOG World Congress in Sydney, also found an increase in the number of live births from the current average of 23 percent to a reported 42 percent.

Study co-author Dr Raine-Fenning said: “This is the first well-designed trial conducted into endometrial scratching and the results are promising. Other trials have provided anecdotal evidence, but these have been limited, and many have questioned the validity of the technique. We are now carrying out a follow up study in Nottingham to provide further guidance into the use of endometrial scratching and early results are encouraging.”

Endometrial scratching, or injury, is defined as medically administered damage to the inner lining of the womb and was first demonstrated as a beneficial procedure in reproductive medicine in 2003.

However ‘scratching’ is an intrusive procedure and many people are still unsure as to how it works or indeed if it definitely does work. Furthermore, optimal timings and protocol for this intervention are yet to be clearly defined.

Up to 15 percent of women of reproductive age have problems conceiving and reproductive treatment failure is a cause of psychological distress for many couples.

Current attempts to improve reproductive treatments carry significant risks or are not financially viable. This clinical trial strived to determine the optimal timing of this promising intervention, simplifying protocols and minimising the impact to the patient.

The trial recruited 158 women, all of whom had previously received unsuccessful courses of reproductive treatment and, critically, were taking an oral contraceptive pill directly before the trial treatment commenced.

Of these women, 77 were randomised to either be in the control group or to receive the ‘scratching’ intervention, which was administered 7-14 days before core reproductive treatment began as part of standard pre-treatment gynaecological screening.

Of the 77 women, 39 achieved clinical pregnancy and 33 cases resulted in live births, compared with 23 live births in the control group.

The results of the clinical trial, which were published early online in the journal Ultrasound in Obstetrics & Gynecology, also demonstrated that endometrial scratching had no effect on miscarriage or multiple pregnancy rates compared with standard protocols.

Despite the widespread use of the technique, the mechanism behind the success of endometrial scratching remains unknown.

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