Endometrial scratching for infertility: The never-ending story

Infertility, defined as the absence of spontaneous conception after 12 months of unprotected sexual intercourses, is a major public health issue. It is estimated that up to 15% of couples suffer from infertility and that most of them will refer for counselling to infertility specialists. Concurrently, the demands for assisted reproduction techniques are steadily increasing worldwide. Endometrial scratching is an intentional endometrial injury offered to infertile women with the purpose of enhancing endometrial receptivity before intrauterine insemination or embryo transfer. Endometrial scratching is a simple and low-cost procedure that consists in a voluntary mechanical disruption of endometrial lining, with minor patients' discomfort. Whilst the data about the effectiveness of endometrial scratching in intrauterine insemination is low but coherent, there is a great deal of confusion about the role of endometrial scratching before IVF-embryo transfer cycles. The aim of this commentary is to summarize the current evidence about the effectiveness of endometrial scratching before assisted reproduction techniques and future perspectives about the use of this technique in infertile women.