Impact of Endometrial Scratching on IVF/ICSI Outcomes: A Meta-Analysis

Area of Science:

• Reproductive Medicine
• Gynecology

Background:

• Infertility affects 17.5% globally, with assisted reproductive technologies (ART) showing limited success.
• Endometrial scratching (ES) is a debated procedure to improve implantation rates in ART.
• Conflicting evidence exists regarding the efficacy of ES in enhancing pregnancy outcomes.

Purpose of the Study:

• To systematically evaluate the effectiveness of endometrial scratching (ES) on pregnancy outcomes in women undergoing IVF or ICSI.
• To provide a meta-analysis of randomized controlled trials (RCTs) assessing ES prior to ART procedures.
• To determine the impact of ES on clinical pregnancy rate (CPR), live birth rate (LBR), and ongoing pregnancy rate (OPR).

Main Methods:

• Systematic literature search of PubMed, Cochrane Library, and Scopus databases.
• Inclusion of eight randomized controlled trials (RCTs) adhering to PRISMA guidelines.
• Meta-analysis of data from 3210 patients undergoing IVF or ICSI with ES in the preceding luteal phase.

Main Results:

• Endometrial scratching (ES) group showed a significantly higher clinical pregnancy rate (CPR) (RR 1.09, p=0.02).
• Pooled data revealed a significant increase in live birth rate (LBR) after ES (RR 1.12, p=0.01).
• Ongoing pregnancy rate (OPR) was also statistically significant in the ES group (RR 1.13, p=0.03).

Conclusions:

• Endometrial scratching (ES) demonstrates a small but statistically significant positive effect on LBR, CPR, and OPR in women undergoing IVF/ICSI.
• The procedure offers an absolute benefit of approximately 4-5 additional successful pregnancies per 100 individuals.
• ES may particularly benefit patients with impaired endometrial receptivity, potentially improving reproductive outcomes and reducing treatment costs.