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

Background/Objectives: Infertility affects about 17.5% of people globally, with higher rates in women. Despite advances in assisted reproductive technologies, success remains limited. Endometrial scratching (ES) is proposed to enhance implantation by altering cytokines and gene expression, but evidence is conflicting. Methods: A systematic search of the PubMed, Cochrane Library, and Scopus databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight randomized controlled trials (RCTs) involving women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), with ES performed in the luteal phase of the cycle preceding IVF or ICSI, were included. Results: The meta-analysis included 3210 patients and 1445 clinical pregnancies (754 in the ES group and 691 in the control group). In the ES group, a significantly higher clinical pregnancy rate (CPR) (RR 1.09, 95% CI 1.01-1.18, p = 0.02) was revealed. Pooled data from six studies reporting live birth rates (1268 births) showed a significant increase in the LBR after ES (RR 1.12, 95% CI 1.03-1.22, p = 0.01). The ongoing pregnancy rate (OPR) was also statistically significant in the ES group (RR 1.13, 95% CI 1.01-1.26, p = 0.03). Conclusions: This meta-analysis shows a small but statistically significant and consistent positive effect of ES on the LBR, CPR, and OPR in women undergoing IVF or ICSI, with a modest but measurable absolute benefit of approximately 4-5 additional events per 100 individuals. This procedure may particularly benefit patients with impaired endometrial receptivity, potentially enhancing reproductive outcomes while reducing the time and cost required to achieve a successful pregnancy. Further research is warranted to optimize its use and identify patients most likely to benefit.