Fertility specialists’ views, behavior, and attitudes towards the use of endometrial scratching in Italy (original) (raw)
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Use of Endometrial Scratching in IVF/IUI – A Worldwide Opinion and Clinical Practice Survey
Clinical and Experimental Obstetrics & Gynecology, 2022
Background: Following recent publications regarding the use of the controversial procedure, endometrial scratching (ES), we wish to gain insights into in vitro fertilization (IVF) clinicians' knowledge and practice, including an updated literature review, current versus past utilization, patient selection, timing and frequency. Methods: Internet-based self-report multiple-choice/multiple-answer survey of IVF clinics. Results: Of the 143 IVF units completing the survey, 119 have used ES in IVF/intrauterine insemination (IUI). Of the respondents with ES experience, 94% recommended ES to patients with repeated implantation failure, 32.3% to patients with a thin endometrium, and 3.5% to general IVF/IUI patients. The majority of respondents performed ES only once prior to an IVF cycle. Of current or past ES users, 73% stopped or reduced ES frequency after reading recent ES-related publications. This was despite the finding that 57.2% believed that ES increased implantation and live-birth likelihood in selected IVF/IUI patients. Conclusions: Despite previous widespread utilization of ES, the lack of consensus regarding patient selection, timing, and benefits of the procedure, has prompted many IVF clinicians who used the procedure in the past to abandon the intervention. According to our study, ES is practiced most commonly for patients with repeated implantation failure and performed once during the luteal phase. Further research is needed to obtain definitive practice guidelines based on ES successes and failures-specifically a prospective randomized controlled study according to the methodology used by Barash et al., original publication.
Should we stop offering endometrial scratching prior to in vitro fertilization?
Fertility and Sterility
Should We Stop Offering Endometrial Scratching and Why? Yes, we should stop. But first to reflect on the evidence base on which we started: After observing an unusually high pregnancy rate among women undergoing repeated endometrial biopsy, an Israeli research team conducted a study in 134 women and reported a twofold increase in the pregnancy rate among women undergoing endometrial biopsy compared with control women (1). Unfortunately, women were ''randomly'' selected on the basis of their agreement to undergo endometrial biopsy, which is not at all random. Yet that small observational study was the beginning of the common in vitro fertilization (IVF) add-on of ''endometrial scratching,'' and it now has almost 400 citations. That study was followed by further nonrandomized research reporting benefit from local injury (2,3), and subsequently by 2010 four small unregistered randomized controlled trials (RCTs) with methodologic limitations, three of which were from the same research team in Iran: Two reported benefit (4,5), one no difference (6), and one reported harm (7). Yet by 2010, fertility clinics worldwide
International Journal of Reproductive Biomedicine, 2021
Background The prevalence of infertility is increasing worldwide and the treatment is one of the important issues. Objective This study aimed to evaluate the effect of local endometrial scratching on pregnancy outcomes in women with previous failure of intrauterine insemination. Materials and Methods This non-randomized clinical trial study was performed on 336 women referred to the infertility clinic of Ali ebn-e Abitaleb Hospital of Zahedan (between May and November 2019). Women were divided into two groups: endometrial scratch as case and a control group. In the case group (n = 173), endometrial scratching was performed on days 8–9 of the menstrual cycle in addition to routine infertility treatments, while in the control group (n = 163), only routine treatment was performed. Chi-square test was used to compare the frequency of male factor severity and the percentage of successful pregnancies between both groups and was used to investigate the effect of male factor on the fertilit...
Human Reproduction, 2020
STUDY QUESTION Does endometrial scratching in women with one failed IVF/ICSI treatment affect the chance of a live birth of the subsequent fresh IVF/ICSI cycle? SUMMARY ANSWER In this study, 4.6% more live births were observed in the scratch group, with a likely certainty range between −0.7% and +9.9%. WHAT IS KNOWN ALREADY Since the first suggestion that endometrial scratching might improve embryo implantation during IVF/ICSI, many clinical trials have been conducted. However, due to limitations in sample size and study quality, it remains unclear whether endometrial scratching improves IVF/ICSI outcomes. STUDY DESIGN, SIZE, DURATION The SCRaTCH trial was a non-blinded randomised controlled trial in women with one unsuccessful IVF/ICSI cycle and assessed whether a single endometrial scratch using an endometrial biopsy catheter would lead to a higher live birth rate after the subsequent IVF/ICSI treatment compared to no scratch. The study took place in 8 academic and 24 general hosp...
Human Reproduction, 2021
STUDY QUESTION Is a single endometrial scratch prior to the second fresh IVF/ICSI treatment cost-effective compared to no scratch, when evaluated over a 12-month follow-up period? SUMMARY ANSWER The incremental cost-effectiveness ratio (ICER) for an endometrial scratch was €6524 per additional live birth, but due to uncertainty regarding the increase in live birth rate this has to be interpreted with caution. WHAT IS KNOWN ALREADY Endometrial scratching is thought to improve the chances of success in couples with previously failed embryo implantation in IVF/ICSI treatment. It has been widely implemented in daily practice, despite the lack of conclusive evidence of its effectiveness and without investigating whether scratching allows for a cost-effective method to reduce the number of IVF/ICSI cycles needed to achieve a live birth. STUDY DESIGN, SIZE, DURATION This economic evaluation is based on a multicentre randomized controlled trial carried out in the Netherlands (SCRaTCH trial)...
Endometrial scratch injury with office hysteroscopy before IVF/ICSI: A randomised controlled trial
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2020
Endometrial scratch injury (ESI) has been proposed to improve endometrial receptivity and thereby increase implantation rates in assisted reproductive technology (ART) treatment. ESI has been widely incorporated into clinical practice despite inconclusive evidence of its effect on reproductive outcomes. We aimed to assess pregnancy and live birth rates in subfertile women receiving ESI before IVF treatment in comparison to controls. Study design: This was a randomised controlled trial (RCT) with no blinding of participants, investigators or health care personnel. Women in ART treatment were allocated to either office hysteroscopy with ESI (ESI group) or no intervention (control group). In total 184 women in IVF/ICSI treatment with minimum one previous failed IVF/ICSI cycle, were included in the final analysis. The primary outcome was positive serum hCG (s-hCG). Secondary outcomes were ongoing pregnancy and live birth rate. Only per-protocol analyses were performed as all patients included at one centre had to be excluded. The trial is registered at ClinicalTrials.gov, NCT01743391. Results: Our results showed a non-significant increase in positive s-hCG (OR 1.23, 95 % CI (0.65-2.33)), ongoing pregnancy (OR 1.52, 95 % CI (0.73-3.17)), and live birth rates (OR 1.69, 95 % CI (0.78-3.64)) per randomised woman between the ESI and the control group. Conclusion: We observed no significant differences in positive s-hCG or other reproductive outcomes in the ESI vs. the control group. While the crude estimates of positive reproductive outcomes were higher in the ESI group, statistical significance was not reached, and the study was not powered to show smaller differences. However, data from this study will be re-evaluated in the context of an individual participant data meta-analysis (IPD-MA) of RCTs on ESI.
Objective: To explore the impact of endometrial scratch injury (ESI) on intrauterine insemination (IUI) success. Methods: One hundred and fifty four infertile women received 100 mg of oral clomiphene citrate for 5 days starting on day 3 of the menstrual cycle. Patients were randomized to 2 equal groups: Group C received IUI without ESI and group S had ESI. Successful pregnancy was confirmed by ultrasound. Results: 13, 21, and 10 women got pregnant after the first, second, and third IUI trials, respectively, with 28.6% cumulative pregnancy rate (PR). The cumulative PR was significantly higher in group S (39%) compared to group C (18.2%). The PR in group S was significantly higher compared to that in group C at the second and third trials. The PR was significantly higher in group S at the second trial compared to that reported in the same group at the first trial but nonsignificantly higher compared to that reported during the third trial, while in group C, the difference was nonsignificant. Eight pregnant women had first trimester abortion with 18.2% total abortion rate with nonsignificant difference between studied groups. Conclusion: The ESI significantly improves the outcome of IUI in women with unexplained infertility especially when conducted 1 month prior to IUI
Human Reproduction, 2021
STUDY QUESTION What is the clinical-effectiveness and safety of the endometrial scratch (ES) procedure compared to no ES, prior to usual first time in vitro fertilisation (IVF) treatment? SUMMARY ANSWER ES was safe but did not improve pregnancy outcomes when performed in the mid-luteal phase prior to the first IVF cycle, with or without intracytoplasmic sperm injection (ICSI). WHAT IS KNOWN ALREADY ES is an ‘add-on’ treatment that is available to women undergoing a first cycle of IVF, with or without ICSI, despite a lack of evidence to support its use. STUDY DESIGN, SIZE, DURATION This pragmatic, superiority, open-label, multi-centre, parallel-group randomised controlled trial involving 1048 women assessed the clinical effectiveness and safety of the ES procedure prior to first time IVF, with or without ICSI, between July 2016 and October 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants aged 18–37 years undergoing their first cycle of IVF, with or without ICSI, were recru...