A new survey finds that one-third of fertility specialists still offer endometrial scratching as an adjunct to in vitro fertilization (IVF), despite lack of evidence that it increases conception rates.

Researchers at the University of Melbourne (UNIMELB; Melbourne, Australia), and Monash University (Melbourne, Australia) undertook an online survey among fertility healthcare personnel to ascertain current practices and views regarding endometrial scratching across Australia, New Zealand, and the United Kingdom. In all, 121 eligible responses were received between October and December 2020, which included 61 fertility specialists, 26 embryologists, and 24 fertility nurses.

The results showed most of the respondents were neutral or did not believe endometrial scratching improved pregnancy and live birth rates, except for in women with recurrent implantation failure. In addition, 55% viewed reducing psychological distress as a benefit of endometrial scratching. Among fertility specialists, 34% still offer endometrial scratching, mostly following recurrent implantation failure. Among fertility specialists not offering endometrial scratching, 51% previously offered it, but no longer do. The survey was published on December 14, 2021, in Human Fertility.

“The use of endometrial scratching appears to have reduced over time, probably following recent publications of studies which do not report that the procedure improves the chance of having a baby,” concluded lead author embryologist Madina Sarwari, MSc, of Monash University, and colleagues. “This is an encouraging finding, as it's clear that many IVF providers do respond to new evidence as it emerges.”

Endometrial scratching is a common IVF add-on procedure using a Pipelle endometrial biopsy device, or similar. It has been suggested that the biopsy induces endometrial inflammation, which in turn increases endometrial receptivity and facilitates implantation. The decline in use evidenced over the last five years follows several large trials that showed no clear evidence for improved live birth rates following endometrial scratching before IVF. 

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