Common add-on treatment for IVF fails to increase chances of pregnancy

Sarah Lensen

Endometrial scratch — when a small scratch or tissue biopsy is made to the uterus lining before in vitro fertilization to improve chances of fertilization — did not improve pregnancy or live birth rates, according to data recently presented at the European Society of Human Reproduction and Embryology.

“Results from earlier studies have suggested a benefit from endometrial scratching in IVF, especially in women with previous implantation failure,” Sarah Lensen, PhD, from the University of Auckland in New Zealand, said in a press release.

“However, many of these studies had a high risk of bias in their design or conduct and did not provide strong evidence. There was still uncertainty about the validity of a beneficial effect,” she continued.

Lensen and colleagues randomly assigned more than 1,300 women from five countries in a 1:1 ratio to receive the endometrial scratch or not. Those who had the procedure also had a Pipelle biopsy conducted between day 3 of the preceding cycle and day 3 of the IVF/embryo transfer cycle.

Researchers found that clinical pregnancy rate was 31.4% among those who received the procedure vs. 31.2% among those who did not. Live birth rates were 26.1% in both groups. The likelihood of pregnancy remained comparable after controlling for variables, as well as in a subgroup analysis.

“It depends on your perspective,” Lensen said in an interview when asked if the results were surprising. “Most people have found the findings of previous trials that reported benefit from endometrial scratching surprising, because there is no clear biological rationale, and also the endometrium is shed as menstruation between the scratch and embryo transfer; therefore, how any favorable effect in the endometrium could be carried into the subsequent cycle is unclear.”

She added that two other similar trials that are in progress “are likely to provide stronger evidence” regarding the endometrial scratch outcomes. – by Janel Miller

Reference: Lensen S, et l. Endometrial scratching by Pipelle biopsy in IVF (the PIP study): A pragmatic randomized controlled trial. Presented at: European Society of Human Reproduction and Embryology; July 1-4, 2018; Barcelona, Spain.

Disclosure: Healio Family Medicine was unable to confirm the authors’ relevant financial disclosures prior to publication.