Impact of endometrial scratching on reproductive outcome in patients: A systematic review and meta-analysis

Abstract

Background: Endometrial scratching (ES) has demonstrated initial success in women with recurrent implantation failure, but the effect in women with 1 previous assisted reproductive technology (ART) failure is unknown. This meta-analysis aimed to evaluate the impact of ES as a treatment in clinical outcomes for women with at least 1 failed in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)/Intrauterine Insemination (IUI).Methods: PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for randomized controlled trial studies utilizing endometrial scratching for infertility women with at least 1 failed assisted reproductive technology (ART) to collect pregnancy outcomes, including clinical pregnancy rate (CPR), embryo implantation rate (IR), miscarriage rate (MR), live birth rate (LBR), and multiple pregnancy rate (MPR).Results: Sixteen randomized controlled trial (RCT) studies were included in this meta-analysis, including 1770 women in the intervention group and 1934 women in the control group. Overall, the CPR, IR and LBR were significantly higher in the intervention group than in the control group (for CPR, n = 1430, 16 studies, P = .0002, risk ratio (RR) = 1.59, 95% confidence interval [CI] [1.24, 2.03]; for IR, n = 859, 10 studies, P = .0003, RR = 1.67, 95% CI [1.26, 2.21]; for LBR, n = 156, 6 studies, P = .0005, RR = 1.59, 95% CI [1.22, 2.06]). Nonetheless, there was no significant difference in MR (n = 344, 11 studies, P = .62, risk ratio (RR) = 0.92, 95% confidence interval [CI] [0.66, 1.29]) and MPR (n = 98, 3 studies, P = .39, risk ratio (RR) = 0.81, 95% confidence interval [CI] [0.51, 1.30]) between the intervention group and the control group. Conclusion:Endometrial scratching is considered to enhance the reproductive outcomes of embryo implantation. Additional randomized controlled studies are recommended to identify the appropriate time of invasion and the applicable population to confirm whether it can become a routine operation. Abbreviations: 95%CI = 95% confidence interval, ART = assisted reproductive technology, CPR = clinical pregnancy rate, ES = endometrial scratching, ICSI = intracytoplasmic sperm injection, IR = embryo implantation rate, IUI = intrauterine insemination, IVF = in vitro fertilization, LBR = live birth rate, MPR = multiple pregnancy rate, MR = miscarriage rate, PCOS = polycystic ovary syndrome, PRISMA = Preferred Reporting Items for Reviews and Meta-Analyses, PROSPERO = International Prospective Register of Systematic Reviews, RCT = randomized controlled trial, RIF = recurrent implantation failure, RR = risk ratio, WMDs = weighted mean differences.

Comparison of Two Types of Endometrial Scratch before Embryo Transfer and Patient-Reported Pain Scores: A Prospective Randomized Pilot Study

“…Findings from this study suggest that patients who underwent endometrial scratch using the Shepard catheter have significantly lower pain scores compared to those who underwent the Pipelle. Low to moderate pain and discomfort are commonly reported by patients who received the Pipelle for endometrial biopsy (7,8,10). However, to our knowledge, no prior studies have assessed pain scores and ART outcomes using the Shepard catheter compared to the standard Pipelle.…”

“…Endometrial scratch, a procedure that involves intentional disruption of the endometrium prior to embryo transfer, may increase endometrial receptivity and implantation (4)(5)(6). However, while some studies suggest that endometrial scratch prior to embryo transfer may improve implantation rates and clinical pregnancy rates, patients report experiencing moderate pain and discomfort during the endometrial scratch procedure (6)(7)(8)(9)(10) Endometrial scratch is associated with significantly higher pain scores compared to patients who did not receive endometrial scratch during ART (11). In a multicenter randomized control trial of 1,364 patients, the median pain score reported by patients who underwent endometrial scratch was 3.5 out of 10 on a visual analogue scale (IQR=1.9-6.0) (Lensen, 2019).…”

Immune Cell Functionality during Decidualization and Potential Clinical Application

“…For a more detailed insight, many reviews and meta-analytic publications were published concerning this topic, which seems to be declining but is still under a heated debate (reviewed i.a. in [ 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 ]).…”

“…Recurrent implantation failure Thin endometrial lining Scratching [171][172][173][174][175][176][177][178], PRP infusion [183][184][185][186][187][188], G-CSF [267,269,270] Wound-healing-like Decidualization, Regeneration…”

Closer to the Reality—Proteome Changes Evoked by Endometrial Scratching in Fertile Females

“…Nevertheless, ES was not recommended for women undergoing their first IVF cycle but was supposed to be a tool for patients with multiple implantation failures [8,10,11]. From the initial reports on ES, the infertility community controversially assessed these results, and a common point of criticism was the fact that the physiology and subsequent changes of the endometrium executed by the procedure were and are still unclear [12,13]. However, ES is not only applied for the purpose of possibly enhancing pregnancy rates but also as a procedure to gain endometrial tissue for diagnostic investigations such as the detection of uterine natural killer cells (uNK), plasma cells (PC), and Endometrial Receptivity Analysis (ERA) [14].…”