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EBM Verdict
Maternal and child health
Endometrial scratching before in vitro fertilisation does not increase live birth rate
  1. Annette Pluddemann,
  2. Igho Onakpoya
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Annette Pluddemann, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; annette.pluddemann{at}phc.ox.ac.uk

https://doi.org/10.1136/bmjebm-2019-111183

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    Endometrial scratching can be offered to women undergoing in vitro fertilisation to increase the probability of pregnancy. Previous research has indicated that it may increase live birth rates in some women; however, the evidence is conflicting and of moderate quality. This large randomised trial addresses this lack of clear evidence.

    EBM Verdict

    EBM Verdict on: A randomized trial of endometrial scratching before in vitro fertilization. N Engl J Med 2019380:325–34. doi: 10.1056/NEJMoa1808737.

    • Endometrial scratching before in vitro fertilisation does not result in higher live birth rates in women undergoing a first embryo transfer, nor in women with one or more previous failed embryo transfers.

    Endometrial scratching is a procedure that may be offered to women undergoing in vitro fertilisation (IVF) to improve endometrial receptivity and increase the probability of pregnancy. The most common technique is endometrial biopsy, where the endometrium is disrupted using a flexible plastic tube, called a pipelle catheter.1 The biological process as to why this procedure might improve the probability of pregnancy is unclear; one hypothesis is that the inflammatory response in the endometrium …

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    Footnotes

    • Contributors AP and IO conceived and wrote this paper.

    • Funding AP reports grants from NIHR (Programme grants for applied research RP-PG-1210-12003), grants from NIHR School of Primary Care Research (NIHR Evidence Synthesis working group Project No: 390) and occasionally receives expenses for teaching Evidence-Based Medicine. IJO holds grant funding from the NIHR School of Primary Care Research (NIHR Evidence Synthesis working group Project No: 390).

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • Patient consent for publication Not required.

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