Cited by 198Reproductive Health and TechnologiesAssisted Reproductive Technology and Twin PregnancyReproductive System and Pregnancy

A Randomized Trial of Endometrial Scratching before In Vitro Fertilization

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Lensen, Sarah, Osavlyuk, Diana, Armstrong, Sarah, Stadelmann, Caroline, Hennes, Aurélie, Napier, Emma, Wilkinson, Jack, Sadler, Lynn +14 more·2019·New England Journal of Medicine

Abstract

BACKGROUND: Endometrial scratching (with the use of a pipelle biopsy) is a technique proposed to facilitate embryo implantation and increase the probability of pregnancy in women undergoing in vitro fertilization (IVF). METHODS: We conducted a pragmatic, multicenter, open-label, randomized, controlled trial. Eligible women were undergoing IVF (fresh-embryo or frozen-embryo transfer), with no recent exposure to disruptive intrauterine instrumentation (e.g., hysteroscopy). Participants were randomly assigned in a 1:1 ratio to either endometrial scratching (by pipelle biopsy between day 3 of the cycle preceding the embryo-transfer cycle and day 3 of the embryo-transfer cycle) or no intervention. The primary outcome was live birth. RESULTS: A total of 1364 women underwent randomization. The frequency of live birth was 180 of 690 women (26.1%) in the endometrial-scratch group and 176 of 674 women (26.1%) in the control group (adjusted odds ratio, 1.00; 95% confidence interval, 0.78 to 1.27). There were no significant between-group differences in the rates of ongoing pregnancy, clinical pregnancy, multiple pregnancy, ectopic pregnancy, or miscarriage. The median score for pain from endometrial scratching (on a scale of 0 to 10, with higher scores indicating worse pain) was 3.5 (interquartile range, 1.9 to 6.0). CONCLUSIONS: Endometrial scratching did not result in a higher rate of live birth than no intervention among women undergoing IVF. (Funded by the University of Auckland and others; PIP Australian New Zealand Clinical Trials Registry number, ACTRN12614000626662 .).

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Crossref · 10.1056/nejmoa1808737

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  • RCTs and meta-analyses in the IVF/ICSI context have failed to show a reduction in miscarriage rates with endometrial scratch/injury.

    “although to date RCTs and meta-analyses in this patient group have failed to show a reduction in miscarriage rates.205,206”

    From Recurrent MiscarriageGreen‐top Guideline No. 17 (2023) · cites this paper as [206]

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Research works printed but not linked: 3

  1. [5]5. Dekel N, Gnainsky Y, Granot I, Mor G. Inflammation and implantation. Am J Reprod Immunol 2010; 63: 17-21.
  2. [2]2. pregnancy rate for women with unexplained infertility undergoing IUI with ovarian stimulation: a randomized controlled trial. Reprod Sci 2016; 23: 239-43.
  3. [29]29. NJ. What exactly do we mean by 'recurreview and opinion. Reprod Biomed Online 2014; 28: 409-23. Copyright © 2019 Massachusetts Medical Society.

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Authors
Lensen, S., Osavlyuk, D., Armstrong, S., Stadelmann, C., Hennes, A., Napier, E., Wilkinson, J., Sadler, L., Gupta, D., Strandell, A., Bergh, C., Vigneswaran, K., Teh, W. T., Hamoda, H., Webber, L., Wakeman, S. A., Searle, L., Bhide, P., McDowell, S., Peeraer, K., Khalaf, Y., & Farquhar, C.
Affiliations
  • University of Auckland (NZ)
  • Royal Women's Hospital (AU)
  • University College Hospital (GB)
  • Guy's Hospital (GB)
  • From the Department of Obstetrics and Gynaecology, University of Auckland (S.L., D.O., C.F.), and Women’s Health (L. Sadler) and Fertility Plus (D.G., C.F.), Auckland District Health Board, Auckland, Fertility Associates, Christchurch (S.A.W.), and Fertility Associates, Wellington (L. Searle, S.M.) — all in New Zealand; Bath Fertility Centre, Bath (S.A., E.N.), the Department of Medical Statistics, Manchester University NHS Foundation Trust, Manchester (J.W.), and the Department of Obstetrics and...
Venue
New England Journal of Medicine
Published
2019-01-24
Volume
380
Issue
4
Pages
325-334
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2913330914
Cited by
198
References
43
Citations by year
2026: 14 · 2025: 9 · 2024: 15 · 2023: 28 · 2022: 25 · 2021: 43 · 2020: 39 · 2019: 25
FWCI
31.55
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Lirias (submittedVersion, other-oa)
  • Research Explorer (The University of Manchester) (submittedVersion, other-oa)
  • ResearchSpace (University of Auckland) (submittedVersion)
Funders
  • Maurice & Phyllis Paykel Trust
  • Auckland District Health Board, New Zealand
  • Nurture Foundation for Reproductive Health, New Zealand
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
  • Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
Keywords
endometrial scratching, Pipelle biopsy, in vitro fertilization, live birth, embryo implantation, pregnancy outcomes, procedural pain, frozen embryo transfer, fresh embryo transfer
MeSH terms
Adult, Embryo Transfer, Endometrium, Female, Fertilization in Vitro, Humans, Pain Measurement, Pregnancy, Odds Ratio, Treatment Outcome, Live Birth

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