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

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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, Gupta, Devashana, Strandell, Annika, Bergh, Christina, Vigneswaran, Kugajeevan, Teh, Wan T., Hamoda, Haitham, Webber, Lisa, Wakeman, Sarah A., Searle, Leigh, Bhide, Priya, McDowell, Simon, Peeraer, Karen, Khalaf, Yacoub, Farquhar, Cynthia·2019·New England Journal of Medicine

DOI 10.1056/nejmoa1808737

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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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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...
ORCID: Lensen, Sarah
Armstrong, Sarah
Stadelmann, Caroline
Hennes, Aurélie
Wilkinson, Jack
Sadler, Lynn
Strandell, Annika
Bergh, Christina
Vigneswaran, Kugajeevan
Teh, Wan T.
Hamoda, Haitham
Webber, Lisa
Searle, Leigh
Bhide, Priya
McDowell, Simon
Peeraer, Karen
Khalaf, Yacoub
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2019-01-24
Volume: 380
Issue: 4
Pages: 325-334
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1808737
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: bronze
doi.org
Licence: www.nejmgroup.org/legal/terms-of-use.htm (vor)
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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A Randomized Trial of Endometrial Scratching before In Vitro Fertilization

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