New findings show no benefit of ‘scratch’ for first time IVF rounds

‘Gold standard’ study shows no statistical difference in live birth and pregnancy rates in women under 38 who had endometrial scratch before first IVF or ICSI (intra-cytoplasmic sperm injection) treatment compared to those who only received conventional treatment.

New ‘gold standard’ research led by Sheffield Teaching Hospitals NHS Foundation Trust and the University of Sheffield has shown that women undergoing IVF for the first time did not benefit from having an endometrial scratch prior to IVF treatment.

The findings of the £1.2m UK Multicentre Endometrial Scratch Randomised Trial, funded by a prestigious National Institute for Health Research (NIHR) Grant, found no statistical difference in live birth and pregnancy rates in a large number of women who were offered the procedure prior to having their main IVF treatment.

The large randomised study was run across 16 UK fertility centres during 2016 to 2019 and involved 1048 women who were under the age of 38 and having their first cycle of IVF or ICSI. Women taking part were randomly allocated to receive either the endometrial scratch (523 women) or no scratch prior to the commencement of their main treatment (525 women). In medical research, randomised trials are considered to be the most powerful and effective way to deliver the highest level of evidence regarding the effectiveness of interventions due to their potential to limit all sorts of bias.

Results showed that live birth rates were similar in women who received the scratch (38.6%) and in those who did not (37.1%). Similarly, there was no statistical difference in pregnancy rates with 42.6% of women who had the scratch achieving a pregnancy and 40.6% in those who did not have the scratch.

Previous studies into the effectiveness of the endometrial scratch have focused on women who have had repeated unsuccessful IVF/ICSI attempts and have been undertaken on a much smaller scale.

An endometrial scratch is a simple procedure undertaken before IVF or ICSI treatment. It involves a clinician placing a small tube about the size of a small straw through the neck of the womb and gently scratching the lining before the woman undergoes IVF, in the hope of making the womb more receptive to embryo fertilisation.

The findings of the £1.2m study are to be presented at the 36th annual meeting of European Society of Human Reproduction and Embryology today (8 July).

Mr Mostafa Metwally, a Consultant Gynaecologist and Sub-Specialist in Reproductive Medicine and Surgery at Sheffield Teaching Hospitals NHS Foundation Trust who led the trial, said: “Our ‘gold standard’ study set out to determine whether the endometrial scratch should be routinely offered to women as an additional treatment prior to IVF. By comparing the effectiveness of the treatment in a large group of women in similar circumstances, we aimed to provide robust evidence for women undergoing IVF or ICSI for the first time about the benefits of having the endometrial scratch before their treatment.

“These findings are definitive and can help women to make more informed decisions about their treatment. A review of the practice of offering women and endometrial scratch prior to first time IVF or ICSI should now be made.”

Professor Andy Shennan, Professor of Obstetrics, and Clinical Director NIHR Clinical Research Network South London, said: “This important study, funded by the NIHR HTA Programme, provides high quality evidence that a commonly used procedure in assisting infertility treatment is not necessary. The results are welcomed and this paves the way for more research in infertility treatments.”

Sheffield Teaching Hospitals is one of the UK’s leading centres for pioneering innovative research that aims to improve the care of women undergoing fertility treatment.