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New research suggests IVF ‘scratch’ offers no benefit to women undergoing IVF for the first time

Published: 08 July 2020

New NIHR-funded research has shown that women undergoing IVF for the first time did not benefit from having an endometrial scratch prior to IVF treatment.

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 in the hope of making the womb more receptive to embryo fertilisation. 

The findings of the £1.2m UK Multicentre Endometrial Scratch Randomised Trial, 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 led by Sheffield Teaching Hospitals NHS Foundation Trust and the University of Sheffield and was run across 16 UK fertility centres. During 2016 to 2019, 1048 women under the age of 38 and having their first cycle of IVF or ICSI took part in the study. Women taking part were randomly allocated to receive either the endometrial scratch (523 women) or no scratch prior to the start of their main treatment (525 women).

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.

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. Many procedures are routinely adopted in this area, with little evidence, and it is essential to prove efficacy before this happens. The results are welcomed and this paves the way for more research in infertility treatments."  

The study was funded by the NIHR’s Health Technology Assessment (HTA) Programme.

More information on this project can be found on the NIHR Funding and Awards website.

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