Endometrial scratch has gained great popularity over the past few years after the original work published by A Barash in 2003 (1). Nowadays, many IVF clinics offer endometrial scratching, as an IVF add-on, although it is still not clear whether it is of any benefit and to which group of infertile women.

Unexplained infertility remains a distressing condition for many couples, caring physicians included. Many interventions have been tried in the past, in an effort to either identify critical factors that impact on embryo implantation, or to improve the chance of clinical pregnancy. Mechanical injury of the endometrium, endometrial scratching has been such an intervention, mainly tested in infertile women undergoing assisted reproduction treatment with varying degrees of success.

Testing the effect of endometrial scratch in unexplained infertility in couples without assisted conception has been the subject of a recent study by T Wong and his group (2). A randomised control trial, with a carefully designed control group of placebo endometrial biopsies, took place in 8 different fertility clinics, in 3 countries, thus having a pragmatic approach and generalisability of results. Endometrial scratch was performed in late proliferative phase to allow for natural intercourse to take advantage of the intervention in the same cycle.

No difference in live birth rates was seen between the two groups, in a follow-up period of 3 months including the cycle of endometrial scratch, questioning the benefit of a procedure which is  inconvenient and painful for many, cost not being investigated in detail. However, limitations were present in the study, as an almost 10% of women were between 40-42 years of age, a group of women with lower chances of natural fertility, as well as the early termination of the study due to slow recruitment of patients.

While unexplained infertility continues to puzzle fertility specialists across the globe, it is important to weigh carefully the evidence of offered interventions in aim to improve clinical pregnancy and live birth rate. Endometrial scratching still falls short of evidence in favour of its use in women with unexplained infertility, and as such, it should continue to be offered in a research setting, following informed consent of women.

References

A. Barash. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization. doi:10.1016/S0015-0282(03) 00345-5

T Y Wong. Effect of endometrial scratching on unassisted conception for unexplained infertility: a randomized controlled trial. doi.org/10.1016/j.fertnstert.2021.12.009

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