Endometrial scratching performed in the non‐transfer cycle and outcome of assisted reproduction: a randomized controlled trial

Objectives To investigate the effect of endometrial scratching, performed during oral contraceptive pill ( OCP ) pretreatment, on reproductive outcome and on ultrasound markers of endometrial receptivity, and to assess the pain involved in the procedure, in unselected women undergoing assisted reproductive techniques ( ART ). Methods Women undergoing ART were randomly allocated to undergo either endometrial scratching with a pipelle de Cornier or a sham procedure, 7–14 days before starting controlled ovarian stimulation ( COS ). We evaluated subsequent rates of clinical pregnancy, live birth, implantation, miscarriage and multiple pregnancy. Pain during the procedure was evaluated using a 10‐cm visual analog scale. Endometrial thickness and volume and three‐dimensional power Doppler ( 3D‐PD ) indices (vascularization index ( VI ), flow index ( FI ) and vascularization flow index ( VFI )) were assessed during COS when there was at least one follicle ≥ 17 mm in diameter. Results We included 158 women. Endometrial scratching was associated with higher rates of live birth (41.8% vs 22.8%, P = 0.01) and clinical pregnancy (49.4% vs 29.1%, P = 0.01) and higher pain score (6.42 ± 2.35 cm vs 1.82 ± 1.52 cm, P < 0.001), endometrial VI (3.71 ± 1.77 vs 2.95 ± 1.56, P < 0.01) and VFI (0.97 ± 0.51 vs 0.76 ± 0.40, P < 0.01). There was no significant effect of endometrial scratching on rate of miscarriage (15.4% vs 21.7%, P = 0.53) or multiple pregnancy (22.5% vs 25.0%, P = 0.79), or on endometrial thickness (10.12 ± 1.55 mm vs 9.98 ± 1.62 mm, P = 0.59), endometrial volume (6.18 ± 1.63 cm 3 vs 6.01 ± 1.48 cm 3 , P = 0.51) or FI (26.12 ± 2.82 vs 25.91 ± 2.72, P = 0.65). Conclusions Endometrial scratching performed once, during OCP pretreatment 7–14 days before starting COS , increases the chance of live birth and clinical pregnancy, but might cause considerable pain. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.