“Endometrial scratching” does not boost a woman’s chance of a live birth after in vitro fertilisation (IVF), research suggests.
Advocates of this procedure claim injuring the lining of the womb makes it more receptive to the implantation of an embryo when healed due to the release of hormones and changes to its cell structure.
Studies into the approach have thrown up mixed results, causing experts to question how effective it is.
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The latest offering by the University of Sheffield found women who undergo an endometrial scratch, which can be painful, before their first round of IVF are no more likely to have a live birth than those who forgo the procedure.
IVF “add-ons” can be expensive, with patients often footing the bill.
One of the scientists stressed the results “provide conclusive evidence” endometrial scratching is ineffective, adding “it is time to stop this practice”.
“Our study is the largest and most conclusive study in women having first time IVF treatment and the findings conclusively indicate the practice of performing scratch in this group should stop,” said lead author Dr Mostafa Metwally.
The Sheffield scientists looked at more than 1,000 women, aged under 37, before they underwent their first round of IVF.
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The procedures were carried out across 16 centres in the UK between 2016 and 2019.
Results, presented at the virtual European Society of Human Reproduction and Embryology meeting, revealed 38.6% of the women who had an endometrial scratch went on to have a live birth.
This is compared to 37.1% of those who did not have the procedure; not a statistically significant difference.
The research follows a 2019 paper by Indian scientists that found “no high-quality evidence to support the use of IVF add-ons in routine practice”.
As well as endometrial scratching, a woman may be offered a range of options from growth hormones to aspirin to boost her chances of becoming a mother.
“These add-ons make IVF more complicated and increase the overall cost for the treatment, which is borne by the couples and healthcare providers”, the Indian team wrote in the journal Fertility and Sterility.
Regional clinical commissioning groups allocate fertility treatment funding on the NHS in England. This is set nationally in the rest of the UK.
Research recently revealed access to this funding can be a postcode lottery.
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In 2019, scientists from Utrecht University in the Netherlands looked at pregnancy rates in more than 2,500 women across 14 studies.
“It remains unclear if endometrial scratching improves the chance of pregnancy for women undergoing ART [assisted reproductive technology] and, if so, for whom,” they concluded in the journal Human Reproduction Open.
“This means endometrial scratching should not be offered in daily practice”.
Despite this, an online survey carried out by the University of Auckland found more than four in five (83%) fertility specialists in Australia, New Zealand and the UK “commend endometrial scratching prior to IVF”.