BARCELONA: ADJUVANT TREATMENTS

Endometrial scratch, a commonly offered technique to improve IVF success, has been shown in a large randomised trial to be of no value. The scratch procedure, performed in this study with a Pipelle canula, was associated with no improvements in pregnancy or live birth rates, and should, say the international investigators, be abandoned as a procedure by fertility clinics.

The results of the study were presented in Barcelona by Dr Sarah Lensen, a researcher from the University of Auckland, New Zealand. The study was a large randomised trial performed at 13 fertility centres in five countries (New Zealand, UK, Belgium, Sweden and Australia) and involving more than 1300 women having IVF. In IVF, where some studies have shown a benefit in outcome, it's been proposed that injury to the lining of the uterus causes an inflammatory response conducive to embryo implantation following transfer.

However, results from this study showed that clinical pregnancy rate in the endometrial scratch group was 31.4% and in the control group 31.2%; live birth rates were 26.1% in the former and 26.1% in the latter. The probabilities of pregnancy were still comparable after controlling for variables and sub-group analysis, which included patients with a history of implantation failure in IVF (defined as two or more unsuccessful embryo transfers). This group in earlier studies has appeared to gain particular benefit from the procedure.

This latest study also measured pain discomfort score associated with endometrial scratch and found "a moderate amount of pain and bleeding". This too, said the investigators, was further reason why endometrial scratch should be abandoned and removed from the list of IVF adjuvant options.

"Our results contradict those of many studies published previously," said Lensen, "and, although our trial was the largest and most robust study undertaken so far, it can be difficult for one trial to change practice. However, there are other trials under way at the moment, including two large studies from the Netherlands and UK. Nevertheless, even based just on our results, I think clinics should now reconsider offering endometrial scratch as an adjuvant treatment."