Use of Endometrial Scratching in IVF/IUI – A Worldwide Opinion and Clinical Practice Survey

Abstract

Use of Endometrial Scratching in IVF/IUI – A Worldwide Opinion and Clinical Practice Survey Gon Shoham1,* ,† , Heli Alexandroni2,† , Milton Leong3 , Adrian Shulman1,4 , Ariel Weissman1,5 1Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel 2 IVF Unit, Shaare–Zedek Medical Center, 9103102 Jerusalem, Israel 3The IVF Clinic, 13/F Central Tower, Hong Kong 4 IVF Unit, Meir Medical Center, 4428164 Kfar Saba, Israel 5 IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, 5822012 Holon, Israel *Correspondence: gonshoha@tauex.tau.ac.il (Gon Shoham) †These authors contributed equally. Academic Editor: Andrea Tinelli Submitted: 3 December 2021 Revised: 24 January 2022 Accepted: 26 January 2022 Published: 9 May 2022 Abstract Background: Following recent publications regarding the use of the controversial procedure, endometrial scratching (ES), we wish to gain insights into in vitro fertilization (IVF) clinicians’ knowledge and practice, including an updated literature review, current versus past utilization, patient selection, timing and frequency. Methods: Internet-based self-report multiple-choice/multiple-answer survey of IVF clinics. Results: Of the 143 IVF units completing the survey, 119 have used ES in IVF/intrauterine insemination (IUI). Of the respondents with ES experience, 94% recommended ES to patients with repeated implantation failure, 32.3% to patients with a thin endometrium, and 3.5% to general IVF/IUI patients. The majority of respondents performed ES only once prior to an IVF cycle. Of current or past ES users, 73% stopped or reduced ES frequency after reading recent ES-related publications. This was despite the finding that 57.2% believed that ES increased implantation and live-birth likelihood in selected IVF/IUI patients. Conclusions: Despite previous widespread utilization of ES, the lack of consensus regarding patient selection, timing, and benefits of the procedure, has prompted many IVF clinicians who used the procedure in the past to abandon the intervention. According to our study, ES is practiced most commonly for patients with repeated implantation failure and performed once during the luteal phase. Further research is needed to obtain definitive practice guidelines based on ES successes and failures–specifically a prospective randomized controlled study according to the methodology used by Barash et al., original publication. Keywords: endometrial scratching; infertility; survey; IVF; pregnancy outcomes