Scratching of the endometrium before IVF fails to improve birth rates

A randomized trial found that endometrial scrapes prior to in vitro fertilization (IVF), although intended to improve pregnancy, did not improve live birth rates.

Sarah Lensen, Ph.D., Ph.D., from the University of Auckland, New Zealand, reported that the procedure produced a live birth in 26.1% of women, compared to 26.1% among controls (OR adjusted 1.00, 95% CI 0.78-1.27).

In addition, there was no significant difference in other pregnancy outcomes, such as clinically confirmed pregnancy rates, at least 20 months of pregnancy, ectopic pregnancy or miscarriage, wrote authors New England Journal of Medicine in accordance with what was presented in July at the meeting of the European Society for Human Reproduction and Embryology (ESHRE).

An accompanying editorial by Ben W. Mol, MD, of the Monash University in Victoria, Australia, and Kurt T. Barnhart, MD, of the University of Pennsylvania at Philadelphia, pointed out that not only the trial had failed, but showed no "suggestion of advantage" in any secondary outcome examined.

The technique used is consistent with current standards of care, and the population – including both women undergoing IVF and women with previous failed cycles, treated in centers in several countries – could be generalized to infertile populations around the world. wrote. "Therefore, the results of this test should be trusted."

A recent study found that 83% of fertility clinicians in the UK, Australia and New Zealand offer or recommend an endometrial scrape, which can cost patients up to around 500 $.

A 2016 Cochrane review suggested an increased likelihood of clinical pregnancy with an endometrial scratch, but Lensen's group cautioned that most of the included trials exhibited a high risk of bias. Mol and Barnhart found that the quality of the evidence was "moderate", pointing to a host of limitations, including "not prospectively registered, revealing significant and unrealistic effects in samples of limited size, using randomization techniques under -optimal or having been stopped prematurely ".

In addition, Mol and Barnhart stated that Lensen's "well-conducted" trial reinforced the idea that all adjuvants to fertility treatments and IVF should be carefully evaluated before being proposed. to patients who "might be receptive to anything that might hypothetically increase their chances of a baby."

"An unanswered public health issue is whether IVF clinics and doctors around the world should continue to offer unbadessed adjuvants, recognizing the likelihood that they will be ineffective when properly evaluated and that some might cause damage ", wrote the editorialists.

"Misleading information about the effectiveness of adjuvants is already the subject of litigation involving couples who have used IVF," they added, referring to a couple who became the first in the UK to continue an IVF clinic for incarcerating them "worthless and unproven". additional interventions.

Lensen and colleagues randomized 1,364 women for an endometrial scrape between the third day of the cycle preceding the IVF cycle and the third day of the IVF cycle or to serve as controls who did not receive the # 39; s response. There was no significant difference between live birth groups or any pregnancy outcome examined.

In addition, there was no evidence of benefit in women in whom implantation had failed at least twice or in women in whom she had not failed more than once, said – writing that "subgroup badyzes have not identified any population of women could benefit."

2019-01-23T17: 02: 58-0500