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(Reuters Health) – Scratching the inside of the uterus before implanting a fertilized egg into the uterus does not improve the chances it attaches (Reuters Health) – Scratching the inside of the uterus before implanting a fertilized egg into the uterus does not improve the chances it attaches and develops into baby, according to a large study of a popular in vitro fertilization (IVF) technique that now seems to be a waste of time and money.
The method, called endometrial scratching, involves taking a flexible tube allowing gynecologists to take tissue samples from the uterus and use it to create a small scratch in the lining of the uterus. Uterus about a month before the transfer of a fertilized egg.
The scratch was supposed to somehow cause inflammation or affect the immune system so as to facilitate the fixation of the egg.
But the new randomized controlled trial of the technique, which was conducted on half of the 1,364 women included in the study, showed that unaffected women were just as likely to become pregnant and give birth to a child as those who had suffered the scratch.
In fact, the success rates in both groups were identical: 180 live births out of 690 women (26.1%) in the endometrial scratch group and 176 out of 674 women (26.1%) in the endometrial group. the control group, says the research team in the New England Journal of Medicine.
Although the technique has not been proven (previous studies in favor of its use were few or poorly done), a study conducted in the United Kingdom, Australia and New Zealand showed that 83% of physicians specialized in fertility practiced it and generally charged between 200 and 500 US dollars for the futile procedure.
"We recommend that clinics no longer offer this," said Sarah Lensen, lead author of the study, during a phone interview with Reuters Health.
"This shows unequivocally that there is no room for this in our practice of treating patients with infertility," said Dr. Christos Coutifaris, a former president of the Canadian Cancer Society. American Society for Reproductive Medicine.
Even when the researchers looked at subsets of patients that, in theory, could benefit, "there is not even a trend" indicating that scratching improves the success rate, said Coutifaris , from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. t involved in the study.
If nothing else, give up the technique will prevent women some pain. On a scale of 1 to 10, with 10 being the most painful pain, half of the study participants rated the scraping technique as 3.5 or higher, after taking the first pain relievers .
The pain was so great for a woman that she went to the emergency department. Seven people fainted, had vertigo or nausea after the injury. There were two cases of excessive bleeding. The technique did not seem to cause infections.
Ms. Lensen stated that the practice of endometrial scarring began around 2005 after a group of fertility doctors had found that women who had failed in IVF attempts seemed more likely to become pregnant after taking tissue biopsies to understand why their fertilized eggs were not implanted. In fact, the idea has existed since the 1970s, said Coutifaris.
The new study was conducted in 13 centers in five countries and women were recruited over a three-year period. For 25% of volunteers, it was at least their third attempt to have a child through in vitro techniques.
Lensen's team also examined whether scratching had an impact on the chances of having twins, miscarriage or tubal pregnancy. He does not have it.
It did not matter whether the implanted embryos were fresh or frozen.
"Neither the days between endometrial scratch and embryo transfer, nor pain during the procedure was a predictor of live birth in the scratch group of the ## 147 ## 39, endometrium, "report the researchers. "There was also no evidence of any benefit from endometrial scarring in women in whom implantation had failed at least twice or in women in whom she had failed more than once. "
Scratching was usually done 35 days before the transfer of the embryo to the uterus, but doctors had great latitude as to the timing.
Because the study showed no benefit in women from any of the subgroups and was only performed in centers located in different countries, "we have to trust to the results of this test ". Ben Mol of Monash University in Australia and Kurt Barnhart, also of Perleman, write in an accompanying editorial.
SOURCE: bit.ly/2FESdVv. New England Journal of Medicine, posted January 23, 2019.
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