Endometrial scratching during hysteroscopy in women undergoing in vitro fertilization: a systematic review and meta-analysis.

Abstract

Objective:

Endometrial scratching (ES) during hysteroscopy before embryotransfer (ET) remains doubtable on whether it benefits the reproductive outcomes. The optimal technique is not clear and repeated implantation failure as a challenging field in in vitro fertilization (IVF) seems to be the springboard for clinicians to test its effectiveness.

Methods:

Medline, PMC, ScienceDirect, Scopus, CENTRAL, Google Scholar were searched from their inception up to April 2023 for studies to evaluate the effectiveness of adding endometrial scratching during hysteroscopy before ET.

Results:

The initial search yielded 959 references, while 12 eligible studies were included in the analyses, involving 2,213 patients. We found that hysteroscopy and concurrent ES before ET resulted in a statistically significant improvement in clinical pregnancy rate (CPR) [RR = 1.50, (95% CI 1.30-1.74), p < 0.0001] and live birth rate (LBR) [RR = 1.67, (95% CI 1.30-2.15), p < 0.0001] with no statistically significant difference on miscarriage rate [RR = 0.80 (95% CI 0.52-1.22), p = 0.30].

Conclusion:

Our meta-analysis suggests that hysteroscopy with concurrent ES may be offered in IVF before ET as a potentially improving manipulation. Future randomized trials comparing different patient groups would also provide more precise data on that issue, to clarify specific criteria in the selection of patients.

Systematic Review Registration:

PROSPERO (CRD42023414117).

• Authors: Evangelos Papanikolaou, Nikolaos Peitsidis, Ioannis Tsakiridis, Georgios Michos, Antonios Skalias, Dimitrios Patoulias, Alexandros Poutoglidis, Apostolos Mamopoulos, Apostolos Athanasiadis, Grigorios Grimpizis, Robert Najdecki
• Journal: Frontiers in surgery (Front Surg) Vol. 10 Pg. 1225111 ( 2023) ISSN: 2296-875X [Print] Switzerland
• PMID: 37795147 (Publication Type: Journal Article, Review)
• Copyright: © 2023 Papanikolaou, Peitsidis, Tsakiridis, Michos, Skalias, Patoulias, Poutoglidis, Mamopoulos, Athanasiadis, Grimpizis and Najdecki.