I read with interest the article by
Metwally et al., 2022
and the related editorial by Palomba and Macklon, 2022
, both calling into question the usefulness of performing endometrial scratching to enhance endometrial thickness and pregnancy rates in patients undergoing IVF. Based on a systematic review and meta-analysis of randomized controlled trials, Metwally et al. (2002) conclude that there is a lack of evidence that endometrial scratching improves pregnancy outcomes for women undergoing a first IVF cycle. In the related editorial, Palomba and Macklon, 2022
agree that endometrial scratching should not be performed in the first IVF cycle, but admit that future empirical studies might discover specific endometrial conditions that could be responsive to this treatment.Here I would like to stress that there are two other treatment options that can improve endometrial thickness and receptivity in women with repeated implantation failure (RIF). The use of growth hormone is one of them. The beneficial effect of growth hormone was demonstrated by a randomized controlled trial performed in women with a history of RIF with oocytes from donors who were not treated with growth hormone (
Altmäe et al., 2018
). Growth hormone significantly improved implantation, pregnancy, and live birth rates in this scenario. Regarding the other option, there is growing evidence that intrauterine infusion of autologous platelet-rich plasma (PRP) improves endometrial growth and receptivity (reviewed in Lin et al., 2021
).- Lin Y.
- Qi J.
- Sun Y.
Platelet-rich plasma as a potential new strategy in the endometrium treatment in assisted reproductive technology.
Front. Endocrinol. (Lausanne). 2021; 12707584https://doi.org/10.3389/fendo.2021.707584
I strongly suggest that these two non-invasive methods be used prior to resorting to endometrial scratching.
References
- Effect of growth hormone on uterine receptivity in women with repeated implantation failure in an oocyte donation program: a randomized controlled trial.J. Endocr. Soc. 2018; 2: 96-105https://doi.org/10.1210/js.2017-00359
- Platelet-rich plasma as a potential new strategy in the endometrium treatment in assisted reproductive technology.Front. Endocrinol. (Lausanne). 2021; 12707584https://doi.org/10.3389/fendo.2021.707584
- Endometrial scratch in women undergoing first-time IVF treatment: a systematic review and meta-analysis of randomized controlled trials.Reprod. Biomed. Online. 2022; 44: 617-629https://doi.org/10.1016/j.rbmo.2021.11.021
- Endometrial scratching: is it all over?.Reprod. Biomed. Online. 2022; 44: 583-585https://doi.org/10.1016/j.rbmo.2022.03.018
Article info
Publication history
Published online: May 18, 2022
Accepted:
May 16,
2022
Received:
May 1,
2022
Identification
Copyright
© 2022 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
