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Endometrial scratching: less invasive methods should be tried first

      I read with interest the article by
      • Metwally M.
      • Chatters R.
      • White D.
      • Hall J.
      • Walters S.
      Endometrial scratch in women undergoing first-time IVF treatment: a systematic review and meta-analysis of randomized controlled trials.
      and the related editorial by
      • Palomba S.
      • Macklon N.
      Endometrial scratching: is it all over?.
      , 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 S.
      • Macklon N.
      Endometrial scratching: is it all over?.
      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 S.
      • Mendoza-Tesarik R.
      • Mendoza C.
      • Mendoza N.
      • Cucinelli F.
      • Tesarik J.
      Effect of growth hormone on uterine receptivity in women with repeated implantation failure in an oocyte donation program: a randomized controlled trial.
      ). 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 Y.
      • Qi J.
      • Sun Y.
      Platelet-rich plasma as a potential new strategy in the endometrium treatment in assisted reproductive technology.
      ).
      I strongly suggest that these two non-invasive methods be used prior to resorting to endometrial scratching.

      References

        • Altmäe S.
        • Mendoza-Tesarik R.
        • Mendoza C.
        • Mendoza N.
        • Cucinelli F.
        • Tesarik J.
        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
        • 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
        • Metwally M.
        • Chatters R.
        • White D.
        • Hall J.
        • Walters S.
        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
        • Palomba S.
        • Macklon N.
        Endometrial scratching: is it all over?.
        Reprod. Biomed. Online. 2022; 44: 583-585https://doi.org/10.1016/j.rbmo.2022.03.018