{
    "abstract": "In IVF/ICSI treatment, the process of embryo implantation is the success rate-limiting step. Endometrial scratching has been suggested to improve this process, but it is unclear if this procedure increases the chance of implantation and live birth (LB) and, if so, for whom, and how the scratch should be performed.\nThis individual participant data meta-analysis (IPD-MA) aims to answer the question of whether endometrial scratching in women undergoing IVF/ICSI influences the chance of a LB, and whether this effect is different in specific subgroups of women. After its incidental discovery in 2000, endometrial scratching has been suggested to improve embryo implantation. Numerous randomized controlled trials (RCTs) have been conducted, showing contradicting results. Conventional meta-analyses were limited by high within- and between-study heterogeneity, small study samples, and a high risk of bias for many of the trials. Also, the data integrity of several trials have been questioned. Thus, despite numerous RCTs and a multitude of conventional meta-analyses, no conclusion on the clinical effectiveness of endometrial scratching could be drawn. An IPD-MA approach is able to overcome many of these problems because it allows for increased uniformity of outcome definitions, can filter out studies with data integrity concerns, enables a more precise estimation of the true treatment effect thanks to adjustment for participant characteristics and not having to make the assumptions necessary in conventional meta-analyses, and because it allows for subgroup analysis.\nA systematic literature search identified RCTs on endometrial scratching in women undergoing IVF/ICSI. Authors of eligible studies were invited to share original data for this IPD-MA. Studies were assessed for risk of bias (RoB) and integrity checks were performed. The primary outcome was LB, with a one-stage intention to treat (ITT) as the primary analysis. Secondary analyses included as treated (AT), and the subset of women that underwent an embryo transfer (AT+ET). Treatment-covariate interaction for specific participant characteristics was analyzed in AT+ET.\nOut of 37 published and 15 unpublished RCTs (7690 participants), 15 RCTs (14 published, one unpublished) shared data. After data integrity checks, we included 13 RCTs (12 published, one unpublished) representing 4112 participants. RoB was evaluated as 'low' for 10/13 RCTs. The one-stage ITT analysis for scratch versus no scratch/sham showed an improvement of LB rates (odds ratio (OR) 1.29 [95% CI 1.02-1.64]). AT, AT+ET, and low-RoB-sensitivity analyses yielded similar results (OR 1.22 [95% CI 0.96-1.54]; OR 1.25 [95% CI 0.99-1.57]; OR 1.26 [95% CI 1.03-1.55], respectively). Treatment-covariate interaction analysis showed no evidence of interaction with age, number of previous failed embryo transfers, treatment type, or infertility cause.\nThis is the first meta-analysis based on IPD of more than 4000 participants, and it demonstrates that endometrial scratching may improve LB rates in women undergoing IVF/ICSI. Subgroup analysis for age, number of previous failed embryo transfers, treatment type, and infertility cause could not identify subgroups in which endometrial scratching performed better or worse. The timing of endometrial scratching may play a role in its effectiveness. The use of endometrial scratching in clinical practice should be considered with caution, meaning that patients should be properly counseled on the level of evidence and the uncertainties.",
    "authors": [
        {
            "affiliation": "Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.",
            "firstname": "Nienke E",
            "initials": "NE",
            "lastname": "van Hoogenhuijze"
        },
        {
            "affiliation": "Department of Medicine, Utrecht University, Utrecht, the Netherlands.",
            "firstname": "Gemma",
            "initials": "G",
            "lastname": "Lahoz Casarramona"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.",
            "firstname": "Sarah",
            "initials": "S",
            "lastname": "Lensen"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.",
            "firstname": "Cindy",
            "initials": "C",
            "lastname": "Farquhar"
        },
        {
            "affiliation": "Department of Reproductive Medicine, Christian Medical College, Vellore, Tamil Nadu, India.",
            "firstname": "Mohan S",
            "initials": "MS",
            "lastname": "Kamath"
        },
        {
            "affiliation": "Department of Reproductive Medicine, Christian Medical College, Vellore, Tamil Nadu, India.",
            "firstname": "Aleyamma T",
            "initials": "AT",
            "lastname": "Kunjummen"
        },
        {
            "affiliation": "Nurture Fertility, The Fertility Partnership, Nottingham, UK.\nSchool of Medicine, University of Nottingham, Nottingham, UK.",
            "firstname": "Nick",
            "initials": "N",
            "lastname": "Raine-Fenning"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Fertility Clinic, Hvidovre, Copenhagen, Denmark.\nUniversity Hospital Hvidovre, Hvidovre, Denmark.",
            "firstname": "Sine",
            "initials": "S",
            "lastname": "Berntsen"
        },
        {
            "affiliation": "Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.",
            "firstname": "Anja",
            "initials": "A",
            "lastname": "Pinborg"
        },
        {
            "affiliation": "Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium.",
            "firstname": "Shari",
            "initials": "S",
            "lastname": "Mackens"
        },
        {
            "affiliation": "Department of Obstetrics, Konya Education and Research Hospital, Konya, Turkey.",
            "firstname": "Zeynep Ozturk",
            "initials": "ZO",
            "lastname": "Inal"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR.",
            "firstname": "Ernest H Y",
            "initials": "EHY",
            "lastname": "Ng"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Assisted Reproduction Technology Unit, Prince of Wales Hospital, the Chinese University of Hong Kong 9F, Hong Kong SAR.",
            "firstname": "Jennifer S M",
            "initials": "JSM",
            "lastname": "Mak"
        },
        {
            "affiliation": "Department of Reproductive Medicine, Bangalore Assisted Conception Center, Bangalore, Karnataka, India.",
            "firstname": "Sachin A",
            "initials": "SA",
            "lastname": "Narvekar"
        },
        {
            "affiliation": "Reproductive Medicine, SEMEAR Fertilidade, Ribeir\u00e3o Preto, Brazil.",
            "firstname": "Wellington P",
            "initials": "WP",
            "lastname": "Martins"
        },
        {
            "affiliation": "Fertility Clinic, The Fertility Clinic Horsens Regional Hospital, Horsens, Denmark.",
            "firstname": "Mia",
            "initials": "M",
            "lastname": "Steengaard Olesen"
        },
        {
            "affiliation": "Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.",
            "firstname": "Helen L",
            "initials": "HL",
            "lastname": "Torrance"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, VIC, Australia.\nSchool of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK.",
            "firstname": "Ben W",
            "initials": "BW",
            "lastname": "Mol"
        },
        {
            "affiliation": "Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.",
            "firstname": "Marinus J C",
            "initials": "MJC",
            "lastname": "Eijkemans"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, VIC, Australia.",
            "firstname": "Rui",
            "initials": "R",
            "lastname": "Wang"
        },
        {
            "affiliation": "Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.",
            "firstname": "Frank J M",
            "initials": "FJM",
            "lastname": "Broekmans"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.",
    "doi": "10.1093/humupd/dmad014\n10.1002/14651858.CD009517.pub3",
    "journal": "Human reproduction update",
    "keywords": [
        "ART",
        "ICSI",
        "IPD",
        "IVF",
        "endometrial injury",
        "endometrial sampling",
        "endometrial scratch",
        "endometrial scratching",
        "frozen embryo transfer",
        "individual participant data meta-analysis"
    ],
    "methods": null,
    "publication_date": "2023-06-20",
    "pubmed_id": "37336552\n28511086\n12798877\n32593936\n23703895\n34601605\n32123753\n26287812\n27132053\n25349438\n10685547\n24289893\n24548571\n25663182\n30673547\n34110001\n19352180\n31825478\n32372078\n27294218\n28476486\n20607003\n25803542\n23754314\n31042837\n31843072\n26218557\n23063812\n32350891\n27258236\n22835632\n27132052\n11576817\n31462531\n25919529\n26196287\n30895265\n33289528\n30319550\n28874785\n25205759",
    "results": null,
    "title": "Endometrial scratching in women undergoing IVF/ICSI: an individual participant data meta-analysis.",
    "xml": "<Element 'PubmedArticle' at 0x788503f83d80>"
}