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ORIGINAL ARTICLE A Randomized Trial of Endometrial Scratching before In Vitro Fertilization Sarah Lensen, Ph.D., Diana Osavlyuk, M.Sc., Sarah Armstrong, M.B., Ch.B., M.R.C.O.G., Caroline Stadelmann, M.D., Aurélie Hennes, M.Sc., Emma Napier, B.Sc., Jack Wilkinson, Ph.D., Lynn Sadler, M.P.H., Devashana Gupta, C.R.E.I., Annika Strandell, M.D., Ph.D., Christina Bergh, M.D., Ph.D., Kugajeevan Vigneswaran, M.R.C.O.G., Wan T. Teh, F.R.A.N.Z.C.O.G., Haitham Hamoda, M.D., F.R.C.O.G., Lisa Webber, M.R.C.O.G., Sarah A. Wakeman, M.B., Ch.B., Leigh Searle, F.R.A.N.Z.C.O.G., Priya Bhide, M.D., F.R.C.O.G., Simon McDowell, C.R.E.I., Karen Peeraer, Ph.D., Yacoub Khalaf, M.D., F.R.C.O.G., and Cynthia Farquhar, F.R.A.N.Z.C.O.G., M.P.H. January 24, 2019 N Engl J Med 2019; 380:325-334 DOI: 10.1056/NEJMoa1808737 Chinese Translation 中文翻译 Article Figures/Media Metrics 29 References 2 Citing Articles Letters Abstract BACKGROUND Endometrial scratching (with the use of a pipelle biopsy) is a technique proposed to facilitate embryo implantation and increase the probability of pregnancy in women undergoing in vitro fertilization (IVF). METHODS We conducted a pragmatic, multicenter, open-label, randomized, controlled trial. Eligible women were undergoing IVF (fresh-embryo or frozen-embryo transfer), with no recent exposure to disruptive intrauterine instrumentation (e.g., hysteroscopy). Participants were randomly assigned in a 1:1 ratio to either endometrial scratching (by pipelle biopsy between day 3 of the cycle preceding the embryo-transfer cycle and day 3 of the embryo-transfer cycle) or no intervention. The primary outcome was live birth. RESULTS A total of 1364 women underwent randomization. The frequency of live birth was 180 of 690 women (26.1%) in the endometrial-scratch group and 176 of 674 women (26.1%) in the control group (adjusted odds ratio, 1.00; 95% confidence interval, 0.78 to 1.27). There were no significant between-group differences in the rates of ongoing pregnancy, clinical pregnancy, multiple pregnancy, ectopic pregnancy, or miscarriage. The median score for pain from endometrial scratching (on a scale of 0 to 10, with higher scores indicating worse pain) was 3.5 (interquartile range, 1.9 to 6.0). CONCLUSIONS Endometrial scratching did not result in a higher rate of live birth than no intervention among women undergoing IVF. (Funded by the University of Auckland and others; PIP Australian New Zealand Clinical Trials Registry number, ACTRN12614000626662. opens in new tab.)