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Scratching the womb lining may increase IVF success

8 October 2012
Appeared in BioNews 676

Scratching the womb lining may increase a woman's chances of successful IVF treatment, say UK scientists.

A systematic review of eight previous studies into the procedure, known as endometrial scratching, suggests that women are twice as likely to conceive via IVF if they had their womb lining gently scraped a month before. Further research is needed to confirm these findings, however if the research is accurate endometrial scratching could be a quick and low cost means of increasing the efficiency of IVF.

'It's exciting that the chance of pregnancy could be doubled', said Dr Tarek El-Toukhy, consultant gynaecologist at Guy's and St Thomas' hospital, who led the review study. 'Endometrial scratching uses simple, inexpensive equipment that most hospitals already have and which clinicians are already trained to use, so complications are rare'.

The studies reviewed comprised 911 women undergoing IVF, 412 who underwent endometrial scratching and 499 who did not. Of those that did not undergo the procedure, almost 26 percent fell pregnant, compared to 48 percent of those that did undergo the procedure. The technique takes only 15 minutes, when carried out by a trained nurse, and has shown no severe side effects.

Given the complexity involved in successful embryo implantation, it is currently unknown how endometrial scratching may aid this process. Professor Richard Paulson, director of the University of Southern California's fertility program, told ABC News: 'It's a very complicated biochemical process. The embryo has to chemically communicate with the surface of the endometrium, give a kiss of death to some of the cells underneath to make room for implantation, and then invade the tissue much like a cancer'.

It has been suggested that endometrial scratching may trigger the release of growth factors from the womb lining that encourages embryo implantation. However as the technique is carried out a month before IVF treatment, during which time menstruation occurs and the cells lining the womb are lost, it is not clear how these effects would last until the IVF treatment.

'I think the value of this review is that it might entice people to do good randomised control studies so we can know if this truly helps or not', Dr James Goldfarb, director of the University Hospitals Fertility Center, Cleveland, told ABC News.

There will be further investigation as to whether the increase in IVF pregnancies reported after endometrial scratching translates into an increase in births. 'The next step is to see if this applies to birth rates', confirms Dr El-Toukhy. 'Around one third of IVF treatments results in a baby, so improving these odds would make a big difference to people trying to have children through IVF'.

The review was published in the journal Reproductive Biomedicine Online.

Local endometrial injury and IVF outcome: a systematic review and meta-analysis
Reproductive BioMedicine Online |  26 June 2012
Scratching the womb lining could double IVF pregnancy rates
Guy's and St Thomas' NHS Foundation Trust (press release) |  1 October 2012
Simple scratch could double success of IVF treatment
Telegraph |  1 October 2012
Womb-Scratching Technique May Boost IVF Success
ABC News |  2 October 2012
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