title: Endometrial scratching for subfertility: everyone's doing it.
abstract: What proportion of clinicians across Australia, New Zealand and the UK are currently offering or recommending endometrial scratching for subfertility?
  
  
  
  Eighty-three percent of clinicians responding to this survey are recommending endometrial scratching to women undergoing IVF.
  
  
  
  Endometrial scratching is currently being proposed as a technique to increase the probability of implantation in women undergoing IVF. While trial results provide evidence in favour of this procedure, there remains some uncertainty about both the extent of any beneficial effect and the subgroups of women most likely to benefit.
  
  
  
  Cross-sectional survey with responses from a total of 143 public and private fertility care providers surveyed between August and October 2015.
  
  
  
  An online survey was distributed to all 189 fertility clinics across Australia, New Zealand and the UK. All clinicians, nurses and embryologists were eligible to take part. One hundred and forty-three of the 152 responses received were eligible for inclusion, with multiple responses per clinic in 33 cases. At least one response was received from 68 clinics (36% response rate per clinic).
  
  
  
  This survey found that 83% of clinicians commend endometrial scratching prior to IVF. Of these, 92% recommend endometrial scratching to women with recurrent implantation failure (RIF) and 6% recommend it to all women having IVF. Most respondents (73%) agreed that the procedure is beneficial in women with RIF undergoing IVF and disagreed (53%) that the procedure is beneficial for women undergoing their first IVF cycle. The most common timeframe for performing endometrial scratching is the luteal phase of the cycle prior to the IVF cycle. Additionally, only 4% of clinicians recommend endometrial scratching to women undergoing intrauterine insemination or trying to conceive naturally.
  
  
  
  Fertility care providers who recommend endometrial scratching may be more likely to respond to the survey and this could exaggerate the use of the procedure reported here.
  
  
  
  This study was conducted across three countries and may be generalizable to similar settings. While this procedure already appears to be offered by the majority of respondents, the results of further studies in this area may further refine or expand the context in which this procedure is beneficial.
  
  
  
  No funding or competing interests.
  
  
  
  N/A.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand s.lensen@auckland.ac.nz.
authors.forename: S
authors.initials: S
authors.lastname: Lensen
authors.affiliation: Women's Health, Auckland District Health Board, Auckland, New Zealand.
authors.forename: L
authors.initials: L
authors.lastname: Sadler
authors.affiliation: Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Farquhar
mesh_terms: D003430:Cross-Sectional Studies; D010064:Embryo Implantation; D004717:Endometrium / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods / Q000639:trends*; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D011247:Pregnancy; D018873:Pregnancy Rate
keywords: IVF; endometrial biopsy; endometrial injury; endometrial pipelle; endometrial scratching; recurrent failure; recurrent implantation failure