Does adding endometrial scratching to diagnostic hysteroscopy improve pregnancy rates in women with recurrent in-vitro fertilization failure?
OBJECTIVE
To investigate the effect of additional endometrial scratching procedure during hysteroscopy on assisted reproductive technology (ART) cycle outcomes in repeated implantation failure (RIF) patients without endometrial or uterine abnormalities on hysteroscopic evaluation.


METHODS
Three hundred and forty-five RIF patients who underwent ART at a university-based infertility clinic between January 2011 and June 2015 were recruited in this retrospective cohort study. Uterine cavities of all included patients were evaluated by diagnostic hysteroscopy 7-14 days prior to the subsequent ART cycle. Women without endometrial abnormalities were allocated into two groups; the scratching group was consisted of patients who underwent endometrial scratching by using monopolar electric energy with needle forceps during hysteroscopy, and the control group was consisted of patients who underwent only diagnostic hysteroscopy.


RESULTS
The implantation rate was significantly higher in the scratching group than the control group (37.7% versus 24.5%; p = 0.04). Clinical and ongoing pregnancy rates were also found to be significantly higher in the scratching group than the control group (37.7% versus 27.6%; p = 0.03; and 33.3% versus 23%; p = 0.03, respectively).


CONCLUSIONS
Endometrial scratching during diagnostic hysteroscopy seems to enhance implantation and as well pregnancy rates in comparison to diagnostic hysteroscopy alone.
a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey.
Mehmet Murat
MM
Seval
a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey.
Yavuz Emre
YE
Şükür
a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey.
Batuhan
B
Özmen
a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey.
Özgür
Ö
Kan
a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey.
Murat
M
Sönmezer
a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey.
Bülent
B
Berker
a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey.
Cem
C
Atabekoğlu
D000328:Adult; D010064:Embryo Implantation / Q000502:physiology*; D004717:Endometrium / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007247:Infertility, Female / Q000175:diagnosis* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D012189:Retrospective Studies
Assisted reproductive technology; endometrial scratching; hysteroscopy; infertility; ovulation induction