AUTHOR=Papanikolaou Evangelos , Peitsidis Nikolaos , Tsakiridis Ioannis , Michos Georgios , Skalias Antonios , Patoulias Dimitrios , Poutoglidis Alexandros , Mamopoulos Apostolos , Athanasiadis Apostolos , Grimpizis Grigorios , Najdecki Robert 

TITLE=Endometrial scratching during hysteroscopy in women undergoing in vitro fertilization: a systematic review and meta-analysis

JOURNAL=Frontiers in Surgery

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2023.1225111

DOI=10.3389/fsurg.2023.1225111

ISSN=2296-875X

ABSTRACT=<sec><title>Objective</title><p>Endometrial scratching (ES) during hysteroscopy before embryotransfer (ET) remains doubtable on whether it benefits the reproductive outcomes. The optimal technique is not clear and repeated implantation failure as a challenging field in <italic>in vitro</italic> fertilization (IVF) seems to be the springboard for clinicians to test its effectiveness.</p></sec><sec><title>Methods</title><p>Medline, PMC, ScienceDirect, Scopus, CENTRAL, Google Scholar were searched from their inception up to April 2023 for studies to evaluate the effectiveness of adding endometrial scratching during hysteroscopy before ET.</p></sec><sec><title>Results</title><p>The initial search yielded 959 references, while 12 eligible studies were included in the analyses, involving 2,213 patients. We found that hysteroscopy and concurrent ES before ET resulted in a statistically significant improvement in clinical pregnancy rate (CPR) [RR = 1.50, (95% CI 1.30–1.74), <italic>p &lt;</italic> 0.0001] and live birth rate (LBR) [RR = 1.67, (95% CI 1.30–2.15), <italic>p </italic>&lt; 0.0001] with no statistically significant difference on miscarriage rate [RR = 0.80 (95% CI 0.52–1.22), <italic>p</italic> = 0.30]</p></sec><sec><title>Conclusion</title><p>Our meta-analysis suggests that hysteroscopy with concurrent ES may be offered in IVF before ET as a potentially improving manipulation. Future randomized trials comparing different patient groups would also provide more precise data on that issue, to clarify specific criteria in the selection of patients.</p></sec><sec><title>Systematic Review Registration</title><p>PROSPERO (CRD42023414117)</p></sec>