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Meta-Analysis
. 2023 Jul;51(7):3000605231175365.
doi: 10.1177/03000605231175365.

Endometrial scratch injury in infertile women undergoing in vitro fertilization cycles: a systematic review and meta-analysis

Ahmed M Maged  1 , Akmal El-Mazny  1 , Yossra Lasheen  1 , Noura El-Nassery  1
Affiliations
Meta-Analysis

Endometrial scratch injury in infertile women undergoing in vitro fertilization cycles: a systematic review and meta-analysis

Ahmed M Maged et al. J Int Med Res. 2023 Jul.

Abstract

Objective: This study aimed to evaluate the effect of endometrial scratch injury (ESI) in infertile women undergoing in vitro fertilization (IVF).

Methods: We screened MEDLINE, CENTRAL, EMBASE, Web of Science, and the Cochrane Central Register from inception to April 2023 using keywords related to endometrial scratch, implantation, infertility, and IVF. We included 41 randomized, controlled trials of ESI in IVF cycles (9084 women). The primary outcomes were the clinical pregnancy, ongoing pregnancy, and live birth rates.

Results: The clinical pregnancy rate was reported in all 41 studies. The odds ratio (OR) for the clinical pregnancy rate had an effect estimate of 1.34 with a 95% confidence interval (CI) of 1.14 to 1.58. The live birth rate was reported in 32 studies with 8129 participants. The OR for the live birth rate had an effect estimate of 1.30 with a 95% CI of 1.06 to 1.60. The multiple pregnancy rate was reported in 21 studies with 5736 participants. The OR for the multiple pregnancy rate had an effect estimate of 1.35 with a 95% CI of 1.07 to 1.71.

Conclusion: ESI increases the clinical pregnancy, ongoing pregnancy, live birth, multiple pregnancy, and implantation rates in women undergoing IVF cycles.

Keywords: Clinical pregnancy rate; endometrial injury; endometrial scratch; implantation; in vitro fertilization; infertility.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
PRISMA flow chart. RCTs, randomized, controlled trials.
Figure 2.
Figure 2.
Clinical pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 2.
Figure 2.
Clinical pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 2.
Figure 2.
Clinical pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 2.
Figure 2.
Clinical pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 3.
Figure 3.
Ongoing pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 3.
Figure 3.
Ongoing pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 3.
Figure 3.
Ongoing pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 3.
Figure 3.
Ongoing pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 4.
Figure 4.
Live birth rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 4.
Figure 4.
Live birth rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 4.
Figure 4.
Live birth rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 4.
Figure 4.
Live birth rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 5.
Figure 5.
Miscarriage rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 5.
Figure 5.
Miscarriage rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 5.
Figure 5.
Miscarriage rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 5.
Figure 5.
Miscarriage rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 6.
Figure 6.
Multiple pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 6.
Figure 6.
Multiple pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 6.
Figure 6.
Multiple pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 6.
Figure 6.
Multiple pregnancy rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 7.
Figure 7.
Implantation rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 7.
Figure 7.
Implantation rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 7.
Figure 7.
Implantation rate according to (a) the time of endometrial scratch injury, (b) the number of previous IVF cycles, (c) the number of endometrial scratch injuries, and (d) the intensity of endometrial scratch injury. M-H, Mantel–Haenszel; CI, confidence interval; IVF, in vitro fertilization.
Figure 8.
Figure 8.
Risk of bias summary and graph.
See this image and copyright information in PMC

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