Comparing Two Types of Endometrial Scratch Before Embryo Transfer: A Prospective Randomized Pilot Study

Purpose: Although endometrial scratch may improve outcomes in certain groups of women undergoing assisted reproductive technology (ART), the type of endometrial procedure has not been specified. Our objective was to determine if two types of endometrial scratch prior to embryo transfer result in similar implantation and live birth rates. Also, to determine if patients experience similar pain from both types of endometrial scratch. Methods: : This was a prospective, non-blinded, randomized controlled trial with parallel treatment arms of women undergoing blastocyst embryo transfer. Patients underwent endometrial scratch with either vigorous Pipelle curette or four-quadrant scratch with the Shepard insemination catheter. Results: : There were 78 patients in the Pipelle curette group and 92 in the Shepard catheter group. There was no difference in implantation rates for the two groups (56.5% ±48 for Pipelle curette group vs. 59.7%±52 for Shepard catheter group, p-value 0.9). Live birth rates were also similar for the two groups (48.1% ±50 for Pipelle curette group vs. 46.8%±50 for Shepard catheter group, p-value 0.7). Mean pain score was significantly less for the Shepard catheter group than for the Pipelle curette group (3.0±2.4 vs. 3.9±2.2, p-value 0.01). Conclusions: : Our study demonstrates no difference in implantation or live birth rates for two types of endometrial scratch. There was a difference in patient pain scales with endometrial scratch by a Shepard insemination catheter having a significantly lower pain score than by Pipelle curette. This data gives guidance as to the type of endometrial scratch to be performed prior to ART.