For woman undergoing in vitro fertilization (IVF), endometrial scratching did not increase the probability of a live birth, according to a study published in The New England Journal of Medicine.

A team of investigators conducted the Pipelle for Pregnancy trial (PIP, PIP Australian New Zealand Clinical Trials Registry number, ACTRN12614000626662), a pragmatic, multicenter, open-label, randomized controlled trial to assess whether the probability of live birth could be increased by endometrial scratching via endometrial pipelle biopsy in women undergoing IVF. The main outcome was live birth.

Women undergoing IVF with either fresh-embryo or frozen-embryo transfer with no recent exposure to disruptive intrauterine instrumentation were eligible to participate in the study. Of the 3627 women who were assessed, 1364 participants were randomly assigned to either the endometrial scratch group (n=690) or the control group (n=674).

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Live-birth frequency was 26.1% for both groups (adjusted odds ratio, 1.00). No significant difference in the rates of ongoing pregnancy, clinical pregnancy, multiple pregnancy, ectopic pregnancy, or miscarriage was seen between the 2 groups. On a pain scale of 0 to 10 (10 indicating the worst pain from endometrial scratching), the median reported score for women in this group was 3.5.

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“An important limitation of our trial is the lack of blinding,” the authors noted. “Because the outcomes of pain and bleeding were captured only in the endometrial scratch group, it is not possible to compare the frequency of these adverse events between trial groups.”

“The procedure was associated with a mild amount of pain and a small number of adverse events,” concluded the investigators.


Lensen S, Osavlyuk D, Armstrong S, et al. A randomized trial of endometrial scratching before in vitro fertilization. N Engl J Med. 2019;380(4):325-334.