A Randomised Trial of Endometrial Scratching in Women with Polycystic Ovary Syndrome undergoing Ovulation Induction cycles

Abstract Research Question To evaluate whether endometrial scratch improved the chance of a live birth in women with PCOS undergoing ovulation induction and trying to conceive. Design An international, multicentre, randomised, sham-controlled trial across six fertility clinics in three countries (New Zealand, United Kingdom and Brazil). Women with a diagnosis of PCOS who were planning to commence ovulation induction cycles (at least three cycles) in order to conceive were randomly assigned to receive the pipelle (scratch) procedure or a sham (placebo) procedure in the first cycle of ovulation induction. Women kept a diary of ovulation induction and sexual intercourse timing over three consecutive cycles and pregnancies were followed-up to live birth. Primary outcome was live birth and secondary outcomes were clinical pregnancy, ongoing pregnancy, multiple pregnancy, adverse pregnancy outcomes, neonatal outcomes, bleeding following procedure and pain score following procedure. Results 117 women were randomised; 58 to the scratch group and 59 to the sham group. Live birth occurred in 11 (19%) women in the scratch group and 14 (24%) in the sham group (OR 0.76, 95% confidence interval of 0.30 to 1.92). Secondary outcomes were similar in each group. Significantly higher pain scores were reported in the scratch group (adjusted mean difference 3.2, 95% confidence interval of 2.5 to 3.9) when measured on a visual-analogue scale. Conclusion We did not detect a difference in live birth rate for women with PCOS who received an endometrial scratch when trying to conceive using ovulation induction, however, uncertainty remains due to the small sample size in our study.