{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T20:35:22Z","timestamp":1784061322819,"version":"3.55.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T00:00:00Z","timestamp":1695081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats: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 <jats:italic>in vitro<\/jats:italic> fertilization (IVF) seems to be the springboard for clinicians to test its effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats: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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats: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\u2009=\u20091.50, (95% CI 1.30\u20131.74), <jats:italic>p\u2009&amp;lt;<\/jats:italic>\u20090.0001] and live birth rate (LBR) [RR\u2009=\u20091.67, (95% CI 1.30\u20132.15), <jats:italic>p\u2009<\/jats:italic>&amp;lt;\u20090.0001] with no statistically significant difference on miscarriage rate [RR\u2009=\u20090.80 (95% CI 0.52\u20131.22), <jats:italic>p<\/jats:italic>\u2009=\u20090.30]<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats: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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p>PROSPERO (CRD42023414117)<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1225111","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T21:43:21Z","timestamp":1695159801000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Endometrial scratching during hysteroscopy in women undergoing in vitro fertilization: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"10","author":[{"given":"Evangelos","family":"Papanikolaou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Peitsidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Tsakiridis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Michos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios","family":"Skalias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Patoulias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Poutoglidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos","family":"Mamopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos","family":"Athanasiadis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grigorios","family":"Grimpizis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Najdecki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"CD012856","DOI":"10.1002\/14651858.CD012856.pub2","article-title":"Screening hysteroscopy in subfertile women and women undergoing assisted reproduction","volume":"4","author":"Kamath","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"B2","first-page":"235","article-title":"Implementation of hysteroscopy in an infertility clinic: the one-stop uterine diagnosis and treatment","volume":"6","author":"Campo","year":"2014","journal-title":"Facts Views Vis Obgyn"},{"key":"B3","doi-asserted-by":"publisher","first-page":"21","DOI":"10.17511\/joog.2015.i01.05","article-title":"Impact on IVF outcome following Pre-IVF hysteroscopy and endometrial scratching","volume":"1","author":"Jayakrishnan","year":"2015","journal-title":"Obsgyne Rev J Obstet Gyneco"},{"key":"B4","first-page":"977","article-title":"Uterine cavity assessment in infertile women: sensitivity and specificity of three-dimensional hysterosonography versus hysteroscopy","volume":"11","author":"Ahmadi","year":"2013","journal-title":"Iran J Reprod Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1002\/rmb2.12348","article-title":"The impact of endometrial injury on reproductive outcomes: results of an updated meta-analysis","volume":"19","author":"Nahshon","year":"2020","journal-title":"Reprod Med Biol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"108","DOI":"10.31083\/j.ceog4905108","article-title":"Use of endometrial scratching in IVF\/IUI\u2014a worldwide opinion and clinical practice survey","volume":"49","author":"Shoham","year":"2022","journal-title":"Clin Exp Obstet Gynecol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2030","DOI":"10.1016\/j.fertnstert.2010.02.022","article-title":"Local injury of the endometrium induces an inflammatory response that promotes successful implantation","volume":"94","author":"Gnainsky","year":"2010","journal-title":"Fertil Steril"},{"key":"B8","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1097\/GCO.0b013e32832a0654","article-title":"Local injury to the endometrium: its effect on implantation","volume":"21","author":"Li","year":"2009","journal-title":"Curr Opin Obstet Gynecol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1152\/ajplegacy.1952.170.3.522","article-title":"Inhibition of decidual cell formation in the pseudopregnant rat by histamine antagonists","volume":"170","author":"Shelesnyak","year":"1952","journal-title":"Am J Physiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1080\/01443615.2022.2033963","article-title":"The effect of hysteroscopy and conventional curretage versus no hysteroscopy on live birth rates in recurrent in vitro fertilisation failure: a retrospective cohort study from a single referral centre experience","volume":"42","author":"Acet","year":"2022","journal-title":"J Obstet Gynaecol"},{"key":"B11","first-page":"297","article-title":"Evaluation of endometrial scratching by hysteroscope or pipelle curette on the outcome of assisted reproduction","volume":"26","author":"Hafez","year":"2020","journal-title":"ZUMJ"},{"key":"B12","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.ejogrb.2020.06.034","article-title":"Endometrial scratch injury with office hysteroscopy before IVF\/ICSI: a randomised controlled trial","volume":"252","author":"Berntsen","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1016\/j.rbmo.2019.02.014","article-title":"Systematic and standardized hysteroscopic endometrial injury for treatment of recurrent implantation failure","volume":"39","author":"Gurgan","year":"2019","journal-title":"Reprod Biomed Online"},{"key":"B14","first-page":"34","article-title":"Effect of adding endometrial scratching to hysteroscopy on pregnancy rates in women with recurrent implantation failure in IVF\/ICSI cycles","volume":"15","author":"Senna","year":"2018","journal-title":"Life Sci J"},{"key":"B15","first-page":"1","article-title":"Does endometrial injury increase the chance of pregnancy during IVF among patients with recurrent implantation failures?","volume":"2","author":"Kovacs","year":"2018","journal-title":"Gynecol Reprod Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1080\/09513590.2016.1255325","article-title":"Endometrial injury for RIF patients undergoing IVF\/ICSI: a prospective nonrandomized controlled trial","volume":"33","author":"Siristatidis","year":"2017","journal-title":"Gynecol Endocrinol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1080\/09513590.2016.1190818","article-title":"Does adding endometrial scratching to diagnostic hysteroscopy improve pregnancy rates in women with recurrent in-vitro fertilization failure?","volume":"32","author":"Seval","year":"2016","journal-title":"Gynecol Endocrinol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"15031","DOI":"10.18535\/jmscr\/v4i12.118","article-title":"Does endometrial injury guided hysteroscopy improve implantation rate of frozen-thawed embryo transfer?","volume":"4","author":"Abdelrahman","year":"2016","journal-title":"JMSCR"},{"key":"B19","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/j.ejogrb.2012.06.029","article-title":"Does a single endometrial biopsy regimen (S-EBR) improve ICSI outcome in patients with repeated implantation failure? A randomised controlled trial","volume":"164","author":"Shohayeb","year":"2012","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1186\/1477-7827-9-140","article-title":"Site-specific endometrial injury improves implantation and pregnancy in patients with repeated implantation failures","volume":"9","author":"Huang","year":"2011","journal-title":"Reprod Biol Endocrinol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Br Med J"},{"key":"B22","article-title":"Review manager (RevMan)","year":"2020"},{"key":"B23","author":"Sch\u00fcnemann","year":"2013"},{"key":"B24","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/S0015-0282(99)00531-2","article-title":"Temporal analysis of connexin43 protein and gene expression throughout the menstrual cycle in human endometrium","volume":"73","author":"Granot","year":"2000","journal-title":"Fertil Steril"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1016\/S0015-0282(03)00345-5","article-title":"Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization","volume":"79","author":"Barash","year":"2003","journal-title":"Fertil Steril"},{"key":"B26","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.rbmo.2021.11.021","article-title":"Endometrial scratch in women undergoing first-time IVF treatment: a systematic review and meta-analysis of randomized controlled trials","volume":"44","author":"Metwally","year":"2022","journal-title":"Reprod Biomed Online"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1553","DOI":"10.1111\/jog.13077","article-title":"Hysteroscopic-guided local endometrial injury does not improve natural cycle pregnancy rate in women with unexplained infertility: randomized controlled trial","volume":"42","author":"Shokeir","year":"2016","journal-title":"J Obstet Gynaecol Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1016\/j.fertnstert.2008.01.043","article-title":"Endometrial biopsy-induced gene modulation: first evidence for the expression of bladder-transmembranal uroplakin ib in human endometrium","volume":"91","author":"Kalma","year":"2009","journal-title":"Fertil Steril"},{"key":"B29","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1186\/s12884-018-2160-z","article-title":"Does endometrial scratching increase the rate of spontaneous conception in couples with unexplained infertility and a good prognosis (hunault >30%)? Study protocol of the SCRaTCH-OFO trial: a randomized controlled trial","volume":"18","author":"Bui","year":"2018","journal-title":"BMC Pregnancy Childbirth"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.1225111\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T21:43:30Z","timestamp":1695159810000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.1225111\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,19]]},"references-count":29,"alternative-id":["10.3389\/fsurg.2023.1225111"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2023.1225111","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,19]]},"article-number":"1225111"}}