It may not sound pleasant, but a procedure known as endometrial scratching has been shown to improve both pregnancy and birth rates when it is performed once in women who are undergoing reproductive treatment.
Endometrial scratching is medically assisted damage to the womb, specifically the inner lining, and researchers say it was first successfully demonstrated to be beneficial in 2003.
The procedure is intrusive, however, and the results of its effectiveness have not been fully documented.
But a team of Brazilian scientists, in collaboration with Dr. Nick Raine-Fenning, of the Nottingham University Research and Treatment Unit (NURTURE), have demonstrated a benefit to the specific timing of endometrial scratching in a clinical trial.
Results of the trial were published in the journal Ultrasound in Obstetrics & Gynecology.
Women who received the scratching technique yielded 20% more live births, compared with women in the control group.
Scratching yielded more live births
In the trial, Dr. Raine-Fenning and his colleagues sought to investigate the effect of endometrial scratching within a certain time frame - 7-14 days before core reproductive treatment began.
There were a total of 158 women who took part in the trial, and all of them had previously received unsuccessful reproductive treatment. They were all taking an oral contraceptive pill (OCP) just before the trial treatment commenced.
On the importance of having women on an OCP beforehand, Dr. Raine-Fenning told Medical News Today:
"Many units use the 'pill' to control cycles and provide a degree of 'down regulation' prior to IVF. It gives them control of when treatment will happen and some believe it can improve outcome, although this is far from clear and of great debate."
The researchers say that 77 of the women were randomized to receive the scratching technique, and it was indeed given 7-14 days before any reproductive treatment began.
Of the 77 women who received the scratching technique, 39 became pregnant and 33 cases resulted in live births. This is in comparison with 23 live births from the control group.
The difference represents a 20% increased clinical pregnancy rate in women who underwent endometrial scratching.
The study also shows that the technique did not affect miscarriage or multiple pregnancy rates, compared with the standard protocols.
Hope, but in the future
The researchers note that up to 15% of women who are of reproductive age have trouble conceiving, and reproductive treatment failure can cause psychological distress for many couples, which is why the prospect of better chances may provide hope.
Dr. Raine-Fenning explains:
"This is the first well-designed trial conducted into endometrial scratching and the results are promising. Other trials have provided anecdotal evidence, but these have been limited and many questioned the validity of the technique."
He says that he and his team are now conducting a follow-up study in Nottingham to create further guidance on endometrial scratching. "Early results are encouraging," he says.
Though the scratching technique does increase the chances of live birth and clinical pregnancy, the researchers do caution that it might cause considerable pain.
When asked how long until this procedure may become widely available to patients, Dr. Raine-Fenning told Medical News Today that there are still a number of clinical trials and repeated work that needs to be done before it would become common practice.
However, he added:
"For privately funded patients [in the UK], many clinics are offering this already, including ourselves, although reluctantly as we want to do the trial and do not feel there is enough evidence yet to warrant charging patients."
He did say, however, that "it is hard to refuse someone who may be facing their last chance, especially if this takes 5 years to become mainstream."