A common IVF treatment marketed as a fertility booster and costing hundreds of dollars is useless, research shows.
Endometrial scratching did not offer women a better chance of taking home a baby after IVF, found the largest and most comprehensive trial of the procedure.
The popular IVF add-on did not increase the rate of live births, according to the results of the randomised controlled trial of 1364 women in five countries (Australia, New Zealand, UK, Sweden and Belgium) who were undergoing embryo transfers.
“On this basis of this study, which is the biggest and most robust to date, we would encourage IVF clinics to stop offering it,” said senior study author Cindy Farquhar, Postgraduate Professor of Obstetrics and Gynaecology at the University of Auckland.
The study participants were randomly assigned to receive endometrial scratching or to a control group.
The live birth rate for both groups was identical (26.1 per cent), found the three-year study published in the New England Journal of Medicine.
The findings come amid the Victorian government’s 12-month review of IVF clinics, as well as the current safeguards in place to protect patients.
Endometrial scratching involves collecting a biopsy sample of a woman’s endometrium using a pipelle (a plastic biopsy catheter about three millimetres in diameter). The procedure is similar to a smear test.
The theory was “scratching” or “injuring” a woman’s endometrium triggered an inflammatory or immune repair response that made it more susceptible to embryo implantation.
Endometrial scratching involves collecting a a biopsy sample of a woman’s endometrium. The procedure is similar to a smear test.Credit:Stock
Previous studies that had shown some benefits of the technique used small sample sizes, were poorly designed and had a high risk of bias.
But despite a lack of robust evidence, a recent survey found 83 per cent of fertility clinicians in the UK, Australia and New Zealand offer or recommend endometrial scratching at a cost of hundreds of dollars to increase the chances of having a baby via IVF.
Women who have had multiple failed implantation attempts were most likely to be offered scratching.
Professor Ben Mol at Monash University, who wrote an accompanying editorial, said it was “great news” to discover the procedure didn’t help.
“The concern is that there are many more of these add-on therapies that are offered without a sound scientific base, and many of these will turn out not be effective once properly evaluated,” he said.
He pointed to a UK evaluation of 38 IVF add-ons that found a lack of evidence for all but one treatment.
“Endometrial scratching was that one procedure and now we learn it doesn’t work either,” he said.
The Victorian Assisted Reproduction Treatment Authority (VARTA) requires clinics to provide patients with clear information about the evidence, risks and benefits available for all tests, treatments or procedures.
Practitioners are obligated to make a declaration to VARTA at the end of the financial year stipulating that they have abided by this requirement.
VARTA CEO Louise Johnson said clinicians reported that patients often requested specific treatments, including adjuvant therapies such as endometrial scratching.
“They may have seen something online or they may know someone who has had it and had a baby,” Ms Johnson said.
“But clinics have a responsibility to patients and where there is no evidence that something works, patients should be informed.”
She encouraged patients to thoroughly question their doctors about the evidence, risks and benefits before having any treatment, test or procedure.
Senior research fellow Karin Hammarberg at Monash University’s School of Public Health said it was disturbing that adjuvant therapies akin to “snake oil” were being marketed to vulnerable women struggling to have a baby.
“You would do anything if you thought it would give you some little additional chance, an edge,” Dr Hammarberg said.
“And clinicians want to offer them hope that something might make a difference. But really they shouldn’t be making money out of it.”
Dr Hammarberg said if adjuvant therapies were proven not to be beneficial they should be “stamped out”.
She hoped the trial results would give patients the information they needed to make an informed choice about the procedure.
Kate Aubusson is Health Editor of The Sydney Morning Herald.