Sant'Andrea Hospital, University "Sapienza" of Rome, Rome, Italy.
Eugin, Taranto, Italy.
BMC Womens Health. 2023 Jul 29;23(1):397. doi: 10.1186/s12905-023-02564-0.
Endometrial scratching (ES) or injury is intentional damage to the endometrium performed to improve reproductive outcomes for infertile women desiring pregnancy. Moreover, recent systematic reviews with meta-analyses and randomized controlled trials demonstrated that ES is not effective, data on the safety are limited, and it should not be recommended in clinical practice. The aim of the current study was to assess the view and behavior towards ES among fertility specialists throughout infertility centers in Italy, and the relationship between these views and the attitudes towards the use of ES as an add-on in their commercial setting.
Online survey among infertility centers, affiliated to Italian Society of Human Reproduction (SIRU), was performed using a detailed questionnaire including 45 questions with the possibility to give "closed" multi-choice answers for 41 items and "open" answers for 4 items. Online data from the websites of the infertility centers resulting in affiliation with the specialists were also recorded and analyzed. The quality of information about ES given on infertility centers websites was assessed using a scoring matrix including 10 specific questions (scored from 0 to 2 points), and the possible scores ranged from 0 to 13 points ('excellent' if the score was 9 points or more, 'moderate' if the score was between 5 and 8, and 'poor' if it was 4 points or less).
The response rate was of 60.6% (43 questionnaires / 71 infertility SIRU-affiliated centers). All included questionnaires were completed in their entirety. Most physicians (~ 70%) reported to offer ES to less than 10% of their patients. The procedure is mainly performed in the secretory phase (69.2%) using pipelle (61.5%), and usually in medical ambulatory (56.4%) before IVF cycles to improve implantation (71.8%) without drugs administration (e.g., pain drugs, antibiotics, anti-hemorrhagics, or others) before (76.8%) or after (64.1%) the procedure. Only a little proportion of infertility centers included in the analysis proposes formally the ES as an add-on procedure (9.3%), even if, when proposed, the full description of the indications, efficacy, safety, and costs is never addressed. However, the overall information quality of the websites was generally "poor" ranging from 3 to 8 and having a low total score (4.7 ± 1.6; mean ± standard deviation).
In Italy, ES is a procedure still performed among fertility specialists for improving the implantation rate in IVF patients. Moreover, they have a poor attitude in proposing ES as an add-on in the commercial setting.
子宫内膜搔刮术（ES）或损伤是一种有意损害子宫内膜的操作，旨在提高有生育需求的不孕妇女的生殖结局。此外，最近的系统评价和随机对照试验表明，ES 并不有效，安全性数据有限，因此不应在临床实践中推荐。本研究的目的是评估意大利不孕中心的生育专家对 ES 的看法和行为，以及这些观点与他们对 ES 作为附加治疗在商业环境中的应用的态度之间的关系。
使用详细问卷对意大利生殖学会（SIRU）附属的不孕中心进行在线调查，问卷包括 45 个问题，其中 41 个问题可以选择“封闭式”多项选择答案，4 个问题可以选择“开放式”答案。还记录和分析了不孕中心网站上的在线数据，这些数据导致了与专家的隶属关系。使用包括 10 个具体问题的评分矩阵评估了不孕中心网站上提供的 ES 信息质量（评分从 0 到 2 分），可能的分数范围为 0 到 13 分（如果分数为 9 分或更高，则为“优秀”，如果分数为 5 到 8 分，则为“中等”，如果分数为 4 分或更低，则为“差”）。
应答率为 60.6%（71 个 SIRU 附属不孕中心中的 43 份问卷）。所有纳入的问卷均完整填写。大多数医生（~70%）报告说，他们只为不到 10%的患者提供 ES。该操作主要在分泌期（69.2%）进行，使用 Pipelle（61.5%），通常在 IVF 周期前在医疗门诊（56.4%）进行，以改善植入（71.8%），而不进行药物治疗（如止痛药、抗生素、止血药或其他药物），无论是在操作前（76.8%）还是后（64.1%）。只有一小部分纳入分析的不孕中心正式提出 ES 作为附加程序（9.3%），即使提出了，也从未涉及适应症、疗效、安全性和费用的全面描述。然而，网站的整体信息质量普遍较差，评分为 3 到 8 分，总得分较低（4.7±1.6；平均值±标准差）。
在意大利，ES 仍然是生育专家为提高 IVF 患者的着床率而进行的一项操作。此外，他们在将 ES 作为附加治疗在商业环境中提出时态度不佳。
