Obstetric and Neonatal Outcomes Following Endometrial Scratching in the SCRaTCH-OFO trial

Abstract

Abstract Objective To evaluate whether endometrial scratching affects obstetric and neonatal outcomes in women with unexplained infertility. Study design This was a secondary analysis of the SCRaTCH-OFO randomized controlled trial, which included women with unexplained infertility and a good prognosis for spontaneous conception (Hunault score >30%). Participants were randomized to receive either a single endometrial scratch or no intervention, followed by at least six months of timed intercourse. Women who conceived within 12 months and delivered a live-born infant ≥24 weeks of gestation were included in this analysis. Obstetric and neonatal outcomes were assessed using structured postpartum questionnaires. Main outcome measures The primary outcome was a composite of placentation-related pregnancy complications (PRPC), including conditions such as preeclampsia (PE), intrauterine growth restriction (IUGR), and placental abruption. Neonatal outcomes included gestational age and birthweight. PRPC risk was analyzed using log-binomial regression adjusted for maternal age and smoking. Results A total of 353 participants with an ongoing pregnancy were selected from the original study. A placentation-related pregnancy complication occurred in 12.2% of the scratch group and 18.2% of the control group. No statistically significant difference was observed in PRPC risk between the scratch and control group (RR 0.673, [95% CI 0.403–1.107]). Neonatal outcomes were comparable between groups. No increase in severe neonatal complications was observed. Conclusion This is the first study to comprehensively report on pregnancy complications and neonatal outcomes after endometrial scratching. The findings suggest no increased risk of adverse outcomes, but more studies are needed to draw firm conclusions. The study highlights the importance of including maternal and neonatal health in fertility research.