Hysteroscopic Endometrial Fundal Incision versus Hysteroscopy Only in Oocyte Recipients: A Randomized Controlled Trial Assessing The Reproductive Outcomes

Background: Endometrial scratching (ES) remains controversial regarding its potential effectiveness in improvingpregnancy rates. The objective of the present study was to assess the impact of endometrial fundal incision (EFI) duringhysteroscopy on reproductive outcomes in a population of oocyte recipients. Materials and Methods: A randomized controlled trial was conducted between 2020 and 2023 at the Third Departmentof Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessalonikiand “Assisting Nature Centre of Reproduction and Genetics”. The study population consisted of women whounderwent hysteroscopy randomly assigned in a 1:1 ratio to either EFI (one to three months before embryotransferwith donor oocytes) or no intervention throughout office hysteroscopy. Clinical pregnancy and live birth rates werethe primary outcomes. Results: After the exclusion of patients with intraoperative diagnosed endometrial pathology, a total of 124 womenunderwent randomization. The pregnancy test was positive in 79% (n=49/62) of the women in the EFI compared to59.7% (n=37/62) in the hysteroscopy-only group (P=0.019), while the live birth rates did not differ between the twogroups (58.1%, n=36/62 vs. 51.6%, n=32/62, P=0.470). Conclusion: EFI during hysteroscopy seems to improve pregnancy rates in oocyte recipients without intrauterinepathology, while live birth rates are not affected by the EFI. These results should be interpreted with caution beforethe implementation of EFI in the routine in vitro fertilization (IVF) practice (registration number: NCT04580056).