Journal of Assisted Reproduction and Genetics

, Volume 36, Issue 2, pp 299–305 | Cite as

Effect of endometrial mechanical stimulation in an unselected population undergoing in vitro fertilization: futility analysis of a double-blind randomized controlled trial

  • Ashley M. EskewEmail author
  • Lauren D. Reschke
  • Candice Woolfolk
  • Maureen B. Schulte
  • Christina E. Boots
  • Darcy E. Broughton
  • Patricia T. Jimenez
  • Kenan R. Omurtag
  • Sarah L. Keller
  • Valerie S. Ratts
  • Randall R. Odem
  • Emily S. Jungheim
Assisted Reproduction Technologies



Implantation failure is a major limiting factor of successful in vitro fertilization (IVF). The objective of this study was to determine if endometrial mechanical stimulation (EMS) by endometrial biopsy in the luteal phase of the cycle prior to embryo transfer (ET) improves clinical outcomes in an unselected subfertile population.


Double-blind, randomized controlled trial of EMS versus sham biopsy and odds of clinical pregnancy after IVF and embryo transfer. Secondary outcomes included spontaneous miscarriage and live birth.


One hundred women enrolled and were randomized from 2013 to 2017. Enrollment was terminated after futility analysis showed no difference in clinical pregnancy between EMS versus control, 47.2% vs 61.7% (OR 0.55, 95% CI 0.25–1.23, p = 0.15). There were no significant differences between women who underwent EMS and those who did not in terms of positive pregnancy test 54.7% vs 63.8% (OR 0.69, 95% CI 0.31–1.53, p = 0.36), miscarriage 7.5% vs 2.1% (OR 3.76 95% CI 0.41–34.85, p = 0.22), or live birth 43.4% vs 61.7% (OR 0.48 95% CI 0.21–1.06, p = 0.07).


EMS in the luteal phase of the cycle preceding embryo transfer does not improve clinical outcomes in an unselected subfertile population and may result in a lower live birth rate. We caution the routine use of EMS in an unselected population.


Endometrial mechanical stimulation Endometrial injury Endometrial scratch Embryo transfer In vitro fertilization Assisted reproductive technology 


Financial support

This study was financially supported by the following: 5T32HD055172-09 and UL1 TR002345.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ashley M. Eskew
    • 1
    Email author
  • Lauren D. Reschke
    • 1
  • Candice Woolfolk
    • 1
  • Maureen B. Schulte
    • 2
  • Christina E. Boots
    • 3
  • Darcy E. Broughton
    • 1
  • Patricia T. Jimenez
    • 1
  • Kenan R. Omurtag
    • 1
  • Sarah L. Keller
    • 1
  • Valerie S. Ratts
    • 1
  • Randall R. Odem
    • 1
  • Emily S. Jungheim
    • 1
  1. 1.Department of Obstetrics and GynecologyWashington University School of MedicineSt. LouisUSA
  2. 2.Reproductive Medical Associates of St. LouisCreve CoeurUSA
  3. 3.Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and InfertilityNorthwestern UniversityChicagoUSA

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