What is Endometrial Scratching? The endometrial scratching is an out-patient procedure which is relatively painless (comparable to a cervical smear test). In order for IVF to be successful, an embryo must attach itself to the wall of the womb for a pregnancy to begin. Embryo implantation into the womb can fail for various reasons including poor quality embryos or abnormal embryo genetics. For some couples, IVF can fail due to ‘poor endometrial receptivity’. This is where the lining of the womb is not favourable for the embryo to implant. Recent studies have suggested that a procedure known as an Endometrial Scratching may improve implantation rates in patients who have had multiple failed IVF cycles despite having good quality embryos. Many people are not aware of the Endometrial Scratching and how it works but it is very similar to a smear test although it may be slightly more uncomfortable. The procedure itself requires no local or general anaesthetic, and whilst the procedure only takes a few minutes, you would need to allow up to 30 minutes for your appointment. Sir Robert Edwards – the IVF pioneer behind the birth of Louise Brown, the world’s first test-tube baby – was a firm believer in the technique, as is Mr Gafar at Newlife clinic in Epsom. Early research studies have shown improved pregnancy rates for those patients who had previously experienced a failed IVF cycle.
How does Endometrial Scratching work? The idea behind endometrial scratching is that it causes a reaction in the endometrium with the release of certain inflammatory substances, which make the endometrium more receptive to an implanting embryo. Recent studies have suggested that the endometrial scratch may improve implantation rates in patients who have had multiple failed IVF cycles despite good quality embryos, with significantly higher implantation, pregnancy and most importantly live birth rates following the technique. Whilst ‘scratching’ doesn’t sound like a pleasant procedure, it is very straight forward. The technique involves using a catheter, an instrument similar to a coffee-stirrer, to make scratches on the lining of the womb. The aim is that the scratch will elicit an inflammatory response which it is then believed will allow for a fledgling embryo to find it easier to nestle in the furrows. It is also possible that the scratches release hormones that make the womb stickier and so the embryo finds it easier to implant.
What are the Risks associated with the procedure? You may experience slight discomfort as the catheter is being passed into the womb and some uterine cramping soon afterwards. You will have some spotting or bleeding following the procedure but usually lighter than a period. Uncommonly, the access to the uterine cavity may prove difficult. Other than that, there are no serious complications.
When is Endometrial Scratch carried out? Whether you are starting a fresh attempt at IVF (+/- ICSI) or frozen embryo transfer cycle the Endometrial Scratching is carried out in the second half of the cycle before you start your treatment, known as the Luteal phase.