Endometrial Scratch






What is endometrial scratching?

Endometrial scratch is a procedure used to help embryos implant more successfully after in-vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI) in patients who had failed cycles despite transfer of good quality embryos.

Endometrial scratch (ES) is a procedure offered by MFC to suitable patients. It involves taking a biopsy of the endometrium or lining of the uterus (womb). If it is done approximately 7 days before starting stimulation for an IVF cycle, it has been shown to improve pregnancy success rates in some women. These are generally women having another fresh cycle of IVF or ICSI who have had two or more previous embryo transfers with good quality embryos but where implantation has not occurred and they have not conceived. ES is thought to do this by aiding implantation of the embryo/blastocyst. We also do it before some frozen embryo transfer cycles but the evidence for this is not so strong.

ES still requires further international study to determine if it is of benefit in other groups e.g. women trying naturally, IUI, first IVF cycles, frozen embryo cycles or women with previous miscarriage. A large international review has just been published by the Cochrane Library which confirms a benefit for some couples but which urges caution until the results of bigger studies become available.

How does scratching help implantation?

Research and evidence suggests that scratching the uterine lining causes a ‘repair or wound healing reaction’ which may increase embryo implantation rates by triggering the release of immune cells, growth factors, hormones and chemicals. The new lining which grows after the procedure is thought to be more receptive to an implanting embryo and so increases the chances of pregnancy. Scientists believe that the genes which are responsible for implantation of embryos are sometimes not ‘switched on’ during the time when embryos are supposed to implant. Endometrial scratching may ‘switch on’ these genes.

Preparing for an endometrial scratch

The best time to perform the endometrial scratch is approximately 7 days before the expected menstrual period on which your fresh IVF or ICSI cycle is about to start. For down regulation cycles this is usually also the day that you start your down regulation medications.

ES cannot be performed if there is any chance you may be pregnant. If you have intercourse at any time from the first day of your period you MUST use reliable protection.

  • You may eat and drink normally before the procedure
  • It helps to have a comfortable full bladder
  • Mild pain relief (e.g. Nurofen 100mg) may be taken 40 minutes prior to ES
  • No sedation is required and the procedure is similar to that of an embryo transfer
  • At MFC ES is carried out in our procedure rooms so the usual rules regarding no makeup, scents etc. apply

How is the procedure performed?

  • The procedure is similar to an embryo transfer:
  • A speculum is gently inserted into the vagina so the cervix can be seen
  • The cervix is cleaned with sterile gauze
  • A thin flexible catheter is inserted through the opening of the cervix, and the uterine lining is gently ‘scratched’. (Inserting and moving the intrauterine catheter up and down may cause mild abdominal cramping similar to period pain)

After the procedure

  • You can go back to normal activity e.g. work, driving
  • You will need to wear a sanitary towel (not a tampon)
  • Some mild bleeding and cramping are common after the procedure
  • Other complications such as infection or perforation of the uterus are extremely rare.

You should contact Merrion Fertility immediately if you experience any of the following symptoms within a few days of the procedure:

  • Unexplained fever
  • Persistent bleeding or foul-smelling vaginal discharge
  • Increasing lower abdominal pain
  • Feeling generally unwell

For other treatments, please refer to Success Rates for details of the most recent published results.

Cost of Endometrial Scratch:  €250