Endometrial Scratch

In-vitro fertilization (IVF) has transformed the lives of countless couples struggling with infertility, offering them the hope of conceiving a child. Despite significant advancements in this field, not all IVF cycles result in successful implantation and pregnancy. The endometrial scratch technique is an emerging procedure to improve the chances of embryo implantation in IVF treatments. This article delves into the endometrial scratch technique, its potential benefits, and the associated risks and considerations.

Endometrial Scratch Technique: An Overview

The endometrial scratch, also known as endometrial injury or endometrial biopsy, is a procedure where the lining of the uterus (endometrium) is deliberately disrupted or injured. This technique is based on the premise that causing minor injury to the endometrium may enhance embryo implantation by inducing an inflammatory response, which promotes the secretion of growth factors and cytokines. These factors are believed to create a more receptive environment for the embryo, thereby increasing the likelihood of successful implantation and pregnancy.

Endometrial Scratch Procedure

The endometrial scratch procedure is usually performed in the menstrual cycle preceding the IVF treatment cycle or early in the stimulation phase of the same cycle. The procedure is relatively simple and can be done in a fertility clinic without anesthesia. The physician will insert a speculum into the vagina to visualize the cervix and clean the area with an antiseptic solution. A thin, flexible catheter or pipeline is inserted through the cervix and into the uterus. The catheter is gently moved back and forth to create a minor injury or scratch in the endometrial lining. The procedure typically lasts around 15 minutes.

Potential Benefits of Endometrial Scratch

Several studies have suggested that the endometrial scratch technique may improve the chances of embryo implantation and pregnancy in women undergoing IVF treatment, particularly in those who have experienced recurrent implantation failure.

A meta-analysis published in the journal Reproductive Biology and Endocrinology in 2019 found that the endometrial scratch technique increased the likelihood of clinical pregnancy in women with recurrent implantation failure by 70%. Another review published in Fertility and Sterility in 2012 found that endometrial injury performed in the cycle preceding the IVF treatment significantly improved the probability of clinical pregnancy and live birth, especially in women with a history of unsuccessful IVF cycles.

It is essential to note that while some studies have reported positive outcomes, others have found no significant improvement in pregnancy rates following the endometrial scratch. Consequently, more research is needed to establish the procedure’s overall efficacy and appropriate timing.

Risks and Considerations of Endometrial Scratch

The endometrial scratch technique is generally well-tolerated, with most women experiencing only mild discomfort during the procedure. However, there are potential risks and side effects to consider:

  1. Pain: Some women may experience mild to moderate pain or cramping during and after the procedure. Over-the-counter pain medications can help alleviate discomfort.
  2. Bleeding: Light bleeding or spotting may occur after the endometrial scratch. This is typically short-lived and resolves on its own.
  3. Infection: Though rare, there is a risk of infection associated with the procedure. If a woman experiences fever, chills, or foul-smelling vaginal discharge following the scratch, she should seek medical attention promptly.
  4. Endometrial damage: There is a small risk that the procedure may cause damage to the endometrial lining, which could potentially impact future fertility.

Who May Benefit from the Endometrial Scratch Technique?

The endometrial scratch technique may benefit women who have experienced recurrent implantation failure or multiple unsuccessful IVF cycles.