Endometrial scratching

For an infertile couple undergoing IVF ET it is extremely frustrating to know that the IVF cycle
has failed. In patient having normal uterine cavity if good quality embryos are transferred,
usually the patient as well as the doctor expect a positive pregnancy result. However, if it does
not happen, it is very difficult to find out the cause for the failed implantation.

There can be many causes of failed implantation. Amongst these causes, defect in endometrial
(uterine lining) receptivity and embryo quality are the important causes. With the advancement
of technology we can know the quality of the embryos. However some of the genetic
abnormalities cannot be diagnosed even with the latest technologies.

For improving the endometrial receptivity the doctors monitor the endometrial thickness on
sonography and also supplement the patients with progesterone and estrogen in the luteal
phase. Couples ask about what can be tried in their next cycle to increase the probability of
pregnancy In many cases of implantation failure the fertility specialist often perform
endometrial scratching.

What is Endometrial Scratching?

It is easy and simple procedure. It can be done at an outpatient unit, without anesthetic. The procedure takes few minutes. The procedure is similar to the D&C which was performed by the gynecologists in olden days to “treat “female infertility. Endometrial scratching is even less invasive than the D&C. In this procedure the gynecologist pass a thin plastic catheter through the cervix into the uterus, gradually move it up and down the endometrial cavity several times and remove a small strip of the uterine lining. The other advantage of this procedure is that it also map the cervical canal , and makes the embryo transfer procedure easy.

How Does Endometrial Scratching Help?

The mechanism how endometrial scratching may lead to increased chance of pregnancy seems to be similar to the process of healing after tissue injury. Usually after any scratch or injury induced in human body, the process of healing causes inflammatory response leading the injured tissue to heal. The local blood flow at the site of injury is also increased which help in tissue healing. The endometrial scratching also results in similar changes in the endometrium to improve environment of the endometrium and improve the receptivity and increase the chances of pregnancy.

At present there are not enough clinical trials performed on endometrial scratching in general IVF patients. Currently it is offered to patients with history of failed IVF cycles. It may cause some discomfort in some patients. Overall the procedure is easy. It is worth trying.