An endometrial scratch is a procedure carried out before IVF proposed to improve endometrial receptivity and increase the probability of pregnancy in women undergoing IVF by scratching the womb’s lining (the endometrium) using a small sterile plastic tube. It is generally only used for patients who have experienced multiple unsuccessful IVF cycles, despite the transfer of good quality embryos.
The endometrium is a layer of tissue that lines the inside of the womb. In the first step of a pregnancy, an embryo will attach to the endometrium in a process called implantation. Endometrial scratching, also known as endometrial injury, is a procedure undertaken to purposely disrupt the endometrium in women who want to get pregnant. It is thought this disruption may somehow increase the chance of an embryo implanting, creating a pregnancy.
The theory is that this procedure triggers the body to repair the scratch site, releasing chemicals and hormones that make the womb lining more receptive to an embryo implanting. Some also suggest that the treatment may activate genes that make the womb lining more receptive to an embryo implanting. Although this is an intrusive procedure, it is not common for patients to have an infection after the scratch. There is a small risk that if you have an infection within your cervix before ‘scratching’, this may cause the infection to spread into the uterus. Your clinic can treat this if necessary. Endometrial scratching does not carry any additional known risks for the child born due to fertility treatment.
Endometrial scratching can be done with many different instruments. The most common technique is the endometrial biopsy procedure, generally done with a thin flexible plastic tube 3mm wide, called a pipeline catheter. The pipeline is inserted through the cervix (neck of the womb) into the womb, where it is moved back and forth and rotated to cause some disruption. This is the same procedure a gynaecologist would use to get an endometrial sample for analysis, called an endometrial biopsy.
The procedure has recently been re-purposed and re-named as endometrial scratching due to its potential use in the fertility area. It is a simple, low-cost procedure that can be done at an outpatient appointment, without anaesthetic, in just a few minutes. It can cause some discomfort or pain and some bleeding. Risks of endometrial scratching include infection and uterine perforation, but these are very rare.