If you have been reading all about IVF, as most people do before starting the treatment, you must have come across the procedure called endometrial scratch, which is known to improve IVF success rates.
Your doctor may offer you an endometrial scratch if you have had several failed IVF or IUI cycles despite having high quality embryos implanted. This technique may help to improve your chances of an embryo successfully implanting in the uterus wall and resulting in a pregnancy.
What is endometrial scratch?
Endometrial scratch, also sometimes call an endometrial biopsy, is a procedure in which your doctor makes a superficial scratch in your uterus lining (endometrium) at a certain point during your menstrual cycle to better prepare your womb for the implantation of an embryo.
It is like a small injury to the uterine lining, which makes it more receptive to the embryo.
Evidence suggests that performing this procedure for women who have had failed IVF or IUI cycles with high quality embryos, can increase their chances of having a baby.
How is it performed?
The endometrial scratch is usually performed around day 21 of your cycle, i.e. in the luteal phase. This should be roughly around a week after ovulation and a week before your next period is due.
Endometrial scratching usually takes only around 15 minutes.
It is important that you do not have unprotected sex during the cycle that you receive this treatment. This is because endometrial scratching may damage an existing pregnancy.
The procedure itself is not very painful and very similar to a smear test. Anesthesia is not required but you will be prescribed some analgesic medication to subside the minor pain.
Following are the steps in endometrial scratching procedure:
- You will need to sign a consent form prior to the procedure. This will confirm that you have not had unprotected sex during this menstrual cycle.
- A speculum will be inserted into your vagina, to enable your doctor to see your cervix. The cervix will then be wiped with a sterile gauze.
- A thin catheter will then be passed through the cervix and used to scratch the endometrium. This may create some mild period-like cramps.
- The catheter will then be removed.
You may experience some bleeding after the procedure, so it is a good idea to take a sanitary towel along with you.
Do I need endometrial scratch during IVF?
An endometrial scratch could be helpful if you have had several failed IVF or IUI attempts, with no obvious cause of implantation problems.
There is no real evidence available to suggest that endometrial scratching will help you if you are undergoing your first cycle of IVF.
The procedure is not offered by all doctors, although if results continue to be promising, it could help women facing repeated IVF failure.
How will it improve my IVF and IUI success?
You may be wondering how exactly endometrial scratching will work to improve your chances of success with IVF and IUI.
Well the scratching procedure triggers a reaction from your body, involving the release of inflammatory substances and hormones, which work to heal the scratch. The release of these substances can make your womb lining more receptive to embryo implantation and therefore, increase the likelihood of a successful treatment cycle.
By intentionally injuring the womb lining, we also increase the blood flow to the area. This too creates a more conducive environment for your embryo to implant.
Research shows that endometrial scratching significantly increases the implantation rate in women who have had previous implantation failures.
What are the risks?
The procedure involved in endometrial scratching is very safe. It is a relatively straight forward procedure, which doesn’t have many reported risks.
You may experience some period-like pain after the procedure, along with some light bleeding.
There is a small risk of pelvic infection following the procedure, as infections of the cervix may be spread into the uterus. You will need to contact your doctor straight away if you experience any of the following symptoms, in the days following your procedure:
- Unexplained fever
- A feeling of being generally unwell
- Bleeding which does not settle down
- A foul-smelling discharge from the vagina
- Persistent pain in the lower abdomen
There is also a very small risk (just around 1%) of miscarriage should you become pregnant following the procedure.
How much does it cost?
As with any additional procedures there is a charge for carrying out an endometrial scratch. The cost of endometrial scratch is just about $200 – $300 but it is not offered commonly yet. More research is needed to know if endometrial scratch can indeed improve IVF results.
(Related read: How does PGS improve IVF results)
Endometrial scratching is a rather simple procedure, which according to initial reports, may significantly increase your chances of a successful pregnancy. Given the high cost of IVF treatment, you may discuss endometrial scratching with your doctor and see if such a procedure can raise your chances of IVF success.
The additional cost and minimal risks of this procedure should be outweighed by the benefits.