Rated amber by the HFEA for increasing the chances of having a baby for most fertility patients undergoing IVF or ICSI

What is endometrial scratch?

In order to have a successful pregnancy, an embryo needs to ‘implant’ in the womb; if it doesn’t, the patient will need to start their cycle again.

Most embryos don’t implant because they have been unable to develop fully to the implantation stage or because of a developmental mismatch between the stage of the embryo and the lining of the womb. In a small number of cases an embryo won’t implant because the lining of the womb isn’t providing them with the right environment. Endometrial scratching (also known as endometrial injury) is carried out before IVF. During the procedure the lining of the womb (the endometrium) is ‘scratched’ using a small sterile plastic tube.

The theory is that this procedure triggers the body to repair the site of the scratch, releasing chemicals and hormones that make the womb lining more receptive to an embryo implanting. Some also suggest the treatment may activate genes that make the womb lining more receptive to an embryo implanting

Risks of endometrial scratching

This is an intrusive and potentially painful procedure and patients can experience cramping. There is a small risk of bleeding. It is not common for patients to have an infection after the scratch but 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 as a result of fertility treatment.

Evidence

A number of high-quality studies have been completed to date with conflicting results. Further evidence is needed before the benefits of endometrial scratching can be confirmed. Studies investigating endometrial scratching focused on patients undergoing IVF or ICSI, and therefore these ratings do not apply to patients undergoing IUI. In addition, there were no moderate/high quality studies explicitly investigating patients with recurrent implantation failure, therefore there is no evidence that endometrial scratching is beneficial for this patient group either.

Aria’s view

While we are able to perform endometrial scratches at Aria, given the conflicting evidence from high quality studies we do not routinely offer endometrial scratching to any of our patients. If this procedure is something you are considering, your Aria Consultant is happy to discuss this with you further, during consultation.