Endometrial scratch: will it work for you?
When going through IVF, you’ll do anything to improve your chances of a successful pregnancy. So could a simple endometrial scratch (i.e. agitating the lining of your uterus) boost the odds of embryo implantation?
Fertility clinics only started offering endometrial scratching recently. Research is still ongoing. But it’s already one of the more accepted add-on treatments. Compared to the evidence on fashionable extras like embryo glue and intralipids, endometrial scratching has slightly more kudos.
Best described as being similar to a smear test, an endometrial scratch involves a quick scrape of your womb lining at a certain point in your cycle. Until July 2018, the research suggested it could improve embryo implantation, especially if you’ve had failed IVF attempts before. You can have a scratch before fertility treatment with your own eggs, donor eggs or frozen embryos. But then a larger randomised trial downgraded its benefits.
How does it work? Well, endometrial scratching seems to provoke a reaction within the inner lining of the womb. Hormones and chemicals are released to help the lining repair itself. A genetic trigger response to an endometrial scratch may give the implantation ‘green light’. In essence, the temporary injury seems to make the endometrium more receptive to an embryo. That means a better chance of a pregnancy and a live birth. Until the 2018 trial said not.
Early studies into endometrial scratching brought intriguing results, gaining the attention of infertility experts. A 2012 study found that having an endometrial scratch was 70% more likely to result in pregnancy in women with unexplained recurrent implantation failure. And researchers in 2015 concluded that endometrial scratching was more likely to improve the birth rate for women with two or more previous IVF failures.
So most clinics tend to offer the procedure to women who’ve had previously unsuccessful attempts at IVF. But an emerging consensus thinks it could improve pregnancy chances for all fertility patients, including those starting their first treatment cycle. Will we see endometrial scratching offered as standard before very fertility cycle? Watch this space. The 2018 trial results may lead to the procedure being offered less, but some patients may still benefit. May.
If you decide to have an endometrial scratch, it’s best carried out in the cycle before your treatment, often on day 21. Your clinic will confirm the optimal date. If you have irregular periods, guidance on timing is particularly important. If you’re controlling your cycle with birth-control pills, Norethisterone or an HRT course prior to your stimulating medication, you may be told to have your endometrial scratch four or so days before your final pill.
An endometrial scratch is quick and often (but not always) painless. No anaesthetic is needed and you can head home immediately afterwards. If you’re having a hysteroscopy and the timing is right, the scratch can be done there and then.
Of course, there’s a fee. In the UK, prices for endometrial scratching vary. But the average cost appears to be between £150 and £300. A few clinics charge more. Given the typical cost of a fertility cycle, it’s a relatively minimal extra for something that could significantly enhance the outcome of your treatment.
A final note of caution. An endometrial scratch carries a small (1%) risk of miscarriage if you get pregnant. Cramping and infection can also happen after the procedure – but not that often. Overall, the evidence for endometrial scratching is contradictory. Talk to your clinic.