At TFP, we offer a procedure called an endometrial scratch. Recent studies have suggested that the endometrial scratch may improve implantation rates in patients who have had multiple failed IVF cycles, despite good quality embryos. Embryo implantation into the womb may fail due to poor embryo quality or abnormal embryo genetics. It can also often fail due to poor endometrial receptivity. This is where the lining of the womb is not favourable for the embryo to implant.
The endometrial scratch is a straightforward outpatient procedure that is relatively painless (similar to a cervical smear test). The procedure involves “scratching” the endometrial lining of the womb with a very small catheter (plastic tube) prior to an attempt to get pregnant.
The procedure is thought to increase the immune system cells and, therefore, the growth factors at the site of the endometrial scratch. This is believed to make the womb lining more receptive to embryo implantation. The HFEA suggests there could be up to a 5% increase in pregnancy rates: more information can be found on their website.
It is recommended that the endometrial scratch is performed in the cycle before you start stimulation medication. Ideally, the procedure should be done between days 19 and 25 of your menstrual cycle.
The scratch can be performed in the same cycle as one in which you are trying to conceive naturally.
The risk of a miscarriage if you get pregnant after the procedure is no more than 1%. Given the increased chance of getting pregnant, the benefits of the procedure outweigh any risks.
You will attend the clinic with a semi-full bladder (drink 300ml of water 1 hour prior to the procedure, and do not empty your bladder during this time). First, the doctor will perform an internal ultrasound scan to assess the shape and position of the womb. A very small catheter will then be inserted through the cervix into the womb. This catheter will be used to scratch four areas on the womb lining. You may experience slight discomfort as the catheter is being passed into the womb.
After the procedure, a small amount of vaginal spotting or bleeding is not unusual. You can commence an IVF cycle as normal the following month or try a natural cycle in the same month.