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Endometrial Scratching
This is a procedure that involves “scratching” the lining of the uterus with a small instrument that is inserted through the cervix. It is simple to perform and requires no anesthetic – for many patients, it is rather like having a smear test performed.
Research has shown that, in some women, causing a very minor injury to the inside of the uterus can provoke a healing reaction that may help embryos to attach during IVF/ICSI treatment. It is usually done about one week before the start of the treatment cycle, around cycle day 21, and may be combined with an hysteroscopy, to check for abnormalities of the insider of the uterus.
It doesn’t seem to be helpful in the first cycle of treatment, so this is usually done for patients who have previously undergone unsuccessful IVF at least once. The research is ongoing, however, to identify those who would benefit the most, and more information will become available in time.
Endometrial Scratching Treatment:
Several approaches have been used to overcome the problem of implantation failure in the treatment of sterility, or improve the chances of successful nidation. Scratching of the endometrium prior to ET is one method of enhancing the likelihood of implantation. Usually, in the luteal phase of the cycle preceding IVF, the endometrium is “scratched” with a small catheter, 3 mm in width, known as the Pipelle. Usually without hooking on the cervix, the catheter is pushed forward through the cervix to the fundus, and then retracted in circular movements in order to stimulate the endometrium. In case further diagnostic investigation is desired, such as the investigation of chronic endometritis or the presence of plasma cells or uterine killer cells, the Pipelle can be used simultaneously to obtain a biopsy specimen of the endometrium. This is regarded as a low-risk procedure with a low rate of complications. Scratching can be performed on an outpatient basis without anesthesia and is associated with minor pain for the majority of patients.
As an alternative to the use of the Pipelle, scratching can also be performed in the course of a diagnostic hysteroscopy. In order to evaluate the uterine cavity and detect or rule out potential barriers to implantation, such as a septum, a polyp, or a myoma, it is usually sufficient to perform a mini-hysteroscopy.
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