Why is my doctor telling me that my endometrium needs to be scratched? I didn’t even know I had an itch!
By Dr. Deborah Wachs
If you are going through in vitro fertilization (IVF), your doctor may recommend that you undergo a procedure called endometrial scratching. Today I will explain the following:
- Why we do endometrial scratching
- How endometrial scratching is done
- The type of women that may be candidates for this procedure
The success of an IVF cycle is determined by a number of factors including the following:
- Age
- Stimulation protocol response
- Embryo quality
- Embryo transfer technique
- Uterine conditions
Implantation of an embryo into the endometrium is the final step that must occur for the successful achievement of a pregnancy.
The implantation of the embryo into the uterus is a complex process. Successful implantation requires attachment and invasion of an embryo into the endometrium. When this process fails, it is usually due to poor embryo quality or abnormal embryo genetics. However, there are situations when good quality embryos are transferred into the uterus, but a pregnancy does not occur due to poor uterine receptivity.
Research has shown that gentle endometrial scratching may improve implantation and pregnancy rates in women who do not conceive during an IVF cycle despite having good embryo quality. Injury of the endometrium via endometrial scratching may lead to the release of factors that may help the process of implantation. Endometrial scratching may also increase expression of genes thought to play a role in preparing the uterus for implantation.
Here is how endometrial scratching works:
- The procedure is performed in the office in the month preceding your embryo transfer and the appointment lasts approximately 15 to 20 minutes.
- After inserting a speculum in the vagina, a flexible, sterile plastic instrument called a Pipelle is introduced through the cervix into the uterus.
- A thin wire in the center of the Pipelle is pulled out which creates suction.
- The Pipelle is then rotated within the uterus a few times to draw some cells from the lining and create local “injury” to the endometrium.
- The procedure can cause uterine cramping and discomfort; therefore it is recommended that an over the counter pain medication such as Aleve or Ibuprofen be taken 1 to 2 hours before the procedure. It is not uncommon to have mild cramping or spotting following the procedure for 1-2 days. The endometrial biopsy can also be performed under anesthesia during a hysteroscopy evaluation of the uterus if this is recommended by your physician.
Many IVF centers are now using endometrial scratching as a more common tool for patients with repeated implantation failure despite the transfer of good quality embryos.
If you have not become pregnant despite the transfer of good quality embryos, you may be a candidate for endometrial scratching. Please ask your physician if this procedure may be beneficial for you.
Deborah Wachs, MD, is a fertility specialist at Reproductive Science Center of the San Francisco Bay Area. She is Board Certified in Reproductive Endocrinology and Infertility and Obstetrics and Gynecology. Dr. Wachs completed her fellowship training in Reproductive Endocrinology and Infertility at the University of California, San Diego. During that time she received extensive clinical training in reproductive surgery, ovulation induction, and in vitro fertilization. She also participated in several federally funded research studies focusing on polycystic ovary syndrome and its pathophysiology. Dr. Wachs is the author of several scientific research papers published in peer-reviewed journals and textbook chapters on this topic.
