Endometrial scratching - A treatment for implantation issues

Unsuccessful IVF is difficult to accept but is not uncommon. Embryo implantation is a complex process and some common causes of failure can be due to poor endometrial lining (endometrium) or a genetically abnormal embryo. Women who have repeatedly failed IVF despite apparently good quality embryos may be candidates for the latest IVF treatment called endometrial scratching which has been shown in several randomised studies to improve (even double) the implantation rate in women who have had repeated failures. 

How does endometrial scratch improve pregnancy?

The process of endometrial scratching as it relates to embryo implantation is not entirely understood and some questions still remain unanswered. Scientists involved in studies believe that there may be two reasons for the increased implantation rates:

  • Increase of endometrial white blood cells. It appears that endometrial injury increases the production of white blood cells which secrete so called growth factors which in turn control embryo implantation.
  • Gene switching within the endometrium. Scientists speculate that sometimes embryos fail to implant due to genetic switching related to endometrial receptivity. That is, genes responsible for implantation of embryos are not switched on during the time when embryos are supposed to implant. Endometrial scratching may increase expression of genes (switching of genes) thought to be responsible for preparation of endometrium for implantation.

The procedure

The procedure is carried out in the luteal phase of the cycle (i.e. after ovulation) before your treatmentNormally this is done between around day 21-day of the cycle. It is carried out in theatre by a doctor. You are advised to take analgesia 1-2 hours before your scheduled procedure, e.g. ibuprofen (e.g. nurofen) or diclofenac (e.g. voltarol)

The procedure will take approximately 15 minutes to complete. Please be aware that it can be uncomfortable or painful in some circumstances and that bleeding after the procedure is to be expected. Post procedure antibiotics will be given if deemed necessary at the time of the procedure.

Please be fully aware that as this procedure is carried out in the luteal phase of the cycle pregnancy must be avoided as the physical procedure will be detrimental to any early pregnancy 

You will be asked to sign a consent form at the time of the procedure to confirm that you have not had unprotected intercourse in that menstrual cycle.

You should bring a partner or friend to escort you home after the procedure.


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Dr Ippokratis Sarris
Lead Consultant St Paul's

Dr Ippokratis Sarris

MA(Cantab) BMBCh(Oxon) DFSRH MRCOG DM Dr Ippokratis Sarris  is a Consultant in Gynaecology, Reproductive Medicine and Surgery. He graduated from Trinity College, Cambridge, in 1999 an....