5 February 2019

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Endometrial Scratching & IVF

Dr Wan Tinn Teh

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Dr Wan Tinn Teh

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After multiple unsuccessful IVF cycles, couples often ask about alternative techniques that they can try on their next cycle to increase their chance of pregnancy. One such technique is endometrial scratching. So, what is endometrial scratching, and can it increase your chance of having a baby?

What is endometrial scratching?

An endometrial scratch is a procedure proposed to improve endometrial receptivity and increase the probability of pregnancy in women undergoing IVF. It is generally only used for patients who have experienced multiple unsuccessful IVF cycles, despite the transfer of good quality embryos.
 
The procedure is sometimes referred to as an endometrial biopsy, as it involves taking a biopsy of the lining of the uterus, called the ‘endometrium’, using a thin catheter (pipille) that is passed through the cervix. No anaesthetic is required, but patients are generally advised to take over-the-counter pain medication beforehand as it can cause some pain. Pain during the scratch procedure was reported during one study as an average of 6/10. An endometrial biopsy can also be performed at the same time as a hysteroscopy.

Does endometrial scratching increase your chance IVF success?

Previously, low quality evidence has suggested that endometrial scratching may increase pregnancy rate for women with multiple failed IVF cycles.

A recent international multicentre, randomized, controlled trial published in the prestigious medical journal – New England Journal of Medicine has shown that endometrial scratching did not result in a higher rate of live birth than no intervention among women undergoing IVF.

When might fertility specialists recommend an endometrial scratch?

As there is clear evidence that endometrial scratching does not increase pregnancy rate in standard IVF, most fertility specialists won’t recommend it. The procedure is also uncomfortable and associated with an additional cost.
 
However for patients that have experienced recurrent unsuccessful IVF cycles, with good quality embryos, your fertility specialist may suggest performing an endometrial biopsy or hysteroscopy to investigate for potential endometrial causes of implantation failure, such as intrauterine adhesion, endometrial polyps etc.

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