Endometrial Scratch is a technique which is being used for women who have had recurrent implantation failure i.e., have had 2 or more embryo transfers (fresh or frozen) using good quality blastocyst embryos, which have not resulted in implantation.
An endometrial scratch involves gently ‘scratching’ the womb lining (the endometrium) using a very thin plastic tube which is normally used to obtain a specimen from the womb lining. The tube is very similar in size to the catheter used to transfer embryos.
It is usually performed on or around day 21 of the cycle before your fertility treatment starts and the effect it produces is thought to last up to 3 months.
Why Do An Endometrial Scratch?
There is some evidence to suggest that a very minor injury to the lining of the womb can actually stimulate the uterus to be more receptive to an implanting embryo. The current evidence is not entirely clear, but it would appear that this effect may only be seen in women who have what we call recurrent implantation failure (RIF) i.e., women who have had at least 2 transfers involving good quality blastocyst embryos which have failed to implant. The current evidence also suggests that not all women will benefit from an endometrial scratch but that some might. As we don’t currently have a test that can identify the women with RIF for whom scratch might be helpful, we offer it to all women with the condition.
Due to a lack of clear evidence for the benefit of an endometrial scratch the Human Fertilization and Embryology Authority (HFEA) have rated endometrial scratch as an amber add-on for most fertility patients undergoing IVF or ICSI, and as a grey add-on for patients with RIF. *
Are There Any Risks Or Side Effects?
The procedure may cause light bleeding /spotting which settles within a day or two. It may also produce a mild crampy period type pain which again is short lasting and is relieved with simple pain killers such as paracetamol or ibuprofen.
Very rarely the procedure may cause a womb infection. If you experience continuing pain, develop flu like symptoms or a vaginal discharge, you will need to contact the clinic or your GP immediately.
Very, very rarely the tube may damage your womb or cause an internal injury – this occurs less than one time in every thousand procedures.
Preparation
You will need to contact the unit on 0191 445 2768 on day 1 of your period and an appointment will be arranged for the scratch procedure to be on day 21 of your cycle or as near to this day as possible.
- It is important to use a barrier method of contraception (e.g., a condom) during this cycle.
- It is advisable to take some analgesia (pain killers) about an hour before the procedure.
- You will need a partially full bladder for the procedure.
The procedure is very similar to a smear test, but you may have some ‘crampy’ pains during the procedure.
The procedure is performed in theatre on the Fertility Unit and takes about 15 minutes.
Discharge Information
It is fine to drive after the procedure and you may return to work.
After the procedure if you have any queries or concerns, heavy bleeding or excessive pain, please do not hesitate to contact us as there will always be someone happy to help.
Telephone: 0191 445 2768 (Direct Line)
Email: [email protected]
or in the case of an EMERGENCY please call 0191 482 0000 and ask for a member of the IVF on call team after office hours.
* Treatment add-ons are optional, non-essential treatments that may be offered in addition to established treatments such as IVF, ICSI or frozen embryo transfer, in an attempt to improve treatment outcomes.
The HFEA provides information on some add-ons, and also rates them to indicate whether an add-on is effective at improving treatment outcomes, according to evidence from studies.
There are five different ratings.
The HFEA currently gives endometrial scratch an amber rating for increasing the chances of having a baby for most fertility patients undergoing IVF or ICSI. This is because it is not clear whether endometrial scratch is effective at improving treatment outcomes.
The HFEA gives endometrial scratch a grey rating for improving the chances of having a baby for patients with RIF. This is because there is insufficient good quality evidence for the HFEA to rate the effectiveness of endometrial scratch at improving the chances of having a baby for patients with RIF.
More information regarding endometrial scratch and add-ons is available on the HFEA website https://www.hfea.gov.uk/treatments/treatment-add-ons/endometrial-scratching