Endometrial scratch: will it work for you?

Endometrial scratch: will it work for you?

When having fertility treatment, you’ll do anything to improve your chances of a successful pregnancy. So could a simple endometrial scratch (i.e. agitating the lining of your uterus) boost your implantation prospects? Here’s our view.

Fertility clinics started offering endometrial scratching about 10 years ago. Research is still ongoing. Initially, it was seen as one of the better add-on treatments. Compared, say, to the evidence on intralipids, endometrial scratching had slightly more kudos. That was then. But read on.

Similar to a smear test, an endometrial scratch involves a quick scrape of your womb lining at a certain point in your cycle. Until recently, the research suggested it could improve embryo implantation, especially if you’d had failed IVF attempts before.

But then, in 2019, a larger trial into IVF and intralipids, downgraded its benefits. Over 1,000 women took part, All had IVF treatment. Half had the scratch and half didn’t. The live birth rate for those who had the scratch didn’t improve. Another fertility add-on lost its lustre.

That disappointing finding echoed a larger review from ESHRE in 2018. While IVF clinical pregnancy rates might be boosted a little after an endometrial scratch, the study found no significant benefits. It’s well worth reading the report, as it gives a good summary of past studies as well.

So not everyone benefits from endometrial scratching. All we can say is that a small group might. Endometrial scratching seems to provoke a reaction within the inner lining of the womb. Hormones and chemicals are released to help the lining repair itself. A genetic trigger response to an endometrial scratch may give the implantation ‘green light’.

In essence, the temporary injury may make the endometrium more receptive to an embryo. That means a better chance of a pregnancy and live birth. Until the 2018 study poured cold water on it, that is.

How much weight do we attach to those earlier studies? One said an endometrial scratch was 70% more likely to result in pregnancy in women with unexplained recurrent implantation failure. Another said endometrial scratching improved live birth rates for women who had two or more previous IVF failures. Small studies. Specific angles. They can’t be completely discounted. But the newer studies are more persuasive.

Most clinics today tend to offer the procedure to fertility patients who’ve had several unsuccessful cycles where implantation issues are suspected. The scratch is optimally carried out in the cycle before your treatment. Your clinic will confirm the optimal date.

If you have irregular periods, guidance on timing is particularly important. If you’re controlling your cycle with BCPs or Norethisterone, you may be told to have your endometrial scratch four or so days before your final pill.

An endometrial scratch is quick, but slightly uncomfortable. No anaesthetic is needed and you can return home immediately afterwards. The risk of infection is low. If you’re having a hysteroscopy, a scratch can sometimes be done at the same time.

In the UK, prices for endometrial scratching vary. But the average cost appears to be between £150 and £300. A few clinics charge more. Given the typical cost of a fertility cycle, it’s a relatively low-cost extra for something that might enhance the outcome of your fertility treatment. Still, the heyday of the endometrial scratch may be over.

39 Comments
  • Lucy
    Posted at 09:06h, 05 May Reply

    I had my endometrial scratch at the same time as my hysteroscopy in March 2016 but then the start of my treatment got delayed (as I was not immune to rubella). Should I have another scratch or is it harmful to have another one? By the time I am due to have egg collection it will have been 3 months since my scratch. All the literature says you should have it during the cycle before IVF. This is my first round of IVF. Unexplained infertility. Thanks in advance.

  • Lucy
    Posted at 09:06h, 05 May Reply

    I had my endometrial scratch at the same time as my hysteroscopy in March 2016 but then the start of my treatment got delayed (as I was not immune to rubella). Should I have another scratch or is it harmful to have another one? By the time I am due to have egg collection it will have been 3 months since my scratch. All the literature says you should have it during the cycle before IVF. This is my first round of IVF. Unexplained infertility. Thanks in advance.

  • Mrs Hobson
    Posted at 17:23h, 26 May Reply

    I am 2nd time trying IVF now with frozen eggs from the 1st fresh cycle try. I opted for the endoscratch this time and had it 3 days ago on day 28 of my cycle, having already started my gown regulation drugs. The Dr who did the procedure was surprised I had been booked in so late to have it done, but did seem to still think it would still have a chance of helping. My period has started today, just 3 days after the procedure, which is when it is due as I have a 31 day cycle, but I am so worried the endoscratch was done too late & therefore not just a waste of money, but more importantly pointless for this try, we really hope not, but what does anyone think please? Any advice welcome, thank you.

  • Mrs Hobson
    Posted at 17:23h, 26 May Reply

    I am 2nd time trying IVF now with frozen eggs from the 1st fresh cycle try. I opted for the endoscratch this time and had it 3 days ago on day 28 of my cycle, having already started my gown regulation drugs. The Dr who did the procedure was surprised I had been booked in so late to have it done, but did seem to still think it would still have a chance of helping. My period has started today, just 3 days after the procedure, which is when it is due as I have a 31 day cycle, but I am so worried the endoscratch was done too late & therefore not just a waste of money, but more importantly pointless for this try, we really hope not, but what does anyone think please? Any advice welcome, thank you.

  • Jaspreet
    Posted at 04:10h, 02 August Reply

    I had my endometrial scratch at the same time as my hysteroscopy in May 2016 but then the start of my treatment got delayed . Should I have another scratch or is it harmful to have another one? By the time I am due to have egg collection it will have been 2 months since my scratch. All the literature says you should have it during the cycle before IVF. This is my first round of IVF.Thanks in advance.

  • Jaspreet
    Posted at 04:10h, 02 August Reply

    I had my endometrial scratch at the same time as my hysteroscopy in May 2016 but then the start of my treatment got delayed . Should I have another scratch or is it harmful to have another one? By the time I am due to have egg collection it will have been 2 months since my scratch. All the literature says you should have it during the cycle before IVF. This is my first round of IVF.Thanks in advance.

  • Lilian
    Posted at 06:06h, 27 January Reply

    Does the endometrial scratch work for ivf

  • Lilian
    Posted at 06:06h, 27 January Reply

    Does the endometrial scratch work for ivf

  • Helen tagoe
    Posted at 09:01h, 09 April Reply

    Hi was wondering do you know if liverpool womens does this treatment? Thank you.xx

    • Jen
      Posted at 16:41h, 11 April Reply

      In reply to Helen – I’ve had one performed at the Womens Liverpool today. Hope this helps answer your question.

  • Helen tagoe
    Posted at 09:01h, 09 April Reply

    Hi was wondering do you know if liverpool womens does this treatment? Thank you.xx

    • Jen
      Posted at 16:41h, 11 April Reply

      In reply to Helen – I’ve had one performed at the Womens Liverpool today. Hope this helps answer your question.

  • Kay
    Posted at 01:44h, 14 April Reply

    My RE had me get the scratch done on cd 6 and get will be in approximately 3 weeks. Is that not enough time to be effective? I’m concerned as to why he didn’t have me get it done the month prior to my fet.

  • Kay
    Posted at 01:44h, 14 April Reply

    My RE had me get the scratch done on cd 6 and get will be in approximately 3 weeks. Is that not enough time to be effective? I’m concerned as to why he didn’t have me get it done the month prior to my fet.

  • Hana
    Posted at 06:27h, 09 May Reply

    Hi Ladies,

    I have 2 failed raw cycle before that was 2014 and early Jan 2017. Had endo scratch , I FET transferred on 27/05/17 and now I am waiting to know the result on 11/05/17. I am feeling period cramps since day 3 sore boobs and frequently going to the toilet late at night until now. Never had this symptom on my previous cycle. Had anyone had this symptom with BFP result. I am feeling very nervous and scared to know the result this Thursday.

    • Cake baby
      Posted at 20:28h, 16 May Reply

      Hi Hana. Hope you had a successful result and a bfp!! But if not stay strong girl..you can do this. Remember you’re not alone x

  • Hana
    Posted at 06:27h, 09 May Reply

    Hi Ladies,

    I have 2 failed raw cycle before that was 2014 and early Jan 2017. Had endo scratch , I FET transferred on 27/05/17 and now I am waiting to know the result on 11/05/17. I am feeling period cramps since day 3 sore boobs and frequently going to the toilet late at night until now. Never had this symptom on my previous cycle. Had anyone had this symptom with BFP result. I am feeling very nervous and scared to know the result this Thursday.

    • Cake baby
      Posted at 20:28h, 16 May Reply

      Hi Hana. Hope you had a successful result and a bfp!! But if not stay strong girl..you can do this. Remember you’re not alone x

  • Joanne lyons
    Posted at 20:10h, 22 May Reply

    I had endrometum scratch on day 22 and my period has now arrived on day 25 is this normal

  • Joanne lyons
    Posted at 20:10h, 22 May Reply

    I had endrometum scratch on day 22 and my period has now arrived on day 25 is this normal

  • emily
    Posted at 00:05h, 23 May Reply

    Hi,

    Long time Google reader, 1st time typer.
    am 27, have regular 28 day cycle.
    2 failed FET IVF so far this 2017. (DH had vasectomy from last marriage)
    I have been told i will be getting a endometrial scratch on 29 MAY which will be day 26….is this getting a bit to late?
    I read alot that it should be around day 21.
    my results from yesterday
    Your hormone levels from today were as follows: OVULATION CONFIRMED
    Estrogen (E2) : 281
    Lutenizing Hormone (LH): 16
    Progesterone (P4): 5.2

  • emily
    Posted at 00:05h, 23 May Reply

    Hi,

    Long time Google reader, 1st time typer.
    am 27, have regular 28 day cycle.
    2 failed FET IVF so far this 2017. (DH had vasectomy from last marriage)
    I have been told i will be getting a endometrial scratch on 29 MAY which will be day 26….is this getting a bit to late?
    I read alot that it should be around day 21.
    my results from yesterday
    Your hormone levels from today were as follows: OVULATION CONFIRMED
    Estrogen (E2) : 281
    Lutenizing Hormone (LH): 16
    Progesterone (P4): 5.2

  • Tamara
    Posted at 00:24h, 21 August Reply

    Hi, I had an Endometrial scratch on 30/05/17. Since then, I haven’t had a period. I have been experiencing excruciating cramps and loose stool. On 03/08, my Fertility Dr put me on some pills to start my period, (which I took for 14 days). My period came yesterday 20/08, light flow accompanied with very painful cramps & loose stool. Are these symptoms of an infection? Is this delay too long for the scratch to be effective for this cycle?

  • Tamara
    Posted at 00:24h, 21 August Reply

    Hi, I had an Endometrial scratch on 30/05/17. Since then, I haven’t had a period. I have been experiencing excruciating cramps and loose stool. On 03/08, my Fertility Dr put me on some pills to start my period, (which I took for 14 days). My period came yesterday 20/08, light flow accompanied with very painful cramps & loose stool. Are these symptoms of an infection? Is this delay too long for the scratch to be effective for this cycle?

  • nik
    Posted at 12:47h, 02 November Reply

    Hi Doc,

    I had OHSS in my fresh cycle after egg collection so embryos were not transferred. After that I had two failed FET cycle with embryo glue. Doctor said there no reason for why embryos didn’t stick.Please suggest me what can I do for next FET.or shall I go for fresh cycle as it produce good result.I have one average and one poor quality embryo left?will endometrium scratch will help?Please help me.
    Thanks,
    Nik

    • Sarah
      Posted at 15:42h, 29 November Reply

      Hi Nik
      I am in the same predicament as you, 2 failed fets after cancelled fresh due to OHSS. Considering paying for a scratch next month, have 2 good qual embies left but have had 4 not thaw properley which has been very disheartening as you can imagine! There’s really good write ups about how a scratch can improve chances so I think I will give it a go!

  • nik
    Posted at 12:47h, 02 November Reply

    Hi Doc,

    I had OHSS in my fresh cycle after egg collection so embryos were not transferred. After that I had two failed FET cycle with embryo glue. Doctor said there no reason for why embryos didn’t stick.Please suggest me what can I do for next FET.or shall I go for fresh cycle as it produce good result.I have one average and one poor quality embryo left?will endometrium scratch will help?Please help me.
    Thanks,
    Nik

    • Sarah
      Posted at 15:42h, 29 November Reply

      Hi Nik
      I am in the same predicament as you, 2 failed fets after cancelled fresh due to OHSS. Considering paying for a scratch next month, have 2 good qual embies left but have had 4 not thaw properley which has been very disheartening as you can imagine! There’s really good write ups about how a scratch can improve chances so I think I will give it a go!

  • Carol
    Posted at 07:27h, 12 June Reply

    Hi ladies
    I’ve had 3 cycles of ivf with donor eggs, 1st one was a fresh egg and it was successful but had miscarriage at 5 weeks, I had a four more eggs frozen, put 1 back the 2nd time but it never took so I opted for the scratch for our 3rd attempt and I got pregnant again but like last time I miscarred again at 4 weeks, heart broken, can’t seem to get by the 4/5 week, help ladies.

    • Sally
      Posted at 19:41h, 26 October Reply

      Hi Carol, I’m really sorry to hear your story. I had a similar situation with natural conception and IVF-always miscarrying at the 4-6 weeks point. Have you been tested for Natural Killer Cells? We discovered that I had a high percentage and took steroids to combat the NKC’s at my frozen embryo transfer cycle and I now have a beautiful boy. I know it’s not always the answer but I’d highly recommend getting tested xx best wishes and good luck x

  • Carol
    Posted at 07:27h, 12 June Reply

    Hi ladies
    I’ve had 3 cycles of ivf with donor eggs, 1st one was a fresh egg and it was successful but had miscarriage at 5 weeks, I had a four more eggs frozen, put 1 back the 2nd time but it never took so I opted for the scratch for our 3rd attempt and I got pregnant again but like last time I miscarred again at 4 weeks, heart broken, can’t seem to get by the 4/5 week, help ladies.

    • Sally
      Posted at 19:41h, 26 October Reply

      Hi Carol, I’m really sorry to hear your story. I had a similar situation with natural conception and IVF-always miscarrying at the 4-6 weeks point. Have you been tested for Natural Killer Cells? We discovered that I had a high percentage and took steroids to combat the NKC’s at my frozen embryo transfer cycle and I now have a beautiful boy. I know it’s not always the answer but I’d highly recommend getting tested xx best wishes and good luck x

  • Amy
    Posted at 21:41h, 19 December Reply

    Hi lovely lady’s hope you can help.
    Had icsi 6 years ago, failed. Saved up and had again last May Day 5 blastocyst 2 good embryos n got pregnant sadly miscarriage at 13 weeks.
    Recently done another fresh cycle grade A embryos n nothing negative test. Been to follow up appointment and they have suggested a scratch and further tests as to why no implantation, as im 30 and have good egg count. Has any one else had this? Still got positive in the wnd? Felt rather shitty once left clinic like it’s never going to happen and like they just want more money
    We’ve got frozen embryos waiting for next cycle to use them

  • Amy
    Posted at 21:41h, 19 December Reply

    Hi lovely lady’s hope you can help.
    Had icsi 6 years ago, failed. Saved up and had again last May Day 5 blastocyst 2 good embryos n got pregnant sadly miscarriage at 13 weeks.
    Recently done another fresh cycle grade A embryos n nothing negative test. Been to follow up appointment and they have suggested a scratch and further tests as to why no implantation, as im 30 and have good egg count. Has any one else had this? Still got positive in the wnd? Felt rather shitty once left clinic like it’s never going to happen and like they just want more money
    We’ve got frozen embryos waiting for next cycle to use them

  • ana
    Posted at 14:46h, 15 April Reply

    I have five ivfs with my own eggs no success pregnancy, had two donor egg ivf one fresh one frozen with endometrium scratch no pregnancy i dont know if i have an implantation problems i have endometriose stage 4. please help me what can i do to get pregnant.

    • sharidah
      Posted at 17:27h, 19 August Reply

      Look into ERA testing. That may help

  • ana
    Posted at 14:46h, 15 April Reply

    I have five ivfs with my own eggs no success pregnancy, had two donor egg ivf one fresh one frozen with endometrium scratch no pregnancy i dont know if i have an implantation problems i have endometriose stage 4. please help me what can i do to get pregnant.

    • sharidah
      Posted at 17:27h, 19 August Reply

      Look into ERA testing. That may help

  • Yoland Sunil D'Souza
    Posted at 04:54h, 04 February Reply

    I had my endometrial scratch on 28th December 2021 its 4/02/2022.i still haven’t got my periods. Generally does periods delay after endometrial scratch.

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