Endometrial scratch: will it work for you?

07 May 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.