Endometrial Scratching in Failed IVF Cycles
When couples undergo IVF, they often hope for success on the first try. While we have high success rates, some may need multiple cycles to achieve a pregnancy.
Even when doctors transfer good-quality embryos, the cycle might still not succeed. Researchers have explored various medical approaches to enhance endometrial receptivity, including endometrial scratching.
What is Endometrial Scratching?
Endometrial scratching is a procedure that helps the endometrium become more receptive. This can increase the chances of success in IVF patients.
Also known as endometrial injury, this technique involves intentionally disrupting the endometrium. Doctors typically recommend it for patients who have experienced multiple failed IVF cycles, even after transferring good-quality embryos. The idea behind this procedure is that disrupting the endometrium may enhance the likelihood of embryo implantation.
When Should Endometrial Scratching Be Performed?
Doctors typically perform endometrial scratching around day 21 of the menstrual cycle, during the luteal phase. This timing is about a week after ovulation and a week before the next expected period. Couples need to avoid unprotected intercourse during this cycle, as the procedure may harm an existing pregnancy.
How is endometrial scratching performed?
Doctors can perform endometrial scratching with different types of instruments. The most common is the endometrial biopsy procedure, generally done with a thin, flexible plastic tube and pipelle catheter. The pipelle goes through the cervix and into the uterus. It moves up and down and rotates to create disruption.
Doctors can perform this simple and affordable procedure in an outpatient department. You don't need any anaesthesia, and you can perform it in less time. It might cause some discomfort or pain.
How Does Endometrial Scratching Work?
Endometrial scratching is believed to work through several mechanisms:
- A local scratch in the endometrium may trigger decidualization, enhancing its receptivity to embryos.
- It could release cytokines and growth factors that promote wound healing, which is beneficial for implantation.
- It may aid in the maturation of the endometrium.
At Dr Arockia Virgin Fernando Fertility Clinic, we take pride in our high success rates for infertility treatments. For patients who have experienced previous failures at other centres, we are happy to review your medical history and IVF records. We look forward to supporting you on your journey to motherhood.
FAQ
An endometrial scratch is a minor medical procedure where a thin catheter is used to gently scrape the lining of the uterus (endometrium). This creates small, controlled injuries that may help improve the chances of embryo implantation during fertility treatments like IVF.
Most women experience mild to moderate cramping during the procedure, similar to menstrual cramps. The discomfort typically lasts only a few minutes during the actual scratching. Some doctors recommend taking over-the-counter pain medication beforehand to minimize any discomfort.
Studies show mixed results, with some research indicating a 10-15% improvement in pregnancy rates for women undergoing IVF. However, success rates vary significantly based on individual factors like age, previous failed cycles, and underlying fertility issues.
The procedure is typically done in the cycle before your IVF treatment, usually between days 15-25 of your menstrual cycle. This timing allows the endometrium to heal and regenerate before embryo transfer in the following cycle.
Costs typically range from ₹16,600 to ₹66,400, depending on your location and healthcare provider. Many insurance plans do not cover this procedure since it is considered experimental, so it is important to check with your provider about out-of-pocket expenses.
An endometrial thickness of 8-12mm is generally considered optimal for embryo implantation. Your doctor will monitor this through ultrasound scans to ensure the lining is adequately developed before transfer.
Embryo transfer typically happens 4-6 weeks after the endometrial scratch procedure. This allows sufficient time for the endometrium to heal completely and develop the proper thickness for implantation.
The theory suggests that the healing process triggered by scratching may make the endometrium more receptive to embryo implantation. While some studies show promise, the medical community remains divided on its effectiveness, and more research is needed.
Light spotting or bleeding usually lasts 1-3 days after the procedure. This is completely normal and indicates the endometrium is healing. Contact your doctor if bleeding becomes heavy or lasts longer than a week.
The effects of endometrial scratching are believed to last for one menstrual cycle, which is why it's performed in the cycle immediately before embryo transfer. The endometrial lining completely regenerates each month, so the benefits are temporary. If pregnancy doesn't occur in the first cycle after scratching, the procedure may need to be repeated for subsequent IVF attempts.
The scratch triggers the body's natural healing response, which may increase blood flow and improve the receptivity of the endometrial lining. This process potentially creates a more favourable environment for embryo implantation during IVF cycles. Research suggests the procedure may help women with recurrent implantation failure by resetting the endometrial environment and improving pregnancy rates.
Studies show mixed results, with some research indicating 10-15% improvement in pregnancy rates for women with recurrent implantation failure. However, success rates vary significantly based on individual factors and underlying fertility issues. The procedure appears most beneficial for women who have had multiple failed IVF cycles rather than first-time IVF patients.
The procedure is typically done in the luteal phase of the menstrual cycle (7-10 days after ovulation) in the cycle before starting IVF treatment. For women with irregular cycles, timing may be adjusted based on hormone levels. Your fertility specialist will determine the optimal timing based on your specific treatment protocol and individual circumstances.
Endometrial scraping, also called endometrial biopsy or uterine scraping, is a medical procedure where a small sample of tissue is removed from the lining of the uterus (endometrium). Your doctor uses a thin, flexible tube or curette to gently collect tissue samples for examination under a microscope.