Endometrial Scratching, also known as endometrial scratch, is a technique in reproductive medicine. Its purpose is to maximize the success of treatment. Throughout this article, we will explore what endometrial scratching entails and when it is performed, among other aspects.
What is an endometrial scratch test?
This is a recommended technique aimed at improving the uterine implantation capacity when an IVF procedure has not been successful. Although this technique slightly affects the uterine lining, uterine receptivity will be enhanced.
Is endometrial scratching effective?
Studies on endometrial scratching suggest that its performance is associated with an increased likelihood of pregnancy. However, scientific evidence regarding its benefits and the knowledge of how to perform it is not extensive. This lack of consensus among specialists regarding when to recommend it is notable. It is not recommended for patients undergoing a single IVF treatment.
When to do endometrial scratch for IVF?
Mechanical alteration of the endometrium has been proven to modulate the gene expression of factors necessary for implantation. Therefore, the ideal time to perform endometrial scratching is before a new IVF treatment, typically between days 19 and 25 of the menstrual cycle. Reproductive specialists will advise its implementation, especially for patients whose previous IVF treatments have failed, even when high-quality embryos were used, and no apparent reasons explain the negative outcome.
Endometrial scratch procedure
To perform this technique, a flexible catheter of about 3 millimetres is inserted through the cervix. It is moved back and forth until it is finally rotated to scrape the uterine lining.
To this day, how endometrial scratching works is not fully understood. It is believed that scraping the endometrium triggers an inflammatory response, similar to when the skin is scratched. The subsequent repair process improves the chances of embryo implantation because:
- Growth factors, hormones, and proinflammatory cytokines are released. These make the recently formed lining more conducive to embryo implantation
- Key genes required for endometrial preparation are activated, which would not occur otherwise in anticipation of implantation
How long does an endometrial scratch last?
Endometrial scratching can be considered an outpatient procedure. It is a simple, minimally invasive technique that typically lasts between 15 and 20 minutes.
What are the success rates after endometrial scratch?
Several studies have focused on the endometrial scratching technique, yielding conflicting results. A Cochrane review involving nine randomized studies with a population of 1,512 patients with unexplained fertility revealed some benefit from this technique. However, the review also highlighted limitations and the risk of drawing solid and conclusive conclusions from these findings. Therefore, further research is needed to determine whether this technique significantly improves pregnancy chances after an IVF cycle.
Is endometrial scratching painful?
Generally, this is considered a safe technique and is performed without anaesthesia. However, it is important to mention some of the related side effects, which may include:
- Mild bleeding
- Abdominal cramps following the procedure
- Pelvic infection or uterine perforation (in rare cases). Infection can result from the spread from the cervix to the uterine cavity. It is recommended to undergo a Chlamydia screening test before endometrial scratching
- Early pregnancy loss, especially when performed during the second phase of the menstrual cycle
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