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Endometrial scratching is a technique used to improve the ability of embryo implantation in the uterus after In-Vitro Fertilization (IVF). It involves injuring superficially the lining of the uterus by scratching it during hysteroscopy or without hysteroscopy, in order to improve the receptivity of the uterus to the embryo.
Endometrial scratching is offered to women who fail to become pregnant after several IVF procedures, despite transfer of good-quality embryos and without a clear reason for the failure. Embryo implantation is thought to be the most important factor influencing pregnancy.
Although some studies suggest that endometrial scratching may double the chances of getting pregnant, conclusive scientific evidence on its benefits and knowledge of the underlying mechanisms is limited.
How Does Endometrial Scratching Work?
The endometrium is the layer of tissue that forms a lining inside the cavity of the uterus. To get pregnant, an embryo has to attach to this lining (implantation). Implantation failure is considered the primary factor in human fertility and is usually because of lack of uterine receptivity.
Scratching the uterine lining may induce an inflammatory response, similar to that of scratching the skin. The subsequent repair process improves the chances of implantation by:
• The release of growth factors, hormones and inflammatory cytokines, will make the newly-formed endometrium more receptive to the implanting embryo.
• Activating genes that are important for preparation of the endometrium, which may not otherwise be activated, at the time of an attempted implantation.
Mechanical disruption to the endometrium has been shown to modulate the genetic expression of factors important for implantation.
When is Endometrial Scratching Performed?
The optimal time for a woman to undergo endometrial scratching by hysteroscopy or without hysteroscopy is during the second phase of the menstrual cycle before the IVF treatment begins. This means during the luteal phase of the menstrual cycle. The Luteal phase occurs after ovulation (when the ovaries release an egg) and before your period starts. During the Luteal phase, the endometrium of the uterus usually gets thicker to prepare for a possible pregnancy.
The Procedure of Endometrial Scratching
Endometrial scratching is simple, minimally invasive, and only takes 15-20 minutes. It can be done during a hysteroscopy through the vagina and the cervix of the uterus. A narrow fiber-optic camera is inserted into the uterine cavity through the vagina and the cervix to make the endometrial scratching. A flexible catheter, 3mm wide, is inserted through the cervix, by the hysteroscopy into the cavity of the uterus and then moved back and forth and rotated in order to make some disruption to the uterine lining. At the same time we can examine the cavity, by the camera to fix problems including the shape, size, septum, polyps, fibroids, or make a biopsy. The patient can leave the hospital or the clinic 2 - 4 hours after the hysteroscopy.