Endometrial Scratching

Overview

Infertility is a real problem faced by many couples who struggle to conceive naturally. Endometrial scratching is an IVF procedure that helps improve the chance of successful implantation in women undergoing fertility treatments such as IVF. 

The procedure involves deliberately wounding the inner lining of the uterus and introducing a foreign body or stimulus to induce increased fertility and better implantation rates.

This article provides a comprehensive overview of endometrial scratching, including its definition, causes & symptoms of infertility, benefits, when it’s recommended, chances of conception, and associated risks.

What is Endometrial Scratching?

Endometrial scratching (also known as endometrial injury) is an IVF procedure that involves deliberately wounding the inner lining of the uterus and introducing a foreign body or stimulus to induce increased fertility and better implantation rates.

It involves a doctor scraping away some of the cells from the uterine wall using a pipelle device or catheter, which helps increase the chances of successful implantation.

Causes & Symptoms Of Infertility

Infertility is defined as a couple’s inability to conceive naturally after 12 months of trying, or 6 months for women over 35.

Possible causes may include:

• Ovulatory Disorders: Irregular or absent ovulation can result from conditions such as polycystic ovary syndrome (PCOS), hormonal imbalances, thyroid disorders, or excessive exercise.
  
• Tubal Factors: Blocked or damaged fallopian tubes can prevent the egg & sperm from meeting, which is essential for fertilisation.
• Uterine Abnormalities: Structural issues in the uterus, such as fibroids, polyps, or congenital abnormalities, can affect implantation and pregnancy.
• Endometriosis: This condition occurs when tissue similar to the uterine lining grows outside the uterus, causing inflammation and scarring that can interfere with fertility.
• Male Factor Infertility: Problems with sperm production, motility, or morphology can reduce the chances of fertilisation.
• Age: Advanced maternal age (typically over 35) and paternal age can impact fertility due to declining egg and sperm quality. Read More
• Lifestyle Factors: Poor diet, excessive alcohol consumption, smoking, drug use, and high levels of stress can negatively affect fertility.
• Unexplained Infertility: In some cases, the cause of infertility may not be identified despite thorough medical evaluation. Read More
  

Common signs and symptoms associated with infertility can vary depending on the cause but may include:

• Irregular Menstrual Cycles: Women with irregular or absent periods may have ovulatory issues that affect their fertility.
  
• Painful Periods: Severe menstrual cramps & pelvic pain could indicate conditions like endometriosis or fibroids.
• Abnormal Discharge or Bleeding: Unusual vaginal discharge, heavy bleeding, or spotting between periods might be indicative of underlying issues.
• Pain During Intercourse: Pain or discomfort during sex can be a sign of conditions like endometriosis, infections, or uterine problems.
• Changes in Libido: A decreased interest in sexual activity or difficulties with arousal can affect the ability to conceive.
• Hormonal Imbalances: Symptoms such as excessive facial or body hair, acne, and weight gain may suggest hormonal irregularities.
• Testicular Abnormalities: Men might experience changes in testicle size, shape, or pain that could indicate issues with sperm production or function.
• Erectile Dysfunction: Difficulties achieving or maintaining an erection can impact male fertility.

It’s important to remember that experiencing one or more of these symptoms does not necessarily mean a person is infertile. If you suspect you or your partner may be experiencing fertility issues, it’s advisable to consult an infertility specialist like Dr. Supriya Puranik. 

She can conduct assessments and tests to determine the exact cause and can suggest appropriate treatment options.

Benefits Of Endometrial Scratching

The main benefit of this procedure is that it can help improve the chance of successful implantation in women undergoing IVF treatment or intrauterine insemination (IUI) by resetting their endometrium, thus creating a favourable environment for embryo implantation.

Following are some other benefits of endometrial scratching:

• Increased Implantation Rates: Endometrial scratching is believed to create a more receptive environment for embryo implantation. The mild injury prompts a healing response in the endometrial tissue, potentially enhancing its ability to support embryo attachment and growth.
  
• Enhanced Blood Flow: The scratching procedure may stimulate increased blood flow to the endometrium, promoting better nourishment and support for the developing embryo.
• Immune Modulation: Some studies suggest that endometrial scratching could influence the immune response in the uterine lining, reducing the likelihood of immune rejection of the embryo.
• Improved Endometrial Thickness: The procedure might encourage the growth of a thicker, more receptive endometrial lining, which is essential for successful implantation and pregnancy.
• Release of Growth Factors: The irritation caused by scratching may trigger the release of growth factors and cytokines that could contribute to a more favourable environment for embryo implantation.
• Improved Synchronisation: In cases where the timing between embryo development and the receptive endometrium is critical, endometrial scratching may help synchronise these processes more effectively.
• Addressing Unexplained Infertility: For couples with unexplained infertility, endometrial scratching might provide a potential intervention to improve the chances of conception.
• Psychological Benefit: Some individuals undergoing fertility treatments find that participating in additional procedures, such as endometrial scratching, helps them feel more proactive and involved in the process.

Studies have shown that endometrial scratches increase live birth rates from 28-40 % when conceived through IVF. This procedure requires no anaesthesia and has minimal associated risks.

Additionally, the procedure may not be suitable or beneficial for all individuals. If you’re considering endometrial scratching as part of your fertility treatment, it’s essential to discuss the potential risks, benefits, and alternatives with your infertility specialist.

They can help you make an informed decision based on your specific circumstances and medical history.

When Is This Procedure Carried Out?

Endometrial scratching is usually recommended if you have had repeated miscarriages after failed IVF treatments or if your embryos appear healthy at first but fail to implant due to an unfavourable uterine environment.

The best person to decide if you are the right candidate for this procedure is Dr. Supriya Puranik – an experienced Gynecologist & leading IVF specialist based out of Pune. 20+ years, and her expertise in infertility treatments gives hopeful couples like you the best chance at parenthood.

Chances Of Conception Through Endometrial Scratching

Studies conducted on couples attempting pregnancy through assisted reproductive technology (ART) showed a 51% conception rate after 3 rounds of embryo transfers for those who underwent endometrial scratching compared to 41% without assistance.

However more data from clinical trials involving larger groups of patients is needed before conclusive results can be obtained regarding this procedure.

What Are The Risks Of Endometrial Scratching?

Some of the potential risks of endometrial scratching include:

• Infection: Any procedure that involves entering the body carries a risk of infection. Proper sterile techniques should be used to minimise this risk.
  
• Bleeding: Endometrial scratching may cause minor bleeding or spotting. While this is usually temporary and resolves on its own, it’s important to monitor for excessive bleeding.
• Pain and Discomfort: The procedure might cause mild to moderate discomfort or cramping, which typically subsides within a short time.
• Uterine Perforation: There is a slight risk of unintentional perforation of the uterine wall during the procedure.
• Ectopic Pregnancy: While not directly caused by endometrial scratching, it’s important to note that fertility treatments, including IVF or IUI, carry a risk of ectopic pregnancy (embryo implanting outside the uterus).
• Adverse Reaction to Anesthesia or Medications: If local anaesthesia or other medications are used during the procedure, there is a small risk of adverse reactions or allergies.
• Failed Implantation: Contrary to the intended goal, there is a possibility that endometrial scratching may not lead to the desired improvement in implantation rates.
• Psychological Impact: Some individuals may experience psychological stress or anxiety related to the procedure or its outcomes.

It’s important to have a thorough discussion with your fertility specialist about the potential risks, benefits, and alternatives associated with endometrial scratching. They can help you make an informed decision based on your individual medical history, fertility goals, and overall health. 

If you have any concerns before or after the procedure, don’t hesitate to communicate with your fertility specialist to ensure you receive appropriate care and support.

Get in touch

Dr. Supriya Puranik has 20+ years of experience helping couples realize their dream of becoming parents by providing them with cutting-edge treatments such as endometrial scratching.

As a leading IVF specialist & gynaecologist in Pune, she has helped many hopeful couples achieve successful outcomes through her individualized approach that looks at root causes and provides solutions tailored to each patient’s requirements.

Her expertise in solving infertility-related problems makes her one of the best options for anyone looking for an experienced fertility specialist.

About Doctor

Dr. Supriya Puranik

Gynaecologist & IVF Specialist

Often known as the last glimmer of hope for people who have lost all hope for conceiving a child, Dr. Supriya Puranik is a leading gynaecologist, high-risk obstetrician and Head of IVF & Gynaecology department at Ankura Hospital, Pune

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