Endometrial Scratch (ES) is sometimes offer to patients who have experienced multiple failed IVF / ICSI cycles, despite having good quality embryos transferred.
Several studies have shown that an ES may increase the chance of pregnancy for patients who have this done prior to their IVF / ICSI treatment.
When should ES be done?
ES is performed in the cycle before you start any drugs as part of an IVF/ICSI treatment or a frozen embryo treatment and it is essential that you practice protected intercourse starting the first day of your period before the scratch is done. Preferably the procedure is done between day 17 and 22 of your menstrual cycle.
What happens during endometrial scratch?
The ES is a short out-patient procedure. The consultant will perform an internal ultrasound scan; this is to assess the shape and position of your womb. The procedure involves introducing a speculum into the vagina - the same instrument as used during a smear test. After wiping the cervix with saline, a small catheter (plastic tube) is inserted in your uterus (womb). The endometrial lining is then ‘scratched’ with the catheter. Once the catheter is inserted it usually takes less than a minute to complete the procedure. Occasionally it is not possible to introduce the catheter through the neck of the womb. If this happens, the procedure needs to be abandoned.
At the time of performing an ES, a small amount of endometrial tissue is usually removed within the Pipelle sampling device (the device used to perform the scratch). In women where we suspect an endometrial abnormality, this tissue can be submitted to the pathology laboratory for further analysis. However in the group of women where we recommend ES for fertility purposes, the likelihood of finding an endometrial abnormality is very low. Hence, unless there are specific reasons, we would not plan to submit this tissue for further analysis. However if you wish to take further advice on this, please discuss this with your doctor. Unless you tell us, we will assume that you are in agreement with the above policy and we would therefore discard the small amount of tissue removed at the time of the scratch.
You may be given an antibiotic to prevent any infection. Be sure and tell us if you are allergic to any medication prior to your procedure.
Going home after ES
It is not unusual to experience mild (period like) cramping and/or a small amount of vaginal spotting or bleeding after ES. Take over the counter pain relief if needed.
The procedure is performed in the cycle before your treatment. If your embryo transfer is cancelled or postponed, the procedure will need to be repeated in the cycle before your next planned treatment. Discuss this with your consultant.
How effective is ES?
Several studies have reported a significant improvement in the pregnancy rate following ES. The data is variable, but some studies claim ES may increase pregnancy rates by up to 50% compared to women who have not had a scratch procedure.
Larger studies are required before the safety and effectiveness of ES are proven beyond doubt, but early results are encouraging. Currently it is not known whether ES has any adverse effects on pregnancy (i.e. increased risk of miscarriage or premature birth) or baby (i.e. increased risk of congenital abnormality), but this is thought to be unlikely.
Note: This treatment does not qualify for the Price Promise below.
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