Endometrial scratching

What is endometrial scratching?

It is a relatively new technique which improves implantation rates in pregnancy. The lining of the uterus (the endometrium) is gently ’scratched’ using a thin catheter (a fine, flexible, sterile, plastic tube). This treatment is available at Spire Cambridge Lea Hospital with Mr Robin Crawford, consultant gynaecologist.

The research evidence suggests that scratching the uterine lining causes a reaction which may increase embryo implantation rates:

  • the repair process releases growth and cell factors leading to a more receptive endometrial lining for the implanting embryo and so increases the chances of pregnancy
  • Endometrial scratching may ‘switch on’ the genes that are responsible for preparation of the endometrium for implantation, which increases the chances of pregnancy

Who may benefit from endometrial scratching?

Mr Crawford offers endometrial scratching to women who have had more than two IVF, ICSI or FET cycles which resulted in a negative pregnancy test, despite having good quality embryos.

When is the best time to have the procedure?

The best time to perform the endometrial scratch is between day 18 and day 23 of the patients’ cycle (the first day of the period counting as day one).

Preparing for the procedure

It is vital that you do not have unprotected intercourse in the four weeks before the planned endometrial scratch procedure, to avoid the risk of a possible pregnancy.

Also, prior to the visit, you:

  • may eat and drink normally before the procedure
  • do not need to empty your bladder before the procedure
  • should wear comfortable clothing that gives easy access to the lower part of the body

How is the procedure performed?

This is not usually a painful procedure and although you may experience some discomfort, no anaesthesia is required.

Much of the procedure is similar to an embryo transfer:

  • a speculum is gently inserted into the vagina so the cervix can be seen
  • the cervix is cleaned with sterile gauze
  • a thin flexible catheter is inserted through the opening of the cervix, and the uterine lining is gently ’scratched’ (Inserting and moving the intrauterine catheter up and down may cause mild abdominal cramping similar to period pain)
  • the catheter is withdrawn at the end of the procedure. Some mild bleeding is common after the procedure

After the procedure

After the procedure, you should:

  • wear a sanitary towel (not a tampon)
  • be able to drive and resume normal daily activities
  • eat and drink normally

What are the risks?

There is a small risk that any infection within the cervix may spread to the uterine cavity during the procedure.  You are advised to contact the hospital immediately any of the following symptoms are experienced within a few days of the procedure:

  • unexplained fever
  • persistent bleeding or foul-smelling vaginal discharge
  • increasing lower abdominal pain
  • feeling generally unwell

Is pain relief needed after the procedure?

Most women experience either discomfort or mild cramping period-type discomfort during the procedure.   Afterwards, if required, she may take over-the-counter painkillers, as directed on the packs, such as:

  • paracetamol alone or with codeine
  • ibuprofen

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