What is endometrial scratching and when should it be considered?

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Endometrial scratching, also known as endometrial biopsy. What does it look like?

Endometrial scratching, also known as the endometrial biopsy, is a procedure that may be useful in IVF treatment. But is it recommended for everybody? What does it look like and what is the reason for using this technique?

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What is endometrial scratching and when should it be considered?

Answer from: Harry Karpouzis, MD, MRCOG, DIUE

Gynaecologist, Founder & Scientific Director IVF Pelargos Fertility Group
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Several years ago, studies started coming out, which showed that performing a biopsy on the recipient’s endometrium before the embryo transfer increases the chances of implantation. The mechanism behind that was not completely clear, even though a lot of studies showed improvements. However, recently a new, large study was published in the New England Medical Journal, which showed surprising results endometrial scratching did not increase clinical pregnancy rates.

In my opinion, endometrial scratching is not something that needs to be done in every single IVF case, as it is an intrusive procedure that can cause discomfort while offering minimal benefits and carrying the risk of causing a womb perforation. It should only be offered to those patients who previously experienced implantation failure with good quality embryos.

What is endometrial scratching and when should it be considered?

Answer from: Mónica Muñoz, MD

Gynaecologist, Medical Director CREA – Medical Centre For Assisted Reproduction
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Endometrial scratching, or endometrial biopsy, is a technique used to help embryos implant themselves following an ovarian stimulation or IVF. The scratch biopsy is a minimally invasive procedure that can be performed within a matter of minutes during a simple office visit. Gynaecologists collect a small sample from the uterus and use it to check for pathological changes. At the same time, the injury sustained during the biopsy stimulates endometrial receptivity.

It’s very important to perform the scratch at the right time – it should be done during the cycle before the transfer. We calculate the correct date by establishing the moment of the previous luteal phase of the cycle – around the twenty-first day of the cycle.

Many studies show increased pregnancy rates after an endometrial biopsy. An endometrial scratch during a non-transfer cycle improves the clinical and implantation rates in patients who previously experienced implantation failure.

What is endometrial scratching and when should it be considered?

Answer from: Hana Visnova, MD

Gynaecologist, Obstetrician, Medical Director IVF CUBE
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The endometrial biopsy or endometrial scratching is a relatively new procedure. It consists of purposefully creating a small injury within the uterine lining. This injury starts a healing process; some studies suggest this process improves the chances of successful implantation. It can be done with various instruments – most commonly a pipelle catheter, which is a 3 mm wide tube. It is inserted through the cervix; once inside, it is moved back and forth to disrupt the endometrium. At this stage, a small sample can also be obtained for later evaluation.

It’s a simple, low-cost procedure that only takes a couple of minutes. It’s usually well-tolerated by patients, although some may experience a minor degree of discomfort or pain. Possible risks include infection or uterine perforation, although the chances for that are negligible.

The results suggest there is a positive effect on endometrial scratching, although the available data is limited and may be biased due to the procedure’s fairly recent introduction. It cannot be conclusively stated that the procedure has a definite effect on the chances of pregnancy. The procedure is, however, extremely simple, and the risk of harming the patient is minimal.

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