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What is endometrial scratching and when should it be considered?

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6 fertility expert(s) answered this question

Answer from: Patricio Calamera, MD, MSc, ObGyn

Gynaecologist, Specialist in Reproductive Medicine
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Well, the scratching, actually we use it but there’s not much evidence or precisely good evidence that it really works but we still use it when we have bad endometrium or the endometrium that doesn’t grow as much as needed to. It’s one of the techniques that we have. We still use it in a tailored way on each patient. Technique that is still in use.

Answer from: Harry Karpouzis, MD, MRCOG, DIUE

Gynaecologist, Founder & Scientific Director
Pelargos IVF Medical 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.

Answer from: Daniel Alexander, MUDr

Gynaecologist, Physician
Gennet
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Endometrial scratching is a method when we do scratching in your endometrium and the small scratching and afterward, the healing process increases the chances for implantation. So, for endometrial scratching, we think about it after an unsuccessful IVF cycle; maybe after a repeated unsuccessful IVF or frozen embryo transfer. So that’s when we think and recommend performing the endometrial scratching. It could be performed in the cycle before the treatment and it could be performed in the current IVF or IVF frozen embryo transfer cycle.

Answer from: Lyubov Mykhaylyshyn, MD, Phd

Gynaecologist, Head of IVF department
Medical centre “Alternativa” for Human Reproduction Clinic “Alterntyva”
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Endometrial scratching is a kind of irritation of the endometrium, so we can perform it either with propeller or hysteroscopy; which is also a kind of endometrial scratching too. Endometrial scratching induces the aseptic inflammatory reaction in the endometrium and this reaction is extremely important for the activation of implantation genes. But recent studies show that there is no benefit of scratching in the whole population of patients with recurrent implantation failure, but we need to realize that we have very properly selected the sub-groups of patients who would really benefit from this procedure, and it looks like it can be considered in patients with low activity of their immune system in the endometrium. So, it looks like it would be beneficial in patients with a low number of NK cells and low activity of NK cells, which depends mainly on so-called KIR-receptors, killer immune-globulin-like receptors. There is a huge variability of those receptors, but genetically we also can find them out and the numbers of them, which make the NK cells very weak. So, in these types of immunological profiles it can be useful, and also scratching it looks like it would be useful in cases of lack of stemetil decidual cells. There is also a subpopulation of stronger cells, which are important for the implementation of the endometrium. Interestingly, we need to realize that the scratching has to be performed very properly, in the proper phase of the menstrual cycle. There was a very nice study published last year by Christopher Blockeel and Mackens. They performed this great change at the beginning of the proliferative phase of the same cycle where the embryo transfer was performed. They had to stop the study prematurely because they found out that they got a very high level of side effects (miscarriage). So we need to know that scratching has to be performed in a cycle before we make the embryo transfer, and the amount of litigation also depends on many factors like body mass index and volume of the uterus. These are factors we have to study well, but it looks like they can be helpful, especially in a group of patients with low immune activity in the uterus.

 

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.

Answer from: Hana Visnova, MD

Gynaecologist, Obstetrician, Medical Director
IVF CUBE SE
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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.

About this question:

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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