When a patient or couple begins an IVF cycle, we are always hopeful that success will be achieved the very first cycle. Despite excellent pregnancy rates, some patients may require more than one cycle to achieve a healthy pregnancy. Most failed cycles occur because the embryo was genetically abnormal and not healthy enough to develop into a baby. Sometimes other factors play a role, too. For instance, if the uterine lining is not optimized, then it may be more difficult for an embryo to implant. Women who have had multiple failed IVF cycles, despite seemingly good quality embryos, may be candidates for what we call “endometrial scratching.” Can endometrial scratching boost IVF success rates? Studies suggest that, in women who have failed prior IVF cycles, endometrial scratching appears to improve the implantation rate of a subsequent cycle.
Endometrial scratching typically involves performing an endometrial biopsy around day 21 of the menstrual cycle. The biopsy is performed with a very small pipelle (tiny plastic tube) that is inserted through the cervix and into the uterus. A small sample of endometrial tissue is obtained. The procedure often causes cramping, and we recommend taking an over-the-counter pain reliever ahead of time. Endometrial scratching can also be done at the time of a hysteroscopy.
The mechanism behind endometrial scratching is not entirely understood, but we speculate that disrupting the lining of the uterus releases growth factors that help to improve embryo implantation. Patients who have failed two or more IVF cycles seem to benefit the most from this procedure. Some studies suggest that endometrial scratching may be as much as 70% more likely to result in a clinical pregnancy as opposed to no treatment (in patients with more than two prior failed cycles).
We are very proud of our pregnancy rates at Fertility Centers of New England. For patients who have not had success with IVF at other centers, we are happy to provide a full review of your medical history and prior cycles. If you are interested in seeing if you would be a good candidate for endometrial scratching or have further questions about the best treatment path for you, please contact us today!
Potdar N, Gelbaya T, Nardo LG. Endometrial injury to overcome recurrent embryo implantation failure: a systematic review and meta-analysis. Reprod Biomed Online. 2012 Dec;25(6):561-71.