• What is an endometrial scratch?

    An endometrial scratch is a procedure that is performed to try and improve the chance of implantation, when an embryo is transferred back in to your womb.

  • What does an endometrial scratch involve?

    Having an endometrial scratch is a lot like having an embryo transfer. During embryo transfer we use a very soft catheter which contains your embryo and is performed as gently as possible. In contrast, an endometrial scratch involves using a firm catheter that is moved repeatedly inside your womb and aiming to temporarily induce damage of the lining of the womb. Most people report the scratch as being more uncomfortable than an embryo transfer, however the discomfort is best described as mild. The procedure itself takes rarely more than 30 seconds to complete.

  • How is it performed?

    After an informed written consent we will:

    • Pass a vaginal speculum similar to a cervical (PAP) smear test
    • Pass a small catheter through the neck of womb which will gently scratch the lining of the womb
    • Occasionally we may have to hold the neck of the womb with an instrument called tenaculum which may cause a little discomfort.

    The procedure will last for 10 minutes. You may experience a tummy cramp (period like discomfort) in the lower part of the abdomen both during and for a short while after the procedure. You may bleed minimally and occasionally and your periods may start early. You do not need to have any specific time for rest afterwards. You may need a few hours off your normal schedule after the procedure as there may be some uncomfortable cramp like discomfort in the lower abdomen for an hour or so after. You might feel that you are going to faint and therefore you should be accompanied someone on your way home.

    The tissue obtained during endometrial injury could be used for research purposes anonymously or sent for an examination in the laboratory if you provide consent. Otherwise the tissue will be disposed with dignity.

  • Do I need an anaesthetic?

    No, the procedure is performed whilst you are awake. We also suggest taking a simple painkiller such as Nurofen/ibuprofen about an hour before the procedure. If you are allergic to Nurofen/Ibuprofen or if you suffer from asthma, please take two tablets of Paracetamol with or without Codeine phosphate ½ to 1 hour before the procedure. Please take a bath or shower on the morning of the procedure. You will be prescribed an antibiotic by the clinician performing the procedure on the day of the procedure.

  • Are there any risks & complications?

    No, it is generally considered a very safe procedure. The procedure is uncomfortable and you may experience some discomfort and very mild vaginal bleeding after the procedure. Some of the rare risks are as follows:

    • Unsuccessful procedure if the neck of the womb is tightly closed
    • Abdominal discomfort which generally passes off within a few hours
    • Pelvic infection can flare up – we will need you to have vaginal swabs for infection and Chlamydia swabs taken before hand. If there is evidence of infection at the time of this test, the procedure will be cancelled and rescheduled after the infection is treated.
    • Prophylactic antibiotic will be provided to all patients having this procedure. This procedure is not suitable for women who are at risk of endocarditis (heart infection)
    • Inadequate endometrial sample.
    • Persistent heavy bleeding is a rare complication (less than 1%)
    • Uterine perforation is an extremely rare complication (less than 0.01%). There is no evidence to suggest that this procedure may cause uterine perforation but has a theoretical risk.
  • How does it work?

    It is likely that by traumatising the lining of the womb (endometrium) it creates an immune response that increases new blood vessel growth and an influx of certain chemicals and cells that play important roles in implantation. There are a number of studies that suggest that when an endometrial scratch is performed in the appropriate patient, the implantation rates and pregnancy rates increase by up to 70%. The procedure is supported by evidence and research in the field of reproductive medicine.

  • How do I know if I would benefit from an endometrial scratch?

    To date, the evidence suggests that it may be of particular benefit for patients who have had a number of high quality embryos and blastocysts transferred in previous IVF cycles without being successful. Your IVF doctor may talk to you about this procedure, however please ask if you require more information. Please note there is no evidence that an endometrial scratch is beneficial for all patients undergoing all treatments.

  • How do I arrange an endometrial scratch?

    In order for you to have an endometrial scratch, it first needs to be agreed with your doctor. You will be given a provisional date for the procedure based on your last period date and anticipated embryo transfer schedule.

  • When is it usually performed?

    The procedure could only be performed during third half of the menstrual cycle (usually days 21-26) prior to your fertility treatment cycle. You will then be contacted a day before your procedure to confirm a specific time. Please arrive 15 minutes before your scheduled appointment. It should not be performed on the day of egg collection because this may reduce clinical and ongoing pregnancy rates. However, the timing of the procedure relative to your treatment is important. Research has shown that having an endometrial scratch too close to your embryo transfer day or during the stimulation stage of your IVF cycle considerably reduces your chance of successful pregnancy.

  • Can I be refused the test?

    There are a number of circumstances in which the test should not be undertaken and your doctor will explain it to you. These include:

    • If there is a possibility of pregnancy
    • Evidence of active pelvic infection
    • Abnormal discharge from the neck of the womb at the time of procedures
    • Abnormal appearance of neck of the womb
    • If there is vaginal bleeding (i.e. a period)
    • If the neck of the womb is tightly closed or stenosed
    • Very large womb (10-15 cm in size)
  • How much does it cost?

    You can contact our Center for Reproductive Medicine for the price.

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