The endometrium is the most inner thin layer of tissue inside the uterus. For a successful IVF trial, embryo should attach to the endometrium in a process called implantation. Success rates of assisted reproductive techniques (ART) are approximately 35-40 %, with the most important limiting factor being embryo implantation.
Endometrial scratching, also known as endometrial injury, is a procedure made to stimulate the endometrium in women wanting to get pregnant.
Previous research has suggested that mild injury to the lining of the womb may improve embryo implantation. Endometrial scratching is especially offered to women who fail to become pregnant after several failed rounds of IVF, despite transfer of good-quality embryos and without clear reason for their lack of success. It is supposed that this disruption may increase the chance of an embryo implantation, and therefore creating a pregnancy.
It is not definitive how endometrial scratching works, but it is thought that scratching the uterine lining may induce an inflammatory response, similar to that of a scratch to the skin. The following repair process may improve the chances of implantation by:
One theory is that endometrial scratching causes some sort of inflammatory response within the endometrium. The release of growth factors, hormones and cytokines make the new endometrium more receptive to an implanting embryo. The wound healing response following the scratch may improve the environment of the endometrium and makes it more likely for an embryo to implant.
Endometrial scratching can be done with several methods using different instruments.The most common technique is the endometrial biopsy procedure, normally done with a thin flexible plastic catheter called pipelle. The pipelle is inserted through the cervix (neck of the womb) into the womb, where it is moved back and forth and rotated in order to cause some disruption. This is the very similar to an endometrial biopsy. It is a simple, low-cost procedure which can be done in just a few minutes. It can also be performed simultaneously with Hysteroscopy, a diagnostic procedure which is recommended after failed IVF attempts Endometrial scratching is usually performed in the cycle before you start any drugs as part of an IVF/ICSI treatment or a frozen embryo treatment. Preferably the procedure is done between day 17 and 22 of your menstrual cycle.
Also It can cause some discomfort or pain the risks of endometrial scratching the infection and uterine perforation are very rare.Animal studies have shown a benefit endometrial scratching. Human trials, on the other hand, have shown conflicting results because of differences in the population studied, method and timing of scratching (luteal or follicular phase).
A large Cochrane review of nine randomized trials with unexplained subfertility suggested an overall benefit from endometrial scratching. Certainly, more research is needed to confirm whether or not endometrial scratching can truly help couples to get pregnant.
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