Scratching of the Endometrium

The Embryo Transfer, as a vital part of the IVF-Treatment, doesn’t always lead to an intended pregnancy. The implantation of an embryo into the uterine endometrium is a complex process, which is not fully understood, even to this day. New methods to improve the implantation process is continually being discussed among experts. Patients with recurring failure of implantation, despite the transfer of embryos with excellent nidation (implantation) potential, can profit from the so-called ‘Endometrium Scratching’.

In the case of a scheduled embryo transfer, the endometrium can be ‘scratched’ with a small catheter during the luteal phase of the menstrual cycle. Specifically, the catheter is inserted into the uterine cavity and aspirates a small amount of endometrial tissue, under ultrasound supervision. Normally this is a painless procedure and only takes several minutes.

The ‘scratching’ of the uterine tissue leads to eventual regeneration of the ‘injured’ tissue. As a consequence, more white blood cells migrate here. These cells then release growth factors and cytokines to the local area, which can mean that extra genes in the endometrium are also activated. This simple process is believed to facilitate the implantation of the embryo into the uterine endometrium.

Despite encouraging and rather promising results, the efficacy of this procedure has not been explicitly proven yet. Hence, ‘scratching’ is not recommended to all our patients, but rather as a last resort or supportive measure after several unsuccessful embryo transfers.