Endometrial scratch increases IVF pregnancy rate in women with previously failed IVF treatment

Endometrial scratching ("endoscratch") is a procedure we have been performing in CRM London since 2010 to increase the IVF pregnancy rates.

How does it work?


The most significant step in achieving a pregnancy is when the embryo implants in the uterus. For that to happen the lining of the uterus must be prepared and synchronised with the growth of the embryos.

In IVF treatment the stimulation of the ovaries with drugs can alter the condition of the lining of the uterus resulting in a decrease in its receptivity to embryos.

While it is not completely understood at present in what way endoscratch improves implantation there is some evidence suggesting that endoscratch can alter the structure and the function of the lining, making it more receptive. It has been thought that the injury causes the lining to regenerate and become synchronised with the growth of the embryo.

How endometrial scratching is performed?


Endometrial scratching is a quick and safe procedure which resembles a smear test and is performed the month prior starting IVF treatment. A speculum is introduced in the vagina and a thin catheter is gently inserted in the uterus in order to cause a small injury to the lining of the uterus. The procedure usually just takes a few minutes and you can leave the clinic a few minutes later. Some women may find the endoscratch uncomfortable but there isn't usually the need for any pain relief or sedation. Some women may wish to takes nurofen or paracetamol approximately 1 hour beforehand.

The scientific studies


When the early scientific studies1-3 on the subject were followed by more robust randomised studies4-5 we decided to start offering endometrial scratching to women with previous implantation failure attempting IVF treatment. The first 30 women treated at CRM London with 2-3 (average 2.6) previous unsuccessful IVF attempts had an astonishing pregnancy rate of 48.4%.

Two recent meta-analyses, which are the most statistically accurate way to show whether treatment is effective or not (Cochrane review with 5 randomised studies6 and a study published in Reproductive BioMedicine Online including 7 studies7) suggest that local injury of the lining of the uterus in the cycle preceding the IVF treatment can possibly double the pregnancy rate.

Dr Robert Forman was previously Director CARE Fertility London said of the treatment "we were one of the first clinics in the UK who started offering this procedure to our patients since 2010 and we have been pleasantly surprised by the good results achieved since".

Dr E. Theodorou, current Medical Director of CARE London explains that "this simple procedure is considered for patients who have previous failed IVF attempts, as we constantly try to offer pioneering but safe treatments. We are awaiting further studies to see how the endometrial scratching could also improve live birth rate after IVF treatment".

Please contact CARE Fertility for further information to see if you could benefit from endoscratch.

Reference

1. Barash, A., Dekel, N., Fieldust, S., Segal, I., Schechtman, E., Granot, I., 2003. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilisation. Fertil. Steril. 79, 1317-1322.
2. Raziel, A., Schachter, M., Strassburger, D., Bern, O., Ron-El, R., Friedler, S., 2007. Favourable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure. Fertil. Steril. 87, 198-201.
3. Zhou, L., Li, R., Wang, R., Huang, H., Zhong, K., 2008. Local injury to the endometrium in controlled ovarian hyperstimulation cycles improves implantation rates. Fertil. Steril. 89, 1166-1176.
4. Karimzade, M., Oskouian, H., Ahmadi, S., Oskouian, L., 2010. Local injury to the endometrium on the day of oocyte retrieval has a negative impact on implantation in assisted reproductive cycles: a randomised controlled trial. Arch. Gynecol. Obstet. 281, 499-503.
5. Narvekar, S., Gupta, N., Shetty, N., Kottur, A., Srinivas, M., Rao, K., 2010. Does local endometrial injury in the non-transfer cycle improve the IVF-ET outcome in the subsequent cycle in patients with previous unsuccessful IVF? A randomised controlled pilot study. J. Hum. Reprod. Sci. 31, 15-19.
6. Nastri CO, Gibreel A, Raine-Fenning N, Maheshwari A, Ferriani RA, Bhattacharya S, Martins WP. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Database of Systematic Reviews 2012, Issue 7.
7. Tarek El-Toukhy, SeshKamal Sunkara, Yakoub Khalaf. Local endometrial injury and IVF outcome: a systematic review and meta-analysis, Reproductive BioMedicine Online (2012) 25, 345-354