Womb scratching: catching on?

Published: 26 February 2013

Fertility Nursing Forum Deputy Chair and Newsletter Editor Chriss Eftekhar reports on fertility treatment’s latest trend

The latest fertility treatment that patients in the know are requesting is, to give it its hippest name, “womb scratching”.

Formally known as an endometrial biopsy, it entails a procedure similar to a cervical smear and takes approximately 15 minutes to perform. A speculum is inserted into the vagina and an endometrial catheter called a pipelle is inserted through the vagina and cervix and lightly scratches the endometrium (the lining of the womb).

This sets off a chain of events whereby this localised injury to the uterine lining sets off an inflammatory reaction of the endometrium, resulting in white blood cells (leukcytes such as macrophages) which then secrete growth factors and cytokines. These substances regulate blastocyst implantation and placental development.

Should selected women undergoing IVF treatment be offered this procedure?

The thinking is that this stimulates the uterus receptivity to the embryo and increases the success rate of live births. It may help women who have had previous failed IVF treatment cycles and women with good egg quality and who also produce good-quality embryos.
It may also help women with underlying uterine receptivity. It may not benefit everyone, especially women with poor embryo quality, advanced maternal age and when genetic problems are indicated.

This procedure should be performed by a trained gynaecologist within a fertility clinic and in theory should carry little risk to the women. It is currently believed that the best time to perform the scratch is once or twice in the month preceding an embryo transfer. It should not be done in the same cycle as ovarian stimulation for fresh IVF, or estradiol for a frozen embryo transfer (FET).

Several recent studies, including a British study published in the journal Reproductive BioMedicine Online, confirm that womb scratching can double the success rate of pregnancy and live birth when performed at the right time. Visit the Fertility Authority webpage to find out more.