For a pregnancy to occur, a concerted interplay of a number of complex mechanisms is needed that will ultimately allow new life to emerge and develop. Once the sperm meets the egg cell, fertilization occurs, the cell begins to divide and an embryo is formed, the key issue becomes its implantation in the uterus. Its mucous membrane, called the endometrium, allows it to connect with the mother’s body. In many cases, disorders of the so-called receptivity of the endometrium or a problem with its proper growth are the reason for infertility. There are a number of methods to help the endometrium function properly. One of them is the so-called “scratching” or scratch biopsy procedure of the endometrium, which aims to stimulate it properly.
What is the procedure based on?
Scratching involves the mechanical disruption of the endometrium with a probe, usually using a vacuum. It is a procedure designed to increase the chances of embryo implantation during a natural cycle or in vitro fertilization (IVF) procedure. The procedure stimulates the regeneration and repair response of the endometrium, which can improve its receptivity, or ability to accept an embryo.
Who should consider the procedure?
The indication for endometrial scratch biopsy is most often a lack of embryo implantation despite good embryo quality. It is recommended for couples in whom the IVF program has been unsuccessful without clear reasons and after ruling out genetic disorders in the transferred embryos. It can also be considered for patients whose endometrium in the natural cycle does not grow to a normal size after ovulation (optimally above 8 mm).
What is the qualification process?
Scratching is performed on doctor’s orders, after a detailed analysis of the patients’ situation, evaluation of records and ultrasound, and history. The procedure is performed in cases of pregnancy failure. Beforehand, an endometrial receptivity test should be performed to determine whether the mucosa requires measures to “silence” the immune system or, on the contrary, its “activation.” In the latter case, frequent intercourse and endometrial scratching are recommended. It is important to inform the doctor before the procedure about any malaise or discomfort, especially in the vaginal or pelvic (lower abdominal) area.
What could be a contraindication to the method?
Contraindications to the procedure may be active infection, blood clotting disorders or poor general condition of the patient. If there are complaints of pain in the abdominal fossa and feverish states indicating systemic diseases, the woman complains of malaise – it is worth diagnosing the cause, treating the abnormalities and implementing the procedure at another time. The procedure should not be painful and is rated as relatively safe.
How to prepare for endometrial scratching?
The procedure is most often performed on a certain day of the menstrual cycle, in a certain rhythm. It is usually performed at least twice in the first and second phases of the cycle preceding the cycle in which pregnancy or embryo transfer will be sought. It can also be performed during the early follicular phase in the same cycle in which efforts for pregnancy or embryo transfer are taking place. Much depends on the situation and previous treatment history. The patient also gets individual recommendations to which she should adhere. Sometimes additional tests are needed before the procedure. After scratching, it is important to evaluate the results and plan the further procedure accordingly – about trying naturally for pregnancy, starting IVF treatment or transferring frozen embryos.
What does the procedure look like step by step?
The procedure is performed in a gynecological chair. The doctor inserts a vaginal speculum to gain access to the cervix. A thin probe/coil is inserted into the uterus, which is used to perform a controlled breach of the endometrial surface. Mechanical scratching of the endometrium along with the use of a vacuum involves gently moving the catheter along the walls of the uterine cavity, which causes local micro-trauma. The procedure takes a few minutes and usually does not require anesthesia, although local anesthesia or pain medication may be considered for some patients. The patient may experience mild uterine cramping or discomfort, which usually subsides within a few hours. There may be some minor spotting from the genital tract after the procedure.
The procedure is not very invasive, but should be used after qualifying and establishing clear indications. It can, in many cases, be beneficial in stimulating endometrial growth, improving endometrial receptivity and increasing the chances of achieving a pregnancy.