ENDOMETRIAL SCRATCHING Endometrial Scratching to improve the success of IVF Treatment This is a procedure whereby the surface lining the uterus (the womb) is superficially irritated using a slim plastic endometrial curette to improve the chances of pregnancy in an IVF/ICSI treatment. Present evidence suggests that scratching the lining of the womb promotes “repair reaction” causing the secretion and release of hormones, growth factors and chemical transmitters that make the new lining favourable to the implantation of embryos. Research also suggests that scratching triggers the genes that are responsible for preparing the lining for implantation. Who may benefit from Endometrial Scratching? Women who have had two or more IVF treatment failures despite the transfer of good embryos and no other apparent cause for failed implantation. When is the best time to do Endometrial Scratching? The best time to perform endometrial scratching is between day 19 and 21 of the cycle preceding IVF/ICSI treatment; the day the woman starts downregulation. Downregulation is the process of using drugs to override the control of the natural cycle and it is used during IVF treatments. How Endometrial Scratching is performed? Endometrial scratching is an outpatient procedure that is performed under sterile conditions and without anesthesia. It is not painful but there may be mild transient discomfort during the procedure that is relieved by taking paracetamol. The patient should be able to return to work after the procedure. You do not need to fast on the day of the procedure. Do wear comfortable clothes that make the lower part of the body accessible. The Procedure • A speculum is gently inserted into the vagina opening it and making the cervix accessible. • The vagina and the cervix are swabbed with antiseptic solution. • A slim rubber curette (like SureFlex curette) is inserted into the uterus through the cervix; it is used to scratch the surface lining of the cervix by moving in up and down and this movement may cause mild cramp. The curette is withdrawn and that’s the end of the procedure. • A sanitary towel should be worn because there may be slight bleeding from the vagina after the procedure. Are there any risks associated with endometrial scratching? There is a slight risk of infection spreading upward from the cervix into the womb. We prescribe antibiotics to minimize this risk. However, you should contact the clinic immediately if you experience symptoms such as: ✓ Offensive vaginal discharge ✓ Fever ✓ Worsening lower abdominal pain

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