Endometrial Scratch


What is an endometrial scratch?

The lining of the uterus (the endometrium) is gently ‘scratched’ using a thin catheter (a fine, flexible, sterile, plastic tube) which is passed through the cervix.

Embryo implantation should occur five to six days after natural fertilisation or following embryo transfer, when the embryo embeds into the lining of the uterus to continue its development.

Who may benefit from an endometrial scratch?

IVI Midland offers endometrial scratching to women who have had more than two IVF, ICSI or frozen embryo transfer (FET) cycles which resulted in a negative pregnancy test, despite having good quality embryos.

How does scratching help implantation?

New research and evidence suggests that scratching the uterine lining causes a ‘repair reaction’ which may increase embryo implantation rates:

  • the repair process releases growth factors, hormones and chemicals. The new lining which grows after the procedure is thought to be more receptive to an implanting embryo and so increases the chances of pregnancy
  • ‘gene switching’ – scientists believe that the genes which are responsible for implantation of embryos are sometimes not ‘switched on’ during the time when embryos are supposed to implant. Endometrial scratching may ‘switch on’ the genes that are responsible for preparation of the endometrium for implantation, which increases the chances of pregnancy

More research is underway to understand exactly how this works.

When is the best time to have the procedure?

The best time to perform the endometrial scratch is at the ‘day 21’ treatment planning appointment, before the IVF, ICSI or frozen embryo transfer (FET) treatment cycle begins.  In a standard 28 day cycle, ‘day 21’ comes just after ovulation, a few days before the woman’s period is due.  If her periods are infrequent or irregular, the clinical team will advise on the best time for the procedure.

Preparing for the procedure

It is vital that the patient does not have unprotected intercourse in the four weeks before the planned endometrial scratch procedure, to avoid the risk of a possible pregnancy.

Also, the patient:

  • may eat and drink normally before the procedure
  • requires a full bladder for the procedure
  • should wear comfortable clothing that gives easy access to the lower part of the body
  • should bring a sanitary towel with her for use after the procedure

How is the procedure performed?

This is not a painful procedure and although the patient may experience some discomfort, no anaesthesia is required.


Much of the procedure is similar to an embryo transfer:

  • a speculum is gently inserted into the vagina so the cervix can be seen
  • the cervix is cleaned with sterile gauze
  • a thin flexible catheter is inserted through the opening of the cervix, and the uterine lining is gently ‘scratched’. (Inserting and moving the intrauterine catheter up and down may cause mild abdominal cramping similar to period pain)
  • the catheter is withdrawn at the end of the procedure. Some mild bleeding is common after the procedure

After the procedure

After the procedure, the patient should:

  • wear a sanitary towel (not a tampon)
  • be able to drive and resume normal daily activities
  • eat and drink normally
  • take the antibiotics prescribed by Midland Fertility (see below)

What are the risks?

There is a small risk that any infection within the cervix may spread to the uterine cavity during the procedure.  After the procedure the patient should take the antibiotics IVI Midland will prescribe for her, as directed, to minimise this risk.  She should contact IVI Midland immediately if she experiences any of the following symptoms within a few days of the procedure:

  • unexplained fever
  • persistent bleeding or foul-smelling vaginal discharge
  • increasing lower abdominal pain
  • feeling generally unwell

Is pain relief needed after the procedure?

Most women experience either discomfort or mild cramping period-type discomfort during the procedure.  If necessary, the IVI Midland clinical team will provide pain relief for the patient before she leaves IVI Midland.  Afterwards, if required, she may take over-the-counter painkillers, as directed on the packs, such as:

  • paracetamol with codeine
  • ibuprofen

Success rates

Endometrial scratching is a new technique at IVI Midland so no meaningful data currently exists.  But data from clinical trials suggests improvement in treatment outcomes in the group of patients who have previously had multiple failed treatment cycles.

For other treatments, please refer to the success rates pages for details of the most recent published results.


Cost of Endometrial Scratch:  £215.00

Endometrial scratching is an additional chargeable service for natural conception patients and also as part of an IVF, ICSI or FET treatment cycle.

More information

Go to the IVI Midland Patient Treatment Information page and download:

  • Miscarriage and Implantation Failure Service
  • IVF
  • ICSI
  • Frozen Embryo Transfer

LU: 6/2/17/JAA