Endometrial scratching before IVF: Evidence, Benefits, and Risks

At BAVISHI Fertility Institute, we believe in personalized fertility care. Not every procedure suits every patient, and endometrial scratching is a clear example. It’s a technique that can help select patients improve IVF outcomes, but it’s not for everybody. Here’s everything you need to know.

What is endometrial scratching?

Endometrial scratching, also called endometrial injury or endometrial biopsy, is a simple outpatient procedure where the lining of the uterus (endometrium) is gently scratched or disturbed using a thin catheter or Pipelle. This is usually done in the cycle before your IVF embryo transfer, typically in the luteal phase or mid-cycle.

The theory is that this minor injury triggers an inflammatory response and wound-healing process in the uterus. This releases growth factors and cytokines that improve blood flow and make the endometrium more receptive for embryo implantation.

Evidence: What do studies say?

The evidence for endometrial scratching has been mixed.  

• Recurrent Implantation Failure (RIF): Several studies and meta-analyses show a real benefit for women who have had 2 or more failed IVF cycles with good quality embryos. Success rates can improve by 10-15% in this group.
  
  
• First IVF cycle: Large randomized trials like the PIP study and recent Cochrane reviews found no significant benefit for women undergoing their first IVF cycle.
  
  
• General population: For unselected patients, routine use is not supported by current evidence.

So, it’s not a one-size-fits-all solution. The key is patient selection.

Benefits of Endometrial Scratching:

• Improved endometrial receptivity: The inflammatory response may upregulate genes involved in implantation.
  
  

• Better blood supply: Increased blood flow to the endometrium supports embryo attachment.
  
  

• Higher pregnancy rates in RIF: Most benefits seen in women with multiple previous failures despite good embryos.
  
  

• Simple & Cost-Effective: No anesthesia needed, takes 5-10 minutes, and adds minimal cost.

Risks and Side effects:

Endometrial scratching is generally safe, but risks include:

• Mild Discomfort/Cramping: Similar to a Pap smear or IUD insertion. Lasts a few minutes.

• Spotting or Light Bleeding: Common for 1-2 days after.

• Infection Risk: Very low, <1%, if done under sterile conditions.

• No Guarantee of Benefit: If done in the wrong patient, it offers no advantage and causes unnecessary discomfort.

Who should consider endometrial scratching?

It is not for everybody. At BAVISHI Fertility Institute, we recommend it only if:

• Recurrent Implantation Failure: You’ve had 2 or more failed IVF/ICSI cycles with good quality embryos and a normal uterine cavity.
  
  
• Unexplained IVF Failure: No clear male or female factor explains the failures.
  
  
• Thin or Suboptimal Endometrium: In select cases where other methods to improve lining have failed.

Who should avoid it?

• First IVF Cycle: No proven benefit.
  
  

• Active Pelvic Infection: Risk of spreading infection.
  
  

• Severe Uterine Anomalies: Structural issues need different management.
  
  

• Patients with bleeding disorders: Relative contraindication.

How is endometrial scratching performed?

• Timing: Usually done 7-14 days before your next period, in the cycle before embryo transfer.

• Procedure: You lie on the exam table like for a Pap smear. A speculum is inserted, the cervix is cleaned, and a thin Pipelle catheter is gently passed into the uterus. The lining is lightly scratched by rotating the catheter. No anesthesia is needed.
  
  

• Duration: 2-5 minutes.
  
  

• Aftercare: Mild cramping is normal. You can resume normal activities the same day. Avoid intercourse/tampons for 24-48 hours.

How does the Bavishi Fertility Institute help you decide?

Choosing the right procedure is critical. At BAVISHI Fertility Institute, we don’t believe in using every technique for every patient. 

• Personalized Assessment: Our senior fertility specialists review your complete history: number of IVF failures, embryo quality, endometrial thickness, and uterine factors.
  
  
• Evidence-Based Decision: We follow ESHRE and ASRM guidelines. If you don’t fit the criteria, we’ll tell you. No unnecessary procedures.
  
  
• Precision & Safety: If scratching is advised, it’s performed by our best team of doctors under ultrasound guidance when needed, ensuring maximum precision and accuracy with minimal discomfort.
  
  
• Comprehensive Approach: We address both female and male infertility factors together. Often, improving sperm DNA quality or embryo selection matters more than endometrial interventions.

Endometrial scratching can be a valuable tool, but only in the right hands and for the right patient. 

Important: Endometrial scratching is a medical procedure. If you are considering it, please consult a healthcare professional to determine if it’s appropriate for your case.

Want to know if endometrial scratching could help your IVF journey? Schedule a consultation with the experts at BAVISHI Fertility Institute. We’ll create a treatment plan customized to your needs, not a standard template.

Conclusion

Endometrial scratching may improve implantation rates for certain patients, particularly those with recurrent implantation failure, but it is not beneficial for everyone undergoing IVF. The decision to include this procedure should be based on your medical history, previous IVF outcomes, and overall fertility profile.

If you have experienced failed IVF cycles and want to explore whether endometrial scratching could be beneficial for you, consult the fertility experts at Bavishi Fertility Institute. Our team will carefully evaluate your case and create a personalized treatment plan designed to maximize your chances of success.

Author Bio

Dr. Parth Bavishi

Dr. Parth Bavishi, MD in Obstetrics and Gynecology, brings over 12 years of invaluable work experience to his role as Director of Bavishi Fertility Institute, leading a group of IVF clinics committed to helping couples realise their dreams of parenthood.

Bavishi Fertility & Institute, is dedicated to provide customised and personalised treatments which are simple, safe , smart and successful.Bavishi Fertility & Institute, works with success and satisfaction for all at heart. Providing an ideal blend of professional treatment and personalised care.

Dr. Parth had special training in infertility at Bavishi Fertility & Institute, the Diamond Institute, USA, and the HART Institute, Japan.

Dr. Bavishi is a distinguished expert in his field. In addition to his clinical practice, Dr.Bavishi is the author of the acclaimed book, ‘Your Miracle in Making: A Couple’s Guide to Pregnancy,’ offering invaluable insights to couples navigating the complexities of fertility. He loves to empower patients to make the correct choice by education both online and offline.

His exceptional contributions have earned him the prestigious Rose of Paracelsus award from the European Medical Association. Dr. Parth has been an invited faculty at many national and international conferences.

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