After the mature egg cells harvested from the woman and the sperm cells harvested from the men are combined with the traditional IVF or ICSI method, quality embryos can be obtained. After the follow up and in the final stage of IVF treatment, these quality embryos are transferred to the uterus. Despite all this, pregnancy may not be achieved, as problems may arise during the implantation stage. In this case, endometrial scratching becomes an option.
In order for a successful pregnancy to be achieved, embryos must be implanted into the uterus. If the embryo is not of sufficient quality or the intrauterine layer does not have the characteristics that the embryo can hold, pregnancy cannot occur. Using this method which is called endometrial stimulation or scratching, it is aimed to trigger the healing process in the inner layer of the uterus and create a suitable environment for implantation.1
It can be stated that the effect of controlled damage to the inner layer of the uterus on the formation of pregnancy is not known with certainty. As a result of the studies, it was seen that the rate of pregnancy only with IVF was approximately 27%, and after endometrial scratching, this rate increased to 27% to 32%.2
Although the exact mechanism of action of endometrial scratching is unknown, it is accepted that after this procedure, an inflammatory response may occur in the tissue and tissue repair may begin. It is thought that with the release of growth factors, hormones and proinflammatory cytokines, the endometrium layer can become ready for implantation. As a matter of fact, after controlled damage to the inner lining of the uterus, the genetic expression of factors important for implantation has been shown to improve.3
Endometrial scratching option can be evaluated if embryo implantation does not occur even after quality embryo transfers and in case of recurrent IVF failures despite the fact that the uterus membrane is thin, responds well to drug treatment, there are no specific problems in the uterus. Nowadays, there are also newly emerging treatment alternatives. In selected patients instead of scratching endometrium PRP can also be preferred.
Patients who are recommended endometrial scratching can have the procedure with two different techniques. Using a thin and flexible tube, maneuvers resembling the removal of parts from the uterine wall can be performed. Another method is hysteroscopy. Since the uterus can be visualized in detail, polyp or myoma formations may also be removed.
Anesthesia may not be applied to patients during stimulation of the uterus. It is possible to have a minimal amount of pain during or after the procedure. In order to maximize patient comfort, sedation may be applied.
In order to perform endometrial scratching within the scope of IVF treatment, the patient should be evaluated by specialists first. Under normal conditions, the process is performed on the 20th - 25th day of the menstrual cycle. The bladder must be full before starting the procedure.4
If performed by experienced physicians, it is considered to be an extremely safe and minimally invasive procedure. It is possible to experience mild discomfort and vaginal bleeding after the procedure. The probability of infection is quite low.
1 https://www.hfea.gov.uk/treatments/treatment-add-ons/endometrial-scratching/
2 https://www.cochrane.org/CD009517/MENSTR_endometrial-injury-women-undergoing-vitro-fertilisation-ivf
3 https://www.news-medical.net/health/Endometrial-Scratching-and-IVF.aspx
4 https://www.liverpoolwomens.nhs.uk/media/3417/endometrial-scratch-information-leaflet.pdf
Not:Bu içerik genel bilgilendirme amaçlıdır, tanı ve tedavi yerine geçmez. Kişisel tanı ve tedavi planı için hekim değerlendirmesi gerekir.
