Endometrial Scratching is a new procedure offered in our London Pre-Assessment clinic, performed in addition to infertility treatments.


  • Infertility affects 10% of couples worldwide.
  • For 25% of all couples experiencing infertility the cause remains “unexplained”.
  • There is currently no way of diagnosing endometrial infertility.
  • During IVF about 75% of the embryos transferred fail to implant and develop.

Embryo implantation remains the biggest challenge in securing a pregnancy with assisted conception. Even when the embryo quality appears good, and the development of the endometrium is satisfactory on ultrasound, it is not possible to easily determine why implantation does not occur in so many cases.

Despite the embryos having good microscopic appearance some still can be genetically abnormal, and so are not capable of implanting. It is however reassuring that there is a generally positive trend between appearance and genetic fitness.

Endometrial infertility means infertility caused by certain conditions of the endometrium – uterine lining – itself. When it comes to the endometrium, understanding is limited and modern science cannot diagnose or correct these conditions. We can only know that there must be something wrong with the uterine environment when in some cases everything else looks well, but the embryos just don’t implant.

Ultrasound appearance and thickness can be used to gauge whether implantation is likely, but this is a far from exact science. There are many complex factors in the endometrium that can affect implantation.

We are now offering women undergoing fertility treatment the option of Endometrial Scratching.

New research and evidence suggests that scratching the uterine lining causes a “repair reaction” which results in significantly higher implantation, pregnancy and most importantly livebirth rates following the technique. Most studies show the livebirth rate to approximately double, even in those women who have previously had four or more unsuccessful cycles.

“Results . . . demonstrate a significant benefit to the timing of endometrial scratching, reporting an increase in the clinical pregnancy rate of women undergoing IVF and ICSI treatment to 49%, compared with the current average (29%), as well as an increase in the number of live births, reported at 42%, compared with the current average (23%).”

What is endometrial scratching?

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.

Who may benefit from endometrial scratching?

Endometrial scratching is offered to all women prior to their IVF, ICSI or FET cycle.
When is the best time to have the procedure?
The procedure is carried out in the luteal phase of the cycle (i.e. after ovulation) in a cycle preceding your treatment. Normally this is done around day 21 of the cycle.

How should you prepare for the procedure?

It is vital that the patient does not have unprotected intercourse during a cycle when the endometrial scratching procedure is planned, to avoid the risk to a possible pregnancy.

Also, the patient:

  • may eat and drink normally before the procedure
  • does not need to fill her bladder before the procedure
  • should wear comfortable clothing that allows easy access to the lower part of the body should bring a sanitary towel with her for use after the procedure
  • should bring a partner or friend to escort her after the procedure

How is the procedure performed?

The procedure is carried out by a doctor. The procedure will take approximately 15 minutes to complete.

You will be asked to sign a consent form at the time of the procedure to confirm that you have not had unprotected intercourse in that menstrual cycle.

Much of the procedure is similar to a smear test or a coil insertion: a speculum is gently inserted into the vagina so the cervix can be seen, and 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”. The catheter is withdrawn at the end of the procedure.

Inserting and moving the intrauterine catheter up and down may cause mild abdominal cramping similar to period pain. You are advised to take analgesia 1-2 hours before your scheduled procedure.

Please be aware that bleeding after the procedure is to be expected.

What are the risks?

There is a small risk that any infection within the cervix may spread to the uterine cavity during the procedure.

Post procedure antibiotics will be given if deemed necessary at the time of the procedure.

You should contact your doctor immediately if you experience 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
The cost of this procedure is £112.
For more information please contact us.