Does an Endometrial Scratch Really Boost Fertility?

When trying to conceive, there are many different methods out there for boosting your fertility, such as supplements or eating a healthy diet full of vitamin-rich foods. You might have also heard of a procedure called an endometrial scratch.

An endometrial scratch, or endometrial injury, is a procedure that’s intended to boost your chances of getting pregnant when going through in vitro fertilization (IVF).

If you’re looking to conceive, a doctor could potentially ask if you want to give it a try, but it's worth paying attention to all the evidence out there before signing up. We turned to the experts to find out what exactly an endometrial scratch entails, and if it really increases your chances of getting pregnant.

How Does an Endometrial Scratch Work?

The endometrial scratch procedure isn’t a lengthy one. It does not require any incisions, and you don’t have to be sedated for it.

A doctor will insert a small, thin tool known as a biopsy pipelle through your cervix into your uterus. This tool slightly resembles a straw, and it is used to gently scratch or "injure" the lining of the uterus.

Technically, the process creates some suction, and pulls a few cells away from the endometrial lining to create the injury, which is supposed to facilitate better embryo implantation. This procedure is usually done in the cycle preceding an embryo transfer. It's also important to keep in mind that one shouldn't attempt to get pregnant in the same cycle they are undergoing a scratch.

In the past, an endometrial scratch was recommended to people who experienced recurrent implantation failure (RIF), with the idea that undergoing this procedure prior to any ovarian stimulation for IVF might boost their chances of successful implantation.

Is an Endometrial Scratch Actually Effective?

Despite the fact that an endometrial scratch is a quick and relatively simple procedure, newer research suggests it won’t actually improve your chances of conceiving.

For example, consider the results of a study published in the New England Journal of Medicine in 2019. A team of researchers conducted a randomized clinical trial of 1,364 women who were undergoing IVF, and they assigned half the women to receive endometrial scratching prior to embryo transfer. Turns out, it didn’t help, as the pregnancy rates were roughly the same.

“Endometrial scratching did not result in a higher rate of live birth than no intervention among women undergoing IVF,” the researchers concluded.

Similarly, a Cochrane review of multiple studies didn’t uncover evidence that endometrial scratching
would produce higher pregnancy or birth rates.

The Cochrane researchers noted that endometrial scratch didn’t seem to be associated with a higher rate of miscarriage, but added that they were “uncertain whether endometrial injury improves the chance of live birth or clinical pregnancy in women undergoing IVF.” The researchers ultimately concluded that endometrial scratching should not be routinely offered to women undergoing IVF, based on the available evidence.

Because of the dearth of evidence supporting its effectiveness in helping women conceive, Allison Petrini, MD, an OB/GYN and reproductive endocrinologist with Texas Fertility Center in Austin, Texas, doesn't recommend it to patients.

“I don’t use it in my practice,” says Dr. Petrini.  “It has not been shown to have any benefit."

Is Endometrial Scratching Right For You?

Consider the actual procedure itself. The authors of the Cochrane review noted that endometrial scratching is “somewhat painful...[and] associated with a small amount of bleeding.” It could cause some cramping, similar to menstrual cramps or what you might experience during the placement of an intrauterine device (IUD), says Dr. Petrini.

But endometrial scratching might not even be offered to you at all. Many experts have suggested that the method should be abandoned altogether, since it doesn’t seem to make much of a difference in whether a person gets (and stays) pregnant.

"By and large, it has faded out of clinical practice," explains Dr. Petrini.

OB/GYN and reproductive endocrinologist Jennifer Nichols, DO, says that she almost never fields any requests from patients about possibly undergoing an endometrial scratch anyway. 

“I think I've had one patient in the last year who’s said, hey, will you do an endometrial scratching?’” says Dr. Nichols, who is the director of fertility preservation services at Sincera Reproductive Medicine. “They just don’t ask for it.” 

A Word From Verywell

It’s normal to want to give yourself the best possible chance of successfully conceiving, especially if you’ve had to cope with challenges like implantation failure in the past. But before signing up for endometrial scratching, consider the research; it might not be one of your best bets. Fortunately, you do have other assisted reproductive technology options that may help you conceive.

However, as with any medical issue, you should talk to your healthcare provider about your specific concerns and ask about the options available to you.