In unexplained infertility implantation failure is a common experience and over 50% of embryos are thought not to implant successfully. Everything may "look good" cycle after cycle: good lining, good follicle, good blood work but no pregnancy occurs. If this situation sounds familiar you may want to explore the merits of endometrial biopsy; superficial scratches to the uterus surface may change the immunological environment favorably and increase the likelihood of a successful conception and pregnancy. This technique - called endometrial scratching or endometrial biopsy - has for the first time been found to help women with unexplained infertility to conceive.
An Egyptian study (1) - published in the Journal Obstetrics And Gynaecology Research, 2012 - examined the effect of a single uterine scratching procedure in women with unexplained infertility. A group of 105 couples with unexplained infertility were randomized to undergo endometrial scratch procedure in the luteal phase of a natural menstrual cycle - or no scratching - and conceptions were tracked for the following 6 months.
For women who underwent endometrial scratching, the clinical pregnancy rate was more than double that of the control group: 25.9% versus 9.8% over a six month period and miscarriage rates were similar though marginally lower in the endometrial scratching group: 12.5% versus 16.5%. The study concluded that:
"Endometrial scratching may improve clinical pregnancy rates in couples with unexplained infertility. Adequately powered studies are mandated to confirm or refute the findings."
Although this is the first study on endometrial scratching in unexplained fertility, a number of studies have evaluated the value of this technique for women undergoing IVF when there has been a history of implantation failure. Logically one would expect to see similar results from using the procedure for treating implantation failure in unexplained infertility. In my practice, women undergoing IVF who have undergone this technique have often had successful pregnancies after long-term implantation failure. Here are some conclusions from prior studies on endometrial scratching and IVF.
A huge 2012 review from the University of Liverpool, UK, published in Reproductive Medicine Online examined the effectiveness of endometrial injury for recurrent implantation failure in women undergoing IVF. The review pooled data from seven controlled studies (four randomized and three non-randomized), with 2062 participants and concluded that:
"...local endometrial injury induced in the cycle preceding ovarian stimulation is 70% more likely to result in a clinical pregnancy as opposed to no intervention...."
"The evidence is strongly in favour of inducing local endometrial injury in the preceding cycle of ovarian stimulation to improve pregnancy outcomes in women with unexplained RIF (recurrent implantation failure)."
"The results suggest that inducing injury is 70% more likely to result in a clinical pregnancy as opposed to no treatment."
"Furthermore, scratching of the lining was 2-times more likely to result in a clinical pregnancy compared with telescopic evaluation of the lining of the womb."
"This study suggests that in women with RIF, inducing local injury to the womb lining in the cycle prior to starting ovarian stimulation for IVF can improve pregnancy outcomes."
Another 2012 review of randomized control trials on this technique by the Cochrane database included 591 women and also concluded favorably that endometrial scratching makes the uterus more baby-friendly and more likely to secure implantation:
"Endometrial injury performed prior to the embryo transfer cycle improves clinical pregnancy and live birth rates in women undergoing ART..."
Although both reviews call for more studies before this technique becomes accepted as standard practice top IVF clinics have been using endometrial scratching to improve pregnancy success for some years now. Many fertility physicians will allow you to pursue this treatment if you simply ask and present them with the studies. The procedure is simple and quick and OB/GYNs are familiar with the technique for performing uterine biopsies for other purposes.
If you do undergo this in-office procedure it can be a little ouchy, be sure to ask your physician about ways to minimize any discomfort with anti-inflammatory medication.
Please note: This article is not intended to diagnose or to provide medical or dietetic treatment for which you should see a physician or dietitian. You are encouraged to discuss any new treatments or diet changes that you wish to pursue with your physician.
(1) J obstet Gynaecol Res. 2012 Oct 29. doi: 10.1111/j.1447-0756.2012.02016.x. [Epub ahead of print]
Endometrial scratching to improve pregnancy rate in couples with unexplained subfertility: A randomized controlled trial.
Gibreel A, Badawy A, El-Refai W, El-Adawi N.
(2) Reprod Biomed Online. 2012 Dec;25(6):561-71. doi: 10.1016/j.rbmo.2012.08.005. Epub 2012 Sep 12.
Endometrial injury to overcome recurrent embryo implantation failure: a systematic review and meta-analysis.
Potdar N, Gelbaya T, Nardo LG.
(3) Cochrane Database Syst Rev. 2012 Jul 11;7:CD009517. doi: 10.1002/14651858.CD009517.pub2.
Endometrial injury in women undergoing assisted reproductive techniques.
Nastri CO, Gibreel A, Raine-Fenning N, Maheshwari A, Ferriani RA, Bhattacharya S, Martins WP.