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Can Endometrial Injury Boost Clomid Success?
Superficially scratching the lining of the uterus - the endometrium - has been demonstrated to improve the chances of embryo implantation in IVF after a prior failed implantation in multiple studies. It's a simple, quick technique where the lining of the uterus is superficially scratched in four different places and most physicians are familiar with the procedure because it is used to analyze endometrial tissue when dysfunctional uterine bleeding is diagnosed.
Other studies have found that endometrial scratching or injury similarly might improve the odds of conception during cycles of injectable fertility medications and when unexplained infertility is diagnosed.
Consequently, for a number of years progressive physicians have been using this simple technique to help improve the chances of embryo implantation and many of my patients have had successful pregnancies after having received this procedure. Needless to say I am a big fan of endometrial scratching when implantation seems difficult to achieve. It often works.
A 2017 study (1) has now evaluated the effect of endometrial scratch injury on clomiphene citrate (Clomid) cycles in 105 women with unexplained infertility with similarly good effect. The endometrial scratch procedure was performed between days 15 and 24 of the cycle prior to ovulation induction.
Women who underwent an endometrial injury procedure experienced significantly higher clinical pregnancy rates which were almost triple - 37% compared to 13% - the pregnancy rates of untreated women. The study concluded that endometrial injury before ovulation could indeed improve the chances of becoming pregnant.
No adverse effects or differences in pregnancy loss rates or multiple pregnancy rates were noted.
Itís hard to get physicians to consider doing this procedure outside of IVF at present as it is rather new, but some progressive physicians are willing to allow women to explore this new line of treatment to improve the chances of success.
(1) Int J Gynaecol Obstet. 2017 Apr 11. doi: 10.1002/ijgo.12178. [Epub ahead of print] A randomized trial of local endometrial injury during ovulation induction cycles. Helmy ME1, Maher MA1, Elkhouly NI1, Ramzy M1.
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