Endometrial scratching consists of a small scraping of the uterine cavity. Normally, this technique is performed in the luteal phase prior to the embryo transfer.
This procedure may be indicated in patients who have had previous unsuccessful transfers in which a problem at the level of the uterus is suspected. To date, the benefit of this technique has not been clearly demonstrated, so its application must be based on strict medical criteria.
As a guideline and speaking in general terms, endometrial scratching can be recommended in women who have undergone two or more high-quality embryo transfers, if possible with a preimplantation genetic diagnosis (PGT-A) performed, and with the rest of the implantation failure studies performed normally. Even so, it is necessary to clarify that we must analyze each case and study each patient in an individual and personalized way in order to make the decision to carry out this treatment.
What do we seek to achieve with this "scraping" of the endometrium? There are studies that relate this injury to the release of growth factors, chemical substances and various hormones that can produce better endometrial growth in the following cycle, with a more "receptive" endometrium, ready for embryo implantation.
In addition to the dubious benefit of this technique already mentioned, we must keep in mind that endometrial scratching is an invasive technique. This procedure has to be performed in the operating room and in most cases under mild sedation to avoid patient discomfort. We must always inform the patient of the possible (although unlikely) complications, such as major bleeding or infection. We always perform endometrial scratching carefully and verify that the bleeding produced is controlled, but it is still an intervention not exempt from this type of risk.