Does endometiral “scratching” help with pregnancy?

At our fertility center, the Center for Fertility and Gynecology in Los Angeles, we stay abreast of the latest breakthroughs and discoveries in the field of fertility.  From high-tech innovations like array CGH for PGD, sperm DNA analysis (SCSA) or novel IVF stimulation protocols, we are proud to stand on the cutting edge of reproductive science.

One recent development we are embracing is the utilization of endometrial “scratching” or “damage” to improve pregnancy rates. The idea is that a small amount of endometrial damage results in a minor inflammatory reaction which makes the endometrium more receptive to an embryo.  This theory originated from the observation that many women become pregnant following an intrauterine procedure such as a D and C.  Doctors have long wondered if the procedure somehow made it easier for an embryo to implant.

BCKGROUND

The idea is further bolstered by the fact that placentas often attach to the uterus in locations of prior damage, such as c-section scars.  Placenta accretea, is an extreme example of this phenomenon, but helps to illustrate the point that placental attachment is not hindered by endometrial disruption. 

STEPS

Within 3 months of the expected embryo transfer, the patient comes into the office for a pipel procedure.  The procedure consists of passing a thin, flexible tube through the cervix and into the uterus.  A small plastic shaft within the tube is then pulled back, creating a suction force within the tube.  This suction removes any emdometrial tissue it comes into contact with.  By rotating the tube, a significant proportion of the uterine lining can be reached.  The procedure ususally takes about 30 seconds to complete.

CANDIDATES

Ideal candidates for this procedure are patients who have failed IVF for unexplained reasons.  Also patients who have had very thick linings or irregular endometrial lining could potentially benefit from a pipel procedure.

SIDE EFFECTS

The pipel procedure is safe and quick.  It can be associated with significant cramping or pain which will generally subside shortly after the procedure. There is also a risk of damage or perfertation of the uterus, although this is a rare side effect. 

BENEFFIT

Studies which have examined the pipel for fertility have found a range of results.  Some experiments demonstrated no benefit at all, while others showed almost a doubling of pregnancy rates.  We believe that there is promising support to consider this procedure because it is based on sound observational data.  However, like any medical procedure, it should only be used in appropriate candidates.

If you have any questions about endometrial scratching or fertility treatment in general, don’t hesitate to contact us.  We’d be happy to chat with you.