How effective is endometrial scratch for implantation failure?

A clinician passes a thin instrument through the cervix to make a small injury to the uterine lining, usually during a cycle before a planned embryo transfer. The proposed effect is a temporary healing response that could change local immune or inflammatory signals. The theory does not prove that the lining will become more receptive or that an embryo will implant.

Implantation failure can involve embryo factors, uterine-cavity problems, lining development, hormone preparation, or other health factors. Endometrial scratch cannot correct all of these. It can cause cramping, spotting, discomfort, and rarely infection or injury, so the possible benefit should be weighed against the procedure.

Ask why your clinician thinks a scratch could help in your particular situation and what evidence they use to recommend it. Review checks of the uterine cavity, embryo information, hormone support, and transfer plan. Confirm when the procedure would happen, what pain relief is available, and what symptoms should be reported. You can also ask what the plan would be if the next transfer does not implant.

After a scratch, contact your clinic for fever, increasing pelvic pain, heavy bleeding, foul-smelling discharge, or feeling unwell. Seek urgent medical help for severe pain, fainting, or heavy bleeding with weakness. Follow your clinic's instructions about medicines and the timing of the next fertility cycle.

What problem are we trying to change with a scratch? What other causes of implantation failure have been assessed? What are the procedure's risks for me, and how would the result change our next transfer plan?