Endometrial Scratch

Endometrial scratch gently disturbs the womb lining before fertility treatment, but its benefit is uncertain.

Endometrial scratch, also called endometrial injury, uses a thin tube to make a small area of irritation in the lining of the womb. It may be offered before an embryo transfer or another fertility treatment, with the idea that healing could change the local environment for implantation. The procedure is different from an endometrial biopsy used to diagnose disease. Its benefit is uncertain, so it is not suitable for everyone.

You discuss your fertility history, treatment timing, medicines and any chance of pregnancy. During the appointment, you lie in a position similar to a cervical screening visit. A clinician places a speculum, cleans the cervix and passes a narrow flexible tube through it. A brief scratching motion disturbs the womb lining. Cramping or spotting can happen afterward. The team records the procedure and plans any later fertility treatment around your cycle.

This is usually a short outpatient procedure, but it can be uncomfortable. Possible problems include pain, bleeding, infection, dizziness or difficulty passing the tube through the cervix. It is not performed during an existing pregnancy. Tell the fertility team about pelvic infection symptoms, unusual bleeding, cervical problems, allergies and all medicines. Contact the clinic urgently for heavy bleeding, fever, worsening pain or feeling faint.

You can ask whether scratch is recommended for your particular treatment history, what evidence the clinic uses and how it could affect scheduling. You may choose to proceed, postpone it, or continue fertility treatment without it. Other options depend on the reason for treatment, such as reviewing the womb cavity, adjusting the embryo-transfer plan or treating an identified condition such as [Implantation Failure](/conditions/implantation-failure/).

The procedure targets the womb lining rather than the ovaries or embryo. It may cause period-like cramps and light spotting. A proposed biological effect does not guarantee implantation or pregnancy. Your clinician should explain why it is being considered and what will happen if you decline.

A fertility specialist may discuss it with someone who has had difficulty with embryo implantation or who is considering assisted reproduction. A history of implantation difficulty does not automatically mean scratch will help. The team considers your diagnosis, previous treatment, womb assessment, cycle timing and preferences. It should be a shared decision rather than a routine add-on.

The clinician confirms consent, checks the planned timing and asks you to empty your bladder if needed. After positioning, a speculum helps the clinician see the cervix. A sterile flexible catheter is guided into the womb, and the lining is gently touched. The catheter and speculum are removed, and you receive advice about cramps, spotting and when to seek help.

Most people return home after the appointment and resume ordinary activities when they feel comfortable. Mild cramps or spotting may settle soon. Use only pain relief that your fertility team says is appropriate for your treatment plan. Keep the clinic informed about persistent pain, fever, unpleasant discharge or bleeding that is more than expected.

The main limitations are discomfort, spotting and the possibility of infection or cervical irritation. The procedure may be technically difficult if the cervix is narrow. Evidence of benefit is not consistent, and it cannot promise successful implantation. Ask how your clinic balances these uncertainties against the inconvenience and cost of an additional appointment.

Alternatives may include proceeding with the planned fertility cycle, checking the womb cavity, addressing fibroids or polyps when present, reviewing embryo-transfer technique, or changing the treatment plan. The appropriate choice depends on your findings and fertility goals; a specialist can explain which options are relevant.

Choose a licensed fertility service where a trained clinician performs the procedure and can provide follow-up. Before booking, ask who will do it, how your cycle will be timed, what discomfort and warning signs to expect, and how declining it would change your plan.