Endometrial scratching to improve IVF success rates

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Endometrial scratching to improve IVF success rates

Couples who are struggling with infertility often seek In-Vitro Fertilisation (IVF) treatment in order to improve their chances of starting a family. But what happens when you have gone through multiple unsuccessful IVF cycles? Is there something else you can try?

Many patients who’ve experienced this first hand, have asked me this question, eager to try out something new to enhance their chances in the next IVF cycle. Therefore, today, I’d like to tell you more about a procedure called endometrial scratching, which has become increasingly popular in recent years.

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What is it?

Endometrial scratching is a procedure that involves agitation of the endometrium, which is the mucus membrane that lines the uterus. For conception to occur, a fertilised egg has to successfully implant itself into the wall of the uterus. Sometimes, implantation fails, usually due to the quality of the embryo or the receptivity of the endometrium. In endometrial scratching, a fertility specialist passes a special thin catheter or pipille through a woman’s cervix. The pipille is then moved up and down to gently make tiny scratches or scrapes in the uterine lining.  The similar effect can also be achieved by introducing a hysteroscope through the cervix to visualised the lining of the uterus during polyps removal.

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Why is it done?

In theory, endometrial scratching is believed to trigger the uterus to repair itself and develop a new lining, which will be more receptive to an embryo implanting. While the effectiveness of the procedure needs further investigation, studies that have been done on endometrial scratching in recent years have shown encouraging results.

One such study was conducted by the University of Nottingham, UK, which involved 158 women who had undergone unsuccessful IVF procedures. The women were divided into two groups, with one group given the endometrial scratching procedure. As a result, they found the women who had undergone the scratching procedure achieved a 49% pregnancy rate, compared to 29% in the other group.

In another study involving 1000 women, presented at the annual meeting of European Society of Human Reproduction and Embryology (ESHRE), endometrial scratching is said to increase pregnancy success rates for couples trying to conceive naturally or with Intrauterine Insemination (IUI).

When is it done?

The endometrial scratching procedure is usually recommended for patients who’ve experienced multiple unsuccessful IVF cycles or Intracytoplasmic Sperm Injection (ICSI) treatment. The procedure is best performed prior to a woman’s period or right after the period. It is done before an IVF or frozen embryo transfer (FET) cycle begins.

Does it hurt?

While the endometrial scratching procedure has been described as generally painless, requiring no anaesthetic, some women do experience discomfort during and after the procedure. The pain is similar to period cramps and there may be slight bleeding afterwards. To help with possible discomfort, patients are advised to take over-the-counter pain medication about an hour before undergoing the scratching procedure.

If you’ve gone through several IVF attempts and are keen on learning more about endometrial scratching, take the next step and ask your fertility specialist if it is right for you.

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Food for Fertility

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The importance of micro-nutrients to conception

The adage goes, “You are what you eat,” and the same is true for fertility. But when you’re trying to conceive, you want to rely on much more than just an old saying. Statistics show that around 11% to 20% of couples experience subfertility. Of this, 10% can be classified as unexplained infertility, while 60% are classified as anovulatory subfertility. In my experience, couples today also find their infertility issues compounded by their hectic lifestyles.

Factors such as stress; unhealthy body weight; excessive smoking, alcohol and caffeine intake; exposure to toxins, as well as recreational drug use, can all play a role in affecting fertility. But even those who maintain a healthy weight, manage their stress and abstain from unhealthy habits may neglect a very important factor – nutrition. Fortunately, there is now hard evidence in the form of scientific proof that shows you can indeed improve your fertility by eating right, particularly by including micro-nutrients in your daily diet.

While macro-nutrients, like protein, unsaturated fats and carbohydrates can be easily obtained from the foods that you eat, micro-nutrients like vitamins, minerals and trace elements are often left out due to an unbalanced and unhealthy diet. Realising that micro-nutrient deficiencies are not uncommon in women of reproductive age, Dr Rina Agrawal, a consultant and associate professor in reproductive medicine and obstetrics/gynaecology at the University Hospital at Warwick University, conducted a study on the role of micro-nutrients in improving pregnancy rates.

The study, which involved 58 suitable candidates consisting of subfertile women with an average age of 32.3 years (range 19–40), investigated whether subfertile women undergoing ovulation induction using standard treatment regimens have higher pregnancy rates when given multiple micro-nutrient (MMN) nutritional supplements, as compared with folic acid alone. The findings of the pilot study unveiled that the women on MMN supplementation had a higher pregnancy rate of 66.7%, as compared with 39.3% for those on just folic acid.

This therefore suggests that additional MMN supplementations, such as vitamins B6, B12, folates, vitamin E, multivitamins, iron, zinc, copper and selenium, does improve female fertility. In addition to finding that the women on MMN supplementation had a higher chance of pregnancy compared to their peers, the women on MMN supplementation also required significantly fewer attempts to become pregnant, as compared with women on folic acid. But there are also other benefits to taking MMN supplements, including reduced reproductive risks ranging from infertility to miscarriage, and fetal structural defects to improved embryogenesis or placentation.

You may need only small amounts of micro-nutrients, but they are no doubt essential. Each vitamin and mineral plays a specific role in ensuring that your bodily systems function in top form, and needless to say they are vital to your overall wellbeing. In order to get more micro-nutrients from your daily diet, you should eat a wide variety of foods from the different food groups. It is also best to avoid eating fast foods and processed foods that are of low nutritional quality. Instead, opt for fresh fruits and vegetables, legumes, nuts and seeds, whole grains, lean meats, fish and low-fat dairy products.

Stay tuned to find out more about foods that can boost fertility.