The procedure, known as womb scratching, or endometrial biopsy, feels much like a pap smear and costs approximately $200, hardly breaking the bank compared to other treatment-associated costs. When timed one month before an IVF cycle, a woman who receives womb scratching is twice as likely to become pregnant as a woman who does not undergo the 15-minute procedure.
How is womb scratching done?
Laurence Jacobs, M.D. of the Fertility Centers of Illinois says the biopsy uses a Pipelle to lightly scratch the endometrial lining. “Local injury of the endometrium produces an inflammatory reaction resulting in increased white blood cells (leukocytes such as macrophages) which secrete growth factors and cytokines. These substances regulate blastocyst implantation and placental development”, he states. This stimulates the uterus’ receptivity to the embryo and increases the success rate of live birth. The most acceptable use of womb scratching is in women with good egg quality, but failed IVF cycles.
The procedure can be performed in-office by an OB/GYN trained in the “four quadrant uterine biopsy”, a method of cell collection similar to a pap-smear or cell collection for cancer screening. However, it is most efficient to combine womb scratching within a fertility treatment protocol or an already scheduled hysteroscopy if fibroids or polyps are suspected.
Dr. Jacobs claims the procedure carries little risk to the patient for pain or infection. In fact, doctors are so confident in the success that many, like Jacobs, offer it routinely to IVF patients who have failed previous cycles despite good embryo quality. Jacobs says, “At the present time, the endometrial biopsy should probably be reserved for those patients failing IVF despite good or excellent embryo quality, where uterine receptivity appears to be the major underlying problem.” Endometrial biopsy may not be the best option for patients of advanced maternal age with a history of failed IVF cycles due to genetically abnormal or poor quality embryos. In that case, genetic testing may be employed to verify the quality of the embryo and genetic soundness prior to embryo scratch.
How effective is womb scratching?
Several recent studies, including a British study published in Reproductive BioMedicine Online, confirm that womb scratching can double the success rate of pregnancy and live birth when performed at the right time.
“Timing is everything”, says Jacobs, “It’s very important to do an endometrial biopsy at the right time. In one study where the biopsy was performed at egg-retrieval, the women who had the procedure experienced lower pregnancy rates than controls.” It is currently believed that the best time to perform the scratch is once or twice in the month preceding an embryo transfer. It should not be done in the same cycle as ovarian stimulation for fresh IVF, or estradiol for a frozen embryo transfer (FET).
Consult your doctor to determine if womb scratching is an option for you.