Does endometrial scratching increase the chances of pregnancy in IVF?
Endometrial scratching (also called endometrial injury) is a procedure that some think can help with IVF by increasing the chances of the embryo implanting. But recent studies show that it doesn’t really improve the odds of having a baby or getting pregnant. So, it’s not really suggested for everyone to do it.
📌 What you will learn in this article
- Does endometrial scratching increase pregnancy rates in IVF?
- How does endometrial injury theoretically work?
- Is this technique useful after implantation failures?
- Is endometrial scratching painful or risky?
- Should you have endometrial scratching before your first IVF?
- Frequently Asked Questions (FAQ)
Since my training years between France and Turkey, and throughout my clinical practice, my philosophy has never changed: practicing “haute couture” reproductive medicine. In our boutique clinic, we prioritize personalized treatments and avoid “assembly line” approaches (factory clinics). That is why it is my duty to combine science with soul, by telling you the truth about popular procedures like endometrial scratching.
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Does endometrial scratching increase pregnancy rates in IVF?
The Cochrane systematic review by Lensen et al. (2021) concluded that the effect of this technique on live births is uncertain and consistent with either no effect or a slight improvement.
I’ve been a doctor for over +30 years, and I’ve seen a lot of medical trends. One that’s been talked about a lot is endometrial scratching. But according to a big review that looked at 37 studies with 8,786 women, it probably doesn’t do much to lower the chance of miscarriage.
The Cochrane review actually points out that the different studies make it tough to say that this should be done all the time.
How does endometrial injury theoretically work?
In theory, endometrial injury is supposed to initiate changes that may improve embryo implantation. This hypothesis is based on triggering a favorable inflammatory response related to wound healing and improving synchronization between the endometrium and the transferred embryo, as described by Lensen et al. (2021).
Think of it as prepping the ground before planting. You want to create the best possible place for that seed to grow. The idea is that this little bit of stress might actually make the uterus more ready for pregnancy by:
- Starting the process of preparing the uterine lining.
- Changing the genes that get the uterus ready.
- Slowing down how fast the uterine lining matures, which can help if things are a bit out of sync because of fertility treatments.
However, although these hypotheses are appealing, they are not supported by clinical evidence of increased live births.
Is this technique useful after implantation failures?
Subgroup analyses have failed to identify populations that would certainly benefit from this intervention.
It is natural to seek all possible solutions after a painful failure. However, the comprehensive study by van Hoogenhuijze et al. (2019) including 14 trials and 2,537 participants found no difference in live birth rates, clinical pregnancy rates, or miscarriage rates between groups with and without injury, whether patients had one or more previous failures. Even studies exploring the number of procedures, such as those by Nahshon et al. (2020), urge the greatest caution regarding potential biases.
| Patient Profile | Proven Impact of Scratching on Live Births |
|---|---|
| No previous IVF failure | No significant difference observed |
| 1 complete IVF/ICSI cycle failure | No significant difference observed |
| 2 or more IVF/ICSI cycle failures | No significant difference observed |
Data source: van Hoogenhuijze et al., 2019
Is endometrial scratching painful or risky?
Beyond physical discomfort, there is the financial aspect. The procedure itself is considered inexpensive, but its cost-effectiveness is difficult to justify given the uncertainty about its clinical efficacy. The study by van Hoogenhuijze et al. (2022) estimated the incremental cost-effectiveness ratio of endometrial scratching at €6,524 per additional live birth. In our personalized approach, we prefer to direct your resources toward validated technologies.
Should you have endometrial scratching before your first IVF?
It is not recommended to perform endometrial scratching before a very first IVF cycle. Combined data from a large multicenter trial (Lensen et al., 2019) show that this technique had no statistically significant positive effect on live birth rates in these women.
These data, rigorously confirmed by Pluddemann and Onakpoya (2020), Vitagliano et al. (2019), and more recently by Metwally et al. (2022), are clear. Overloading your first fertility journey with unproven invasive procedures is not in your best interest.
Frequently Asked Questions (FAQ)
Does endometrial scratching increase pregnancy rates? No. According to the Cochrane meta-analysis including over 8,700 women, the effect of endometrial scratching on live births is uncertain and generally does not provide proven clinical benefit.
Is endometrial scratching painful? The procedure can cause minimal to moderate bleeding as well as pelvic pain that varies between patients, comparable to severe menstrual cramps.
When should endometrial scratching be performed for IVF? Historically, most studies evaluated the procedure performed by pipelle biopsy during the luteal phase of the cycle preceding the IVF cycle.
Should you have endometrial injury after IVF failure? Current research concludes that there is no significant difference in pregnancy or miscarriage rates, even for women who have experienced two or more IVF/ICSI failures.
Is endometrial scratching officially recommended? Due to the high heterogeneity of studies and lack of proven efficacy, endometrial scratching is currently not recommended for routine clinical use.
Legal Notice
Date of last medical review: March 5, 2026. This article was written and medically validated by Dr. Senai Aksoy (Obstetrician-Gynecologist, Reproductive Medicine Specialist) for strictly informational purposes. Each patient is unique and IVF outcomes vary according to many medical factors. This content does not replace medical consultation under any circumstances. Please always consult your physician regarding your personal situation. © Assoc. Prof. Dr. Senai Aksoy - All rights reserved.
The content has been created by Dr. Senai Aksoy and medically approved.