The Endometrial Scratch: My Experience

When going through fertility treatment, it’s fair to say that you will explore any option that’s given to you. You reach a new level of somewhat desperation, willing anything to work and willing to give anything a try. Furthermore, when you enter the territory of multiple cycles, I’ve found that willingness can go one of two ways; you’re eager to try almost anything to help improve your chances of success and reduce your chance of needing to go through the whole rigmarole again, and yet, you become somewhat reluctant to try certain things because those sold to you before in which you invested so much hope, simply failed you.

For me, one of those things I was unsure about was an endometrial scratch. An endometrial scratch is a procedure that has been around predominantly for little over a decade and is one that still has rather varying research and evidence to prove its success. With a likeness to a smear test, an endometrial scratch involves your womb lining being scratched/scraped at a particular point in your cycle, usually around day 16-23. It is often recommended to women who have had previous failed implantation in IVF. It is suggested that the scratching a reaction in the womb, causing chemicals and hormones to be released to help the uterus repair itself, aiding implantation (Your IVF Journey).

The HFEA (Human Fertilisation and Embryology Authority), who regulate fertility treatment in the UK, have a traffic light system on their website which exists to rate “add-ons” based on the controlled research presented. Endometrial Scratching is rated as ‘Amber’, which means there is conflicting evidence from randomised controlled trials.

An endometrial scratch had never been suggested to me before, however, I am a strong believer in knowledge being power, and so the IVF process and all the potential add-ons were something that I had researched to an extent that I imagine some would view as borderline obsessive. Endometrial scratches were something I had long heard of, and yet my clinic had never broached the subject. However, in the world of social media, I have seen and heard of so many experiences and an endometrial scratch is one that had a whole wealth of mixed opinions. Many said it was excruciatingly painful; others said it caused nothing more than a mild cramping. There were people who swore it was the reason their treatment had worked; others had successful cycles but couldn’t be confident it wouldn’t have worked without the scratch; a few had said it didn’t make the slightest difference and it wasn’t worth the time. As we started the preparations for my third cycle with a new clinic and a whole new protocol, it’s something the clinic suggested pretty quickly, and one I accepted with little reluctance. Prior to the clinic suggesting it, I’d always shrugged it off, insisting I’d never try any add-ons that weren’t rated ‘green’ by the HFEA. When push came to shove, ultimately, I was willing to give it everything I had, and if my treatment failed and I had refused, I knew I’d pinpoint the lack of scratching as the reason why.

My scratch was scheduled for day 18 of my cycle and I was full of nerves for a multitude of reasons. I was unsure whether or not it was going to hurt, my husband wasn’t allowed in to hold my hand (another thing I have to thank COVID for…), and we knew that this meant that we were well and truly back on the road. I had been taking norethisterone (a progestin medication used in birth control and menopausal hormone therapy, which stops uterine bleeding, allowing clinics to time a period) for 4 days as my cycle has been medicated, meaning the clinic know pretty much to the day when my cycle will start, so the scratch wouldn’t be wasted by my uterus not playing ball. Norethisterone is far from fun for me, causing me to be irritable and emotional with the skin of a 14-year-old, and so I was already a bag of fatigued emotion without my uterus being scored like a sausage roll. I arrived in the pristine white clinic and my nurse, who is nothing but lovely, introduced herself yet again and explained everything that came with it; how the procedure happened, what it did, why it was being done, and the aftercare. The clinic were always very clear that it may not work; for some people it’s beneficial but there is nothing to suggest it will definitely be the case for me, but given our history, they thought it was worth a trial.

I lay there with my legs in the stirrups as my incredibly tall consultant inserted the speculum. Unfortunately for me, I’m 5ft2, so it meant the bed had to be tilted rather significantly to give the Doctor ‘easy access’ to my cervix. There’s nothing like feeling like you’re about to slide backwards, headfirst down a bed whilst someone peers into your vagina, that’s for sure. It took a little while to get the catheter and the ‘scratching device’ into my uterus; a few problematic corners that didn’t want to play ball, and at this point it was rather uncomfortable. I had a nurse to my left talking to me about the scan I had the week before, telling me how well I was doing, and generally putting her soothing voice to good use. The scratch itself lasted likely less than a minute… it was painful. I had taken 2 paracetamols about 45 minutes beforehand which I do think helped, but it did feel like a bad period pain and most definitely far from natural. Being a woman who loves nothing more than feeding her stomach, I distracted myself by insisting every medical professional in the room told me in great detail what they had for tea the night before. It was a useful tactic, and before I knew it, I was laying flat with no foreign objects in my uterus.

The aftercare was relatively simple; I had 4 antibiotics to take later that day and another in the form of a pessary that needed inserting rectally before bed (not fun). I wasn’t allowed any baths for a couple of days, showers only and only water, no body wash or anything other than pure water near the vagina for the next few days. This included unprotected sex, although from day 1 of my cycle (known as the preparation month, the month before active treatment begins) I had to ensure that any sex was protected, so this wasn’t new. I was rather uncomfortable for the rest of the day; I felt absolutely exhausted and spent the afternoon with a blanket and my book, experiencing nothing more than mild cramping. Within 24 hours, I had forgotten I’d even had it.

Whether or not it pays off is currently anyone’s guess, but for the sake of a 30-minute procedure that was relatively straightforward, with really nothing more than a short-lived discomfort, for me it was worth the shot.

Only time will tell.

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