Endometrial Scratch and IVF: What Does Evidence Say?

What Is an Endometrial Scratch?

An endometrial scratch (sometimes called endometrial injury) is a procedure where a clinician gently disrupts the lining of the uterus using a thin instrument, similar to an endometrial biopsy device. It is typically performed in the cycle before embryo transfer.

The idea behind endometrial scratch IVF is that a controlled “micro-injury” might trigger healing and inflammatory signals that could support implantation. That is the theory. The real question is whether it improves live birth rates in practice.

Why It Became Popular as an IVF Add-On

It became popular for two reasons:

• Early studies suggested a possible improvement in implantation in some groups

• It is relatively quick to perform compared with many other add-ons

However, popularity is not proof. IVF add-ons need to earn their place through outcomes that matter, especially live birth, not just early pregnancy tests.

What Does the Evidence Say in 2026?

For first IVF cycles

The strongest message from large, well-designed studies is that routine endometrial scratching before a first IVF cycle does not improve live birth rates compared with usual care.https://pmc.ncbi.nlm.nih.gov/articles/PMC8859770/

For people with previous unsuccessful IVF attempts

This is where the evidence becomes less tidy. Some analyses suggest there may be a benefit in certain contexts, while others show no meaningful improvement. In other words, results are conflicting, and the effect, if present, is not consistent across all patients.https://academic.oup.com/humupd/article/29/6/721/7202298

How regulators describe it

The UK regulator that rates IVF add-ons has described the evidence for endometrial scratching as unclear overall, with an amber-style rating that reflects mixed findings rather than a proven benefit.https://www.hfea.gov.uk/treatments/treatment-add-ons/endometrial-scratching

Bottom line: for many patients, it is not a routine “must-have”. It is a case-by-case decision, and the decision should be driven by your history, not clinic upselling.

Who Might Consider It, and Who Probably Should Not

A consultant may discuss endometrial scratch IVF if you have had previous embryo transfers that did not result in a live birth and you are exploring carefully selected add-ons. Even then, it should be framed as uncertain benefit, not a promised advantage.

It is generally hard to justify if:

• You are starting your first IVF cycle

• You are being offered it as a blanket protocol without a clear rationale

• You are uncomfortable with procedures that can cause pain or bleeding, and the likely benefit is uncertain

What to Expect if You Do Proceed

If you and your consultant decide it is reasonable to try, you should expect:

• A brief outpatient procedure, often similar in feel to a biopsy

• Cramping during or shortly after

• Light spotting for a short time

Risks are usually low, but no procedure is zero-risk. The key is that you consent to it with a realistic understanding of what it can and cannot achieve.

The Questions Worth Asking Before You Pay for Any Add-On

Use these to keep things clinically sharp:

• What outcome are we trying to improve, live birth or something else?

• What evidence supports this in someone with my history?

• What are the downsides for me, discomfort, cost, delay, risk?

• If it does not work, what is our next step?

• Are there higher-impact steps we should prioritise first?

This is where consultant-led care earns its keep: fewer distractions, more signal.

High-ROI Steps That Often Matter More Than Add-Ons

Without making promises, the fundamentals frequently have greater impact than optional procedures:

• A clear diagnosis and plan for uterine cavity issues (polyps, submucosal fibroids)

• Optimising timing and transfer strategy based on your cycle and response

• Reviewing embryo quality, protocol choices, and any relevant medical factors

• Addressing iron deficiency, thyroid issues, or metabolic factors when clinically indicated

A good plan is usually boring but effective.