Saint Mary s Hospital Reproductive Medicine Service. Endometrial Scratch. Information For Patients INF/DRM/CLI/35 V1

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1 Saint Mary s Hospital Reproductive Medicine Service Endometrial Scratch Information For Patients INF/DRM/CLI/35 V1

2 What is this leaflet about? This leaflet is to inform women undergoing endometrial scratch about what is involved. Your consultant will inform you that this procedure may improve your chances of having a baby. Research is still being gathered but it is initially thought to increase pregnancy and live birth rate in a selected group of patients. What is endometrial scratch? Endometrial scratch is a procedure used to help embryos implant more successfully after in-vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI) in patients who had failed cycles despite transfer of good quality embryos. Currently the evidence suggests that superficially injuring (scratching) the lining of the womb in this group of patients may improve the chances of pregnancy. Who is the procedure for? Endometrial scratch is performed on women who did not get pregnant after transfer of good quality embryos, and in the absence of any other cause of failed implantation. Currently, available evidence does not support the use of endometrial scratch in all patients, including patients going through IVF/ICSI treatment for the first time. It is also possible that in these patients the scratch procedure could do more harm than good. More research is required to evaluate the role of endometrial scratch in patients going through their first cycle of IVF treatment. How does scratching help implantation? New research and evidence suggests that scratching the uterine lining causes a repair reaction in patients with recurrent implantation failure and this may increase embryo implantation rates: 2

3 The repair process releases growth factors, hormones and chemicals. The new lining which grows after the procedure is thought to be more receptive to an implanting embryo and so increases the chances of pregnancy. Gene switching - scientists believe that the genes which are responsible for implantation of embryos are sometimes not switched on during the time when embryos are supposed to implant. Endometrial scratching may switch on the genes that are responsible for preparation of the endometrium for implantation, which increases the chances of pregnancy. Research is still being gathered to understand exactly how this works. When is the best time to have the procedure? The best time to perform the endometrial scratch is approximately one week before your IVF, ICSI treatment cycle begins. The clinical team will advise on the best time for the procedure based on your periods. What preparations are needed for endometrial scratch? It is vital that you do not have unprotected intercourse in the four weeks before the planned endometrial scratch procedure. You should use a condom for contraception during the cycle of the scratch appointment to avoid the risk of a possible pregnancy. We recommend taking some pain relieving medication ½ hour before your procedure, such as two paracetamol tablets (500 mg per tablet) as this may help to relieve any discomfort during the procedure. You may eat and drink normally before the procedure. 3

4 You do not need to empty your bladder before the procedure unless you feel uncomfortable with a full bladder. You should wear comfortable clothing that gives easy access to the lower part of your body. You should bring a sanitary towel with you for use after the procedure. What happens during my appointment and how is the procedure performed? The procedure should only take minutes. You may experience a little discomfort but no anaesthetic is required. The procedure is similar to an embryo transfer or cervical smear test. The procedure will be explained to you by the doctor or nurse performing the procedure. Your recent Chlamydia screening results will be checked in the notes. You will be asked to sign a consent form prior to the procedure. Following that you will be made comfortable on the examination couch. A speculum is gently inserted into the vagina so the cervix can be seen (similar to having a smear test). The cervix is cleaned with sterile gauze. A fine, thin plastic tube (flexible catheter) will then be passed through the opening of the cervix into the cavity of the uterus to gently and superficially scratch the lining of the uterus. (Inserting and moving the catheter up and down may cause mild abdominal cramping similar to period pain). The catheter is taken out at the end of the procedure. Some mild bleeding is common after the procedure. 4

5 What happens after the procedure? An hour or two after the procedure you will be able to continue your normal daily activities, but you may benefit from not going back to work the same day. You can eat and drink normally immediately after. What risks are involved? Endometrial scratch is a very safe procedure. For most women it does not require any anaesthetic. Some women occasionally experience some cramping pains during and after the procedure, but these will ease in a very short time. We recommend that you make arrangements for a relative or a friend to drive you home in case you experience more discomfort than usual during the procedure. We will ensure you are well enough before you leave the clinic. Very rarely, the procedure can cause pelvic infection. There is a small risk that any infection within the cervix may spread to the uterine cavity during the procedure. This would become apparent up to 10 days following the procedure. If you suspect and experience any of the following signs and symptoms within a few days of the procedure, please contact your GP and inform them that you have had an endometrial scratch (biopsy): Foul-smelling vaginal discharge. Persistent bleeding. Increasing lower abdominal pain. Unexplained fever. Feeling generally unwell. Please note that it is recommended to screen all women for Chlamydia prior to endometrial scratch and you already would have been screened with the initial investigations at our 5

6 department before starting your IVF treatment. Your doctor or fertility specialist nurse will check this if you have already had a test for Chlamydia within the last 6 months. Violence, Aggression and Harassment Control Policy We are committed to the well-being and safety of our patients and of our staff. Please treat other patients and staff with the courtesy and respect that you expect to receive. Verbal abuse, harassment and physical violence are unacceptable and will lead to prosecutions. Suggestions, Concerns and Complaints If you would like to provide feedback you can: Ask to speak to the ward or department manager. Write to us: Patient Advice and Liaison Services, 1st Floor, Cobbett House, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL Log onto the NHS Choices website - click on Comments. If you would like to discuss a concern or make a complaint: Ask to speak to the ward or department manager they may be able to help straight away. Contact our Patient Advice and Liaison Service (PALS) Tel: (0161) Ask for our information leaflet. We welcome your feedback so we can continue to improve our services. 6

7 Please use this space to write down any questions or concerns you may have. 7

8 TIG 84/14 Updated March 2015 Review Date March 2017 (SF Taylor CM15628)

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