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Local Endometrial Trauma (Endometrial Scratch): A Treatment Strategy to Improve Implantation Rates (Scientific Impact Paper No. 54)


Implantation continues to be a rate-limiting step in the success of assisted conception treatments. For implantation to occur, a blastocyst must attach to the endometrium under the influence of estrogen and progesterone. Many factors can affect an embryo’s implantation potential, including sperm, oocyte and embryo quality, and iatrogenic factors, such as laboratory conditions and embryo transfer technique. In addition, many conditions of the uterine cavity may influence the ability of the embryo to implant, such as submucosal fibroids, intrauterine adhesions and endometrial polyps.

Several studies have examined the impact of endometrial injury preceding an in vitro fertilisation treatment cycle in women with recurrent implantation failure (RIF), which appear to provide convincing evidence of benefit of superficial endometrial injury (or scratch) in improving the implantation rate, while to date the effect of endometrial trauma on pregnancy outcome in women who have experienced recurrent miscarriage has not been evaluated.

This Scientific Impact Paper discusses the evidence for endometrial trauma and improved implantation rates, the mechanisms by which implantation may improve, timing and technique for inducing endometrial trauma and who may benefit.

COVID disclaimer

This Scientific Impact Paper was developed prior to the emergence of the COVID-19 coronavirus.

Version history

This is the first edition of this paper. Please note that the Scientific Advisory Committee regularly assesses the need to update. Further information on this review is available on request.

Developer declaration of interests

Dr CJ Coughlan FRCOG, Dubai, United Arab Emirates: None declared.

Dr C Harrity, SIMS IVF Clinic, Dublin, Ireland: None declared.

Professor SM Laird, Sheffield Hallam University, Sheffield: None declared.

Professor TC Li FRCOG, Hong Kong: None declared.

This page was last reviewed 28 November 2016.