Role of endometrial scratching in women with implantation failure
Role of endometrial scratching in women with implantation failurebest fertility clinic in Lucknow.
What is Endometrial scratching?Embryo implantation is a rate determining step in the IVF process. To increase the receptivity of endometrium targeted endometrial scratching is performed. It involved wounding of the lining of the uterus in order to improve its chances of implantation.
How does endometrial scratching work?Endometrium is the lining of the uterus. When an embryo is transferred in the uterus it comes in contact with cells of the endometrium. These cells secrete a range of factors which aids in embryonic attachment as well as development of embryo. Endometrium provides oxygen and nutrients to the embryo and protects the embryo from microbial invasion throughout pregnancy. That is why endometrium is considered essential in the process of implantation.
After successful embryo transfer, the cell of endometrium comes into action. In many women repeated implantation failure is the cause of infertility. In such cases endometrial scratching may be essential to improve receptivity of endometrium. The mechanism of endometrium scratching is not clearly understood but it causes inflammatory response.For having the best opinion on endometrial scratching Visit the best fertility clinic in Lucknow.
Mid luteal phase is considered as the window of implantation in the human endometrium. Endometrial scratching at this time may release more amount of Growth-regulated Oncogene- α (GRO-α), Interleukin-15 (IL-15), Macrophage Inflammatory Protein 1B (MIP-1B) and Tumor Necrosis Factor α (TNF-α).
Endometrial scratching leads to expression of pro-inflammatory cytokines which produces a higher number of macrophages and dendritic cells. The cells secrete enzymes and cytokines which are important in tissue remodelling and angiogenesis. It results in endometrial decidualization. Endometrial decidualization is the process of functional and morphological changes in the endometrium to prepare decidual lining for blastocyst implant. Differentiation of stromal cells is an important step for successful implantation.
Another mechanism is activating genes that are important for preparation of the endometrium, which may not be turned on without scratching, at the time of attempted implantation.
Mechanical disruption to the endometrium has been shown to harmonise the genetic expression of factors important for implantation, including laminin alpha 4, integrin alpha 6, matrix metalloproteinase 1 and glycodelin A.
When does endometrial scratching perform?Endometrial scratching is performed at the beginning of the IVF cycle in women with previous failed implantation.
How does endometrial scratching perform?Endometrial scratching is a simple, minimally invasive, low-cost procedure which takes only 15 to 20 minutes. It is carried out during outpatient appointments, and it is the same as endometrial biopsy. A 3 mm wide flexible catheter known as pipelle is inserted into the cervix to reach the uterus. It is moved backward and forward and then rotated to scratch the lining of the uterus.
Does endometrial scratching cause any side effects?Endometrial scratching is a relatively safe procedure which does not require anaesthesia. Women should be tested for chlamydia infection before endometrial scratching. Sometimes it may cause
(i). Mild bleeding
(ii). Abdominal cramps
(iii). Pelvic infection: Pelvic infections spread from inserted catheter into the cervix to uterus. The infections can be observed within 10 days after the procedure.
(iv). If early pregnancy is not detected, endometrial scratching may disrupt it.
(v). Uterine perforation in rare cases
Conclusion:Animal studies have shown positive results from endometrial scratching, on the contrary human trials have shown conflicting results. This is probably due to the timing, method and instruments used, population tested are variable. These factors impact the failure or success of implantation.
One school of thought is that endometrial scratching doubles the chances of embryo implantation whereas some scientists do not support this technique due lack of evidence. Hence, it’s always best to Visit the best fertility clinic for the best opinion.