Endometrial Scratch and Saline Hysterogram

endometrial scratch

At Harley Street Fertility Clinic we would like to maximise your chances of pregnancy during a treatment cycle.

One of the key factors towards that success is embryo implantation, which is a complex process.


In order to increase the probability of implantation a relatively new process called endometrial scratch and saline hysterogram is offered to our patients undergoing IVF/ICSI treatment.

What is the endometrial scratch and saline hysterogram?

The lining of the uterus (the endometrium) is gently ͚scratched͛ using a thin catheter, which is passed through the cervix. At the same time, the uterine cavity is rinsed with normal saline.

How does it help?

Recent research suggests that locally injuring the endometrium (i.e. scratching the uterine lining) causes the uterus to start a’repair reaction’, which may increase the chances of embryo implantation:

  • the injury causes increased production of white blood cells in the local area, thereby releasing growth factors, hormones and other factors. The ͚new͛ lining that grows from the scratch is believed to be more receptive to an embryo and hence, increases the chances of pregnancy
  • scientists also believe that the genes responsible for embryo implantation are sometimes not switched on at the time when the embryo is supposed to implant. It is thought that the endometrial scratch may switch those genes on and thus better prepare the endometrium for implantation.

The endometrial scratch is a relatively new procedure and further research is being performed to understand the exact process by which it works.

The saline wash is performed in order to remove any debris from the surface of the endometrium and provide a clean surface for embryo implantation.

When is the best time to have the procedure?

The best time to have the endometrial scratch is 7 to 10 days before the period starts. This is for a standard 28 day cycle, if your periods are infrequent or irregular, your doctor will advise on the best time for the procedure.

Preparing for the procedure

It is critical that this procedure is not performed during a pregnancy, therefore patients should not have unprotected intercourse in the four weeks prior to this procedure to avoid the risk of a possible pregnancy.

To prevent the risk of spreading any infection, all patients must be screened for Chlamydia and Gonorrhoea prior to the procedure.

We advise that you take over the counter pain relief 30 minutes prior to the procedure. We recommend Ibuprofen (400 mg) and Buscopan (10 mg). If you are allergic to Ibuprofen another option is Paracetamol (1 gram).

A prophylactic course of antibiotic will be prescribed: 1gm of Azithromycin (250mg x 4) orally and 1gm Flagyl suppository rectally the morning of the procedure.

Patients may eat and drink normally before the procedure. Patients are advised to drink 2 glasses of water 30 minutes before the procedure to ensure a half full bladder.

How is the procedure performed?

The endometrial scratch and saline hysterogram are not painful and although you may experience some discomfort, no anaesthesia is usually required. The procedure is similar to an embryo transfer and takes approximately 30 minutes. You will be able to resume normal daily activities after the procedure.

What are the risks?

There is a small risk that any infection in the cervix may be spread to the uterine cavity. You should contact the clinic immediately if you experience any of the following symptoms within a few days of the procedure:

  • Unexplained fever
  • Persistent bleeding or foul-smelling vaginal discharge
  • Increasing lower abdominal pain
  • Feeling generally unwell


The endometrial scratch and saline hysterogram is an additional chargeable service and is not included as part of any treatment cycle such as IVF or ICSI. Please refer to a current price list for the exact charge.

After the procedure

You should wear a sanitary towel after the procedure because there may be persistent vaginal discharge for a few hours as the fluid used in the saline scan drains out of the vagina. This discharge is sometimes blood stained so do not become alarmed if this occurs. You should be able to resume normal daily activities after the procedure.

Endometrial scratch and saline hysterogram is an adjunct treatment and is not recommended for all patients. Please speak to your consultant about whether it might be beneficial for you.

Please refer to the regulator’s web page regarding treatment “add-ons” for further information: HFEA


  1. Barash, A., Dekel, N., Fieldust, S., Segal, I., Schechtman, E., Granot, I., 2003. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilisation. Fertil. Steril. 79, 1317-1322.
  2. Narvekar, S., Gupta, N., Shetty, N., Kottur, A., Srinivas, M., Rao, K., 2010. Does local endometrial injury in the non-transfer cycle improve the IVF-ET outcome in the subsequent cycle in patients with previous unsuccessful IVF? A randomised controlled pilot study. J. Hum. Reprod. Sci. 31, 15-19
  3. Nastri CO, Gibreel A, Raine-Fenning N, Maheshwari A, Ferriani RA, Bhattacharya S, Martins WP. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Database of Systematic Reviews 2012, Issue 7.
  4. Tarek El-Toukhy, SeshKamal Sunkara, Yakoub Khalaf. Local endometrial injury and IVF outcome: a systematic review and meta-analysis, Reproductive BioMedicine Online (2012) 25, 345-35
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