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Endometrial Scratch: What Is It & Can It Help Implantation?

An endometrial scratch is a short, minimally invasive procedure that involves gently disrupting the lining of the womb (the endometrium) to potentially improve embryo implantation during IVF or fertility treatment.

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Author

Tassia O’Callaghan

Reviewed by

Kayleigh Hartigan

13 min read

Published 28 October 2025

Spotlight:

  • The endometrial scratch is designed to stimulate healing and growth in the uterine lining.

  • It’s usually done in the cycle before IVF or embryo transfer.

  • Evidence on whether it increases pregnancy rates is mixed — it’s not routinely recommended by the HFEA.

  • The procedure takes around 10 minutes and can cause mild cramping or spotting.

  • You’ll usually need to pay privately — costs range from £175–£470 in the UK.

What is an endometrial scratch?

An endometrial scratch (sometimes called local endometrial injury or LEI) is a procedure where a fertility specialist gently “scratches” the lining of the womb using a thin catheter. The idea is that this small, controlled injury triggers the body’s natural healing response, releasing growth factors and cytokines that may make the endometrium more receptive to an embryo. [1]

This treatment gained attention after early studies suggested it might improve implantation rates in IVF, particularly for people who’ve experienced repeated implantation failure. However, larger and more recent studies show mixed results, and the HFEA rates it as “amber” — meaning there’s conflicting evidence on its effectiveness. [2]

Is an endometrial scratch the same as a biopsy?

They may sound similar — and both involve the lining of the womb — but an endometrial scratch and an endometrial biopsy are performed for different reasons.

An endometrial scratch is designed to stimulate the womb lining before fertility treatment, usually in the cycle before IVF or ICSI. A thin catheter is gently used to create a small, controlled “injury” in the endometrium. The theory is that this healing response may make the lining more receptive to an embryo implanting. It’s considered an optional add-on rather than a diagnostic test, and no tissue is typically sent to a lab. [2]

An endometrial biopsy, on the other hand, is a diagnostic procedure. Small samples of the endometrium are removed and examined under a microscope to check for abnormalities such as hormonal imbalances, infection, or inflammation. Biopsies are often performed to investigate symptoms like heavy or irregular bleeding, or to assess the uterine environment before IVF. [3,4]

While both procedures can feel similar and are done in an outpatient setting, the purpose and outcomes differ — one aims to improve implantation potential; the other helps identify or rule out underlying uterine issues.

When is an endometrial scratch recommended?

Endometrial scratching isn’t routinely recommended for everyone undergoing fertility treatment. It’s sometimes considered in specific circumstances, where your fertility specialist believes it could help improve implantation before IVF or ICSI. [2]

You might be offered an endometrial scratch if you:

  • Have experienced multiple unsuccessful embryo transfers: If several good-quality embryos have failed to implant, your doctor may suggest an endometrial scratch as a potential way to support the next transfer — though evidence remains mixed.

  • Are preparing for a frozen embryo transfer (FET): Some clinics perform a scratch in the cycle before FET to try to make the uterine lining more receptive during the next treatment cycle.

  • Are taking part in a clinical trial or research programme: Because there isn’t strong evidence proving its effectiveness, the HFEA and professional bodies recommend that endometrial scratching should mainly be offered in a research setting, where patients are not charged for participation.

For most people undergoing IVF or ICSI, routine treatment without add-ons remains the most effective and evidence-based approach. Your clinic will help you decide whether a scratch is appropriate for your individual situation. [2]

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How is an endometrial scratch done?

An endometrial scratch is a short, outpatient procedure — similar to an embryo transfer — that gently disrupts the womb lining to encourage it to heal and regenerate before your next IVF or frozen embryo transfer (FET) cycle. It usually takes around 10–15 minutes and doesn’t require anaesthetic. [5]

Here’s what typically happens:

  • Step 1: Timing and preparation: The procedure is usually scheduled around day 21 of your menstrual cycle, before treatment begins. You’ll be advised to use barrier contraception that month to avoid pregnancy, and to take simple pain relief (like paracetamol or ibuprofen) about an hour beforehand.

  • Step 2: Getting comfortable: You’ll lie on an examination bed, similar to when having a smear test. A speculum is gently inserted into the vagina so the clinician can see your cervix.

  • Step 3: Cleaning and access: The cervix is cleaned with a sterile saline solution to reduce infection risk. A very thin catheter (the same kind used for embryo transfer) is then passed carefully through the cervix into the womb.

  • Step 4: The ‘scratch’: Using gentle suction, the clinician moves the catheter slightly to “scratch” the surface of the endometrium. This takes just a few minutes and may feel like mild period cramps.

  • Step 5: Finishing up: Once complete, the catheter and speculum are removed, and you can rest for a few minutes before heading home. Most people experience light bleeding or spotting for a day or two and can return to normal activities straight away.

Can I ask my GP for an endometrial scratch?

Endometrial scratching isn’t offered on the NHS and can’t usually be arranged through your GP. While your GP may be able to discuss the procedure with you or help rule out any infections beforehand, they won’t be able to perform the scratch itself or refer you directly for it on the NHS. [3,5]

If you’re considering the procedure — for example, after multiple failed embryo transfers — you’ll need to book it privately through a fertility clinic. Each clinic has its own policies, eligibility criteria, and medical approach to add-on treatments like endometrial scratching.

You can use our Clinic Match tool to find trusted UK fertility clinics that offer this procedure and compare their services, approach, and patient reviews to find the right fit for your path.

How much does an endometrial scratch cost?

The cost of an endometrial scratch in the UK usually falls between £175 and £470, but prices can vary depending on the clinic and whether sedation is included. A straightforward procedure without sedation often sits toward the lower end of the range, while opting for sedation can increase the overall price considerably. Some clinics may include it within a broader treatment plan, while others list it as an optional add-on. Because there’s no universal pricing model, it’s always best to confirm costs directly with your clinic before booking — especially if you’re combining the procedure with IVF or embryo transfer preparation.

How to prepare for an endometrial scratch

Preparing for an endometrial scratch is simple and straightforward. Your clinic will confirm the timing and any specific instructions, but these general steps can help you feel ready and supported before your appointment. [2,3]

  • Book at the right time in your cycle: The procedure is usually done in the luteal phase (around day 21) of your cycle, before your next round of IVF or embryo transfer. Your clinic will help you schedule it for the optimal window.

  • Avoid pregnancy that cycle: You’ll be advised to use barrier contraception (such as condoms) or abstain from intercourse, as the procedure shouldn’t be done if there’s any chance of pregnancy.

  • Take mild pain relief beforehand: Taking paracetamol or ibuprofen about an hour before your appointment can help ease potential cramping during the procedure.

  • Check for infections if advised: Some clinics may recommend vaginal or cervical swabs beforehand to rule out infection, as scratching isn’t performed if any infection is present.

  • Arrive clean and comfortable: Take a shower that morning and avoid wearing perfume, deodorant, or body products, which can interfere with the clinic environment.

  • Bring a sanitary pad: It’s normal to experience light spotting afterwards, so it’s best to have a pad with you rather than using tampons.

  • Expect mild discomfort: Most people compare the procedure to a smear test — slightly uncomfortable but quick. You can usually drive home and return to work the same day.

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What are the potential complications of endometrial scratching?

Endometrial scratching is considered a low-risk procedure, but as with any medical intervention, there are some potential side effects and rare complications to be aware of. Most people experience only mild discomfort that settles within a day or two. [2,3,5,6]

  • Abdominal discomfort or cramping: You may feel mild period-like cramps during or shortly after the procedure, which usually ease with over-the-counter pain relief.

  • Light bleeding or spotting: It’s common to have light bleeding for a day or two afterwards — this is part of the normal healing process.

  • Infection: A pelvic or uterine infection can occasionally occur, especially if one is already present. Clinics typically perform vaginal and cervical swabs beforehand and may prescribe a prophylactic antibiotic to reduce this risk.

  • Feeling faint or dizzy: Some people feel briefly light-headed during or after the procedure, so it’s best to rest before driving or heading home.

  • Unsuccessful procedure: If the cervix (neck of the womb) is tightly closed, it may not be possible to perform the procedure safely. In this case, it will be stopped and rescheduled.

  • Unsuitable for some patients: The procedure isn’t recommended for people at risk of endocarditis (a heart infection), and your clinician will assess your medical history before going ahead.

  • Uterine perforation (extremely rare): In very rare cases — fewer than 1 in 1,000 — the catheter may cause a small injury to the womb. If this happens, hospital care may be required, though most cases resolve fully.

If you notice heavy bleeding, fever, or ongoing pain after your appointment, contact your clinic or GP straight away for advice and assessment.

Does an endometrial scratch improve IVF success rates?

The evidence around endometrial scratching and IVF success is mixed — and depends heavily on the context. A 2023 meta-analysis of nearly 9,000 patients found that, overall, endometrial scratching was linked to a slightly higher chance of live birth and clinical pregnancy (about a 12% relative increase). However, this benefit mainly appeared in patients who’d already had multiple failed IVF cycles, and only when the procedure was done in the menstrual cycle before embryo transfer — not during the treatment cycle itself. [7]

For people undergoing IVF for the first time, large UK “gold-standard” trials, such as the 2020 Sheffield study, found no improvement in pregnancy or live birth rates after an endometrial scratch. Because of this, the HFEA rates it amber (unclear benefit) for most IVF patients and grey (insufficient evidence) for those with recurrent implantation failure, while the latest NICE guidance (2025) advises against offering it as a routine add-on. [2,8,9,10]

In short: an endometrial scratch might help a small subset of patients with repeated IVF failures, but it hasn’t been shown to improve success rates for most people starting or undergoing standard IVF or ICSI.

What to do after an endometrial scratch

After an endometrial scratch, recovery is usually quick — most people feel back to normal within a day or two. Still, it helps to take a few simple steps to look after your body and reduce the risk of infection or discomfort. [5]

  • Rest if you need to: You can go back to work or drive straight after the procedure, but taking it easy for the rest of the day can help with any lingering cramps or tiredness.

  • Expect mild spotting or cramps: Light bleeding or period-like pain for a day or two is normal and should settle quickly. Over-the-counter pain relief such as paracetamol or ibuprofen can help.

  • Avoid sex for a few days: Give your womb time to heal and reduce the risk of infection by waiting 2–3 days before having penetrative sex.

  • Watch for signs of infection: If you develop ongoing pain, fever, unusual discharge, or flu-like symptoms, contact your clinic or GP right away. These could be signs of infection that need treatment.

  • Use barrier contraception for the rest of the cycle: Clinics usually advise avoiding pregnancy in the same cycle as your scratch. Using condoms until your next period is the safest approach.

  • Plan your next cycle: The effect of the scratch can last up to three months, so your clinic will usually schedule your embryo transfer or fertility treatment within that window.

Is an endometrial scratch worth it?

Whether an endometrial scratch is “worth it” really depends on your individual situation. For most people going through IVF or ICSI, there’s no strong evidence that it improves success rates — and major fertility bodies like the HFEA and NICE advise that it shouldn’t be offered routinely. The research so far has shown mixed results: some studies found no difference at all, while others suggested a small benefit for patients who’ve had several failed embryo transfers. [2,9]

Because of this uncertainty, endometrial scratching is rated amber for most IVF patients (meaning the evidence is conflicting) and grey for those with recurrent implantation failure (meaning there’s not enough good-quality data to say either way). It’s also an invasive procedure with minor risks like cramping, spotting, or infection.

If you’re considering it, it’s best to discuss the pros and cons with your fertility specialist — particularly how it fits into your treatment plan, your history of IVF outcomes, and whether it’s available as part of a research setting rather than an added cost. For now, most people are likely to get better value — and evidence-backed results — from focusing on standard, proven fertility treatment cycles.

Endometrial scratch FAQs

How painful is endometrial scratching?

Most people describe endometrial scratching as uncomfortable rather than severely painful. The sensation is often compared to strong period cramps or the brief discomfort of a cervical smear, lasting only a few minutes. You might feel some mild cramping or light bleeding afterwards, but this usually settles within a day or two. Taking pain relief like paracetamol or ibuprofen before your appointment can help make the procedure more manageable. [2]

How long does bleeding last after an endometrial scratch?

It’s normal to have some light bleeding or spotting after an endometrial scratch — usually lasting a day or two. For most people, it’s similar to the tail end of a light period and settles quickly without treatment. If bleeding becomes heavy, lasts longer than a few days, or is accompanied by pain, fever, or unusual discharge, contact your clinic or GP for advice. [3,5]

Does endometrial scratching help with a natural pregnancy?

There’s some early research suggesting that endometrial scratching might improve the chances of natural conception in women with unexplained infertility, particularly when combined with luteal phase support. However, the evidence is limited and mixed — small studies have shown potential benefits, while larger, higher-quality trials are still investigating whether it truly makes a difference to live birth rates. For now, it’s considered experimental and should only be done within a research setting, not as a routine fertility treatment. [2,11,12]

Sources

  1. El-Toukhy T, Sunkara S, Khalaf Y. Local endometrial injury and IVF outcome: a systematic review and meta-analysis. Reprod Biomed Online. 2012 Oct;25(4):345-54. doi: 10.1016/j.rbmo.2012.06.012. Epub 2012 Jun 26. PMID: 22885017.
  2. Human Fertilisation & Embryology Authority. Endometrial scratching.
  3. NHS University Hospitals Coventry and Warwickshire, NHS Trust. Endometrial Biopsy / Endometrial Scratch (ES) prior to IVF/ICSI. Reviewed: March 2024.
  4. NHS Bradford Teaching Hospitals, NHS Foundation Trust. Endometrial biopsy.
  5. NHS Gateshead Health, NHS Foundation Trust. Endometrial Scratch. Page last updated: 30 Jul 2025.
  6. Günther V, von Otte S, Maass N, Alkatout I. Endometrial “Scratching” An update and overview of current research. J Turk Ger Gynecol Assoc. 2020 Jun 8;21(2):124-129. doi: 10.4274/jtgga.galenos.2020.2019.0175. PMID: 32517438; PMCID: PMC7294834.
  7. Iakovidou MC, Kolibianakis E, Zepiridis L, Venetis C. The role of endometrial scratching prior to in vitro fertilization: an updated systematic review and meta-analysis. Reprod Biol Endocrinol. 2023 Oct 2;21(1):89. doi: 10.1186/s12958-023-01141-2. PMID: 37784097; PMCID: PMC10544419.
  8. National Institute for Health and Care Research. New research suggests IVF ‘scratch’ offers no benefit to women undergoing IVF for the first time. 8 July 2020.
  9. National Institute for Health and Care Excellence. Fertility problems: assessment and treatment [P] Evidence report for endometrial scratch as a treatment add-on. September 2025.
  10. BBC. Fertility clinics must stop unproven treatments, watchdog warns. 10 September 2025.
  11. Bui BN, Torrance HL, Janssen C, Cohlen B, de Bruin JP, den Hartog JE, van der Linden PJQ, Deurloo KL, Maas JWM, van Oppenraaij R, Cantineau A, Lambalk CB, Visser H, Brinkhuis E, van Disseldorp J, Schoot BC, Lardenoije C, van Wely M, Eijkemans MJC, Broekmans FJM. Does endometrial scratching increase the rate of spontaneous conception in couples with unexplained infertility and a good prognosis (Hunault > 30%)? Study protocol of the SCRaTCH-OFO trial: a randomized controlled trial. BMC Pregnancy Childbirth. 2018 Dec 29;18(1):511. doi: 10.1186/s12884-018-2160-z. PMID: 30594169; PMCID: PMC6311044.
  12. Chang, E., Check, J.H., Liss, J.R., Choe, J. and Cohen, R., 2017. An endometrial scratch can improve pregnancy rates in natural cycles of women with unexplained infertility given luteal phase support. Fertility and Sterility, 108(3), p.e369.