Scratching comes from the English word "scratch", which means "scratch." What does this have to do with endometrium? Endometrial scratching procedure is recommended for women before IVF.
IVF is prescribed to women who are not able to get pregnant themselves. The reasons for this can be many: from hormonal disruptions to the simple incompatibility of partners. The procedure is quite expensive, so every woman wants to get pregnant when she first attempts artificial insemination. In order to make this wish come true, doctors decide to “wake up” the endometrium with scratching.
Let's take a closer look at the essence of the procedure, its features and possible complications.
What is endometrial scratching and what is it done for?
Endometrium scraping is incisions or, to be more precise, scratches on the inner layer of the uterus. This procedure is quite simple and safe. The most important thing is that it increases the chance of successful IVF by 2 times! Why scratch the inner shell? According to observations, the best place for implantation of the fetus is the back wall of the uterus. It is in that part that the layer is incised. What does this give?
- stickiness of a uterine layer increases,
- additional hormones are produced,
- the embryo is often attached to the damaged surface.
These studies were conducted by Brazilian scientists. After applying this additional method, the birth rate of healthy children after IVF increased by one third.
The main advantages of endometrial scarring:
- quickness of the procedure
- lack of special training
- The procedure is performed on an outpatient basis.
- very high efficiency indicators.
Indications and contraindications for scratching
The main indication for scratching is an unsuccessful attempt of IVF and ICSI. Often, the procedure of artificial insemination is carried out more than once. And if the woman has not caught the embryo from the first time, when she tries again, she is scratched to increase the chances of pregnancy.
However, the procedure has contraindications. It is contraindicated for those who have inflammatory processes in the cervical canal.
Of course, if a woman has contraindications for IVF, then scratching is contraindicated. What are the limitations?
- Problems with fallopian tubes. If a woman has adhesions in the tubes, then before performing IVF, she should undergo laparoscopy.
- Severe diseases in which childbirth is contraindicated: heart disease, renal and hepatic failure.
- Pathology of the uterus.
- Cancer in any part of the body is a complete contraindication for labor.
- Diabetes mellitus of severe types.
- Psychoemotional serious disorders.
These are absolute contraindications. There are still limitations in which IVF and scratching are contraindicated, but the procedure is possible when troubleshooting. The following are the relative limitations:
- infectious conditions
- severe infectious conditions (AIDS, hepatitis, tuberculosis, etc.),
- benign lesions in the pelvic organs that require surgery,
- chronic diseases in the acute stage,
- recent injuries, surgery.
After stabilization of a woman’s health, she can be scratched followed by IVF.
Methods for endometrial scratching in preparation for IVF
Thus, the IVF method implies the embryo insertion into the uterus for bearing and giving birth to a child in the usual way. It depends on whether this process is successful, whether the woman becomes a mother or whether she will have to carry out the procedure again and again. To create a favorable background, it is very important to scratch properly and choose the right time for this. Let us analyze the procedure in order.
Dates of the procedure
This process is carried out on a specific day. The date is chosen by the doctor. What does he focus on?
First, the thickness of the endometrium. For favorable conception, there is a standard for the thickness of the inner layer, which contributes to the implantation of the embryo.
Secondly, the date will be closest to the date of the IVF itself. After all, if you make this procedure long before the planning of IVF, then the scratches will have time to heal and will not give the desired result.
Hence the conclusion: the application of notches on the endometrium is carried out almost before the IVF process itself.
The procedure is painless, so it does not need anesthesia. However, a woman may experience some discomfort after the procedure. There may be pain and cramps. In this case, a woman can drink No-shpu or Spazmalgon. Such discomfort does not last long, and the woman quickly returns to her normal pace of life.
A woman is treated with an antiseptic cervix. After the soft tube is inserted into the cervical canal and the piston is released half its length. With this tool, the doctor as if scratches the surface of the uterus, forming incisions in the reservoir. When incising, a woman may feel some discomfort or cramps, but this quickly passes. After the procedure, the woman may observe a slight bleeding.
How does endometrial scratching affect IVF results?
This procedure has only a positive effect on the fertilization process! It doubles the chance of pregnancy. Due to damaged endometrium, the embryo will attach to the wall of the uterus with a higher probability than to a smooth one. Why is that? Because in the place of incisions of the endometrium increased blood supply. The embryo will choose this place for itself to better feed itself. The procedure is suggested to be done to all women who have gone to the step of artificial insemination.
Since the procedure is carried out according to the method of mechanical damage to the mucous membrane, there is a small chance of introducing the infection into the inner layer. In order to avoid this, anti-inflammatory and antibacterial drugs are prescribed immediately after scratching. It is recommended to do the procedure in a proven clinic with an experienced doctor who is aware of all the risks and knows how to avoid them. In this case, no complications will arise.
How often can the endometrium be scratched?
This procedure has no limitations. It can be carried out as long as necessary for successful fertilization.
Do you dream of a child, but you have had unsuccessful IVF attempts? Endometrial scratching is a procedure that doubles the likelihood of successful implantation during embryo transfer to the uterus. Moreover, the duration of the procedure itself is no more than a couple of minutes. For its implementation does not need complex training, the absence of pain allows the procedure without the use of anesthesia, thanks to the use of a thin catheter whose diameter does not exceed 3 mm, there is no need to expand the cervical canal. The procedure is carried out on an outpatient basis, immediately after the intervention, you can go home. In addition, after endometrial scratching, there is virtually no risk of complications. If you are only planning an examination, you can undergo comprehensive diagnostics in our clinic, the most modern equipment is available for patients. With us, the diagnosis of infertility ceases to be a sentence! The best methods of treatment have already helped hundreds of our patients, therefore, do not delay the opportunity to become a happy parent, make an appointment!
Head of the Department of Gynecology Lyubimova Elena Anatolyevna
Why is endometrial scratching in preparation for IVF better done at the Swiss University Hospital?
- We were one of the first in the country who began to carry out this procedure, on account of our gynecologists about 600 interventions performed, ending with the birth of a child with a previously diagnosed infertility.
- The specialists of our Center have tremendous experience in treating patients with gynecological pathologies, each specialist perfectly knows more than 100 methods of treatment according to his specialization.
- Our clinic is equipped with the most modern equipment that allows women to undergo examination and treatment according to the standards of European clinics.
- Each woman in our clinic can undergo the full range of diagnostic and treatment activities: from primary treatment to treatment - all in one place, own laboratories, operating rooms, equipped with expert class equipment and professionals, including well-known experts abroad, to the services of any patient.
How do endometrial scratching in preparation for IVF?
During the procedure, there is no need to expand the cervical canal, since the thinnest catheter is used, the diameter of which does not exceed 3 mm. Therefore, the procedure is painless, its duration is not more than two minutes. Inside the catheter there is a piston, which, after insertion into the uterine cavity, is drawn in half. Due to the negative pressure created, the particles of the endometrium are drawn into the inside of the catheter. At this point, the woman may feel a little discomfort, which quickly passes. At the end of the procedure, slight bleeding is possible, which also passes on its own. After manipulation, spasms may occur that go away on their own, however, they can be stopped easily with the help of drugs prescribed by the doctor. Immediately after the procedure, a woman can leave the clinic.
Are there any complications during endometrial scratching?
Theoretically, there is a slight risk of infection of the mucous membrane of the uterus in the presence of an inflammatory process in the cervical canal. Therefore, after the procedure, it is possible to prescribe antibacterial drugs. However, in our clinic, manipulation is carried out after a thorough examination of the woman, so the risk of complications is excluded.
Board Member AGE Arbeitsgemeinschaft Gynäkologische Endoskopie e.V. (Association for Gynecological Endoscopy) of the German Society of Gynecology and Obstetrics (DGGG), since 2009. Member of the Board of the European Society of Gynecological Surgery, responsible for international cooperation.
Head of the Department of Gynecology
Extensive practical experience in the surgical and conservative treatment of patients with different genital and extragenital pathologies. Owns many types of conservative and surgical treatment of patients with endometrial pathology, benign ovarian neoplasms, infertility, uterine myoma, endometriosis, and pelvic inflammatory diseases.
Owns hysteroscopy, separate diagnostic curettage, colposcopy, treatment of cervical pathology using radio wave technologies, ultrasound diagnostics. Over the years, she gained experience in managing pregnant women.
Ph.D. professor obstetrician-gynecologist, endosurgeon
Doctor of Medical Sciences,
Professor of the Department of Obstetrics, Gynecology and Reproductive Medicine FPK MR RUDN,
Head of the international scientific and clinical program and training courses in laparoscopy and hysteroscopy for doctors, master class
Head of the project of high technologies of the University group of clinics "I am healthy"
What should be the endometrium for IVF?
What should be the endometrium for IVF? The probability of successful implantation of the blastocyst in the uterus depends mainly on the function and thickness of the endometrium.
Qualitative changes (receptivity, the presence of pinopodia) can be determined only when performing a biopsy, which is done only by indications. But the change in thickness is easily monitored by ultrasound.
How much should endometrium be with IVF? Optimally - from 9 to 11 mm at the time of embryo transfer. If it is more than 14 or less than 8 mm, the chances of a successful IVF are significantly reduced. Endometrium 16 mm, as well as 6 mm, with a high degree of probability will lead to the failure of an in vitro fertilization attempt.
If a doctor sees an endometrium on ultrasound, the rate of which does not meet his expectations, embryo transfer is canceled.
How to improve the endometrium before IVF?
The preparation of the endometrium for IVF in the stimulated cycle is carried out in conjunction with the stimulation of superovulation. The drugs prescribed to the woman not only contribute to the maturation of the eggs, but also form the inner layer of the uterus.
When carrying out the procedure in the natural cycle, the endometrium for IVF can not be prepared at all. He himself grows to a normal thickness, if a woman has no dishormonal diseases. The doctor only tracks his growth by ultrasound.
In cryoprocoles on HRT, endometrial preparation is carried out with the help of drugs of esrogens (Proginova, Divigel) and progesterone (Utrozhestan).
Some patients are prescribed scratching of the endometrium, otherwise grooving. IVF in this case is more likely to end with the successful implantation of the embryo in the uterus with an increased thickness of the endometrium. The essence of the procedure consists in applying several incisions (scratches) on the endometrium. In the IVF protocol, scratching / grooving is carried out shortly before embryo transfer.
Endometrial pathology in IVF
The culprit failure in vitro fertilization can be a bad endometrium. IVF in this case is not carried out until the end of treatment of the disease, which has caused pathological changes in the inner layer of the uterus.
It may be observed too weak, or on the contrary, excessive growth of the endometrium. IVF with a high probability becomes ineffective in both cases, if not to take measures to restore the endometrium of the uterus. IVF is prescribed only after treatment and control of its effectiveness using instrumental methods of diagnosis.
Endometriosis, polyps, diffuse or focal hyperplasia of the endometrium can be the cause of excessive growth of the inner layer of the uterus, and IVF in this case is carried out only after hormonal treatment. There may be a need for surgery.
Endometrial hysteroscopy before IVF allows you to remove polyps, foci of internal endometriosis, but the fertilization procedure will have to be postponed until the end of the rehabilitation period, the restoration of the menstrual cycle and the structure of the inner layer of the uterus.
Endometrium before IVF may be on the contrary, too thin. This is a consequence of dyshormonal disorders, damage to the basal layer of the endometrium when performing medical manipulations (for example, surgical abortion), hypoplasia, or inflammatory diseases of the inner layer of the uterus, accompanied by atrophic processes.
How to prepare endometrium before IVF for pathology?
In the case of a pathological increase or decrease in the thickness of the endometrium, the disease is diagnosed, and then treatment is prescribed. Bacteriological examination of the endometrium, hysteroscopy and endometrial biopsy are used for the diagnosis. Before IVF, these methods allow you to identify the cause of the pathological process.
Endometrial biopsy before IVF can be performed simultaneously with hysteroscopy. If the doctor does not consider it necessary to prescribe an examination of the uterus with a hysteroscope, a pipel biopsy of the endometrium is performed before IVF.
This manipulation has only one goal - to take a piece of tissue for analysis (histology). Such a biopsy is performed in one minute. It is minimally invasive, and therefore does not require anesthesia.
Vitro Clinic patients are provided with a wide range of studies on the identification of endometrial pathology: from laboratory to instrumental.
After diagnosis, treatment is prescribed. In the event of infection, antibiotic therapy is carried out. For dyshormonal disorders, drug therapy is prescribed for several months. Endometriosis, intrauterine synechia, polyps may require surgical treatment. The scheme and timing of therapy depends on the identified disease and is monitored by a gynecologist.
In VitroKlinik Rachi, different types of endometrial pathology are treated, as a result of which natural conception or successful IVF programs are possible.
- What is needed for a successful IVF protocol?
- Why cancel embryo replanting?
- The quality of the embryo for transfer and timing
- What is window implantation?
- Current trends in successful embryo replanting
- Conditions required for successful IVF grafting
- What is good delayed transfer?
What is needed for a successful IVF protocol?
For successful embryo replanting 2 components are needed:
- receptive endometrium (hormonally active, able to “accept” the blastocyst),
- quality blastocyst.
At the same time, the embryo must not only correspond to the necessary quality classes, but be complete with respect to the chromosome set, which, unfortunately, is not always the same.
Why cancel embryo transfer?
In the absence of the quality of the two components listed above, the transfer becomes impractical. The lack of quality material for replanting or non-receptiveness (post-receptivity) of the endometrium. Reproductive scientists cancel the transfer of the embryo. In case of problems with the endometrium, the blastocysts are cryopreserved (frozen for storage), the endometrium is “prepared”, or the implantation window is waiting. Перенос осуществляют, когда слизистая матки становится готовой к принятию эмбриона.
Причины отмены переноса эмбрионов
Репродуктологи могут отменить перенос по следующим причинам:
- Ovarian hyperstimulation or OHSS. Getting more than 20 eggs at the puncture, the appearance of symptoms of OHSS: shortness of breath, swelling, an increase in the size of the abdomen are very serious reasons for the abolition of the transfer.
- Endometrial hyperplasia is a less common cause of withdrawal. What should be the endometrium for replanting the embryo? Its size should be 9-12 mm. The excess thickness of the endometrium more than 14 mm makes it lush, but it is not suitable for implantation. It does not have the ability to turn into a secretory endometrium - the implantation window will not open. An effective way to improve the endometrium before embryo replanting is to transfer the procedure over time using cryopreservation. In parallel, it is necessary to find out the cause and conduct treatment (therapeutic or surgical).
- Increasing the level of progesterone on the day of the appointment of an ovulation trigger (values higher than 10–20 nmol / l) reduces the likelihood of “synchronization” of the graft into an open implant window. The low level of progesterone allows physicians to “open” the implantation window themselves using the prescription of progesterone dosage forms. If it is high, it means that it is already open and in this cycle the grafting will not be successful.
- Common diseases (injuries, acute respiratory viral infections, etc.)
The quality of the embryo for transfer and timing
At the dawn of reproductive technology could carry a two-cell embryo. They don't do that now. The reproductologist must be sure that the fertilized egg is transformed into a quality blastocyst. Blastocyst implantation occurs in 70–80% of cases if all other conditions necessary for successful transfer are met. Transferring the embryo of the third day of cultivation, doctors can not guarantee at least some result. Transferring such an embryo, there is no certainty that it will continue to develop in the uterine cavity and reach the blastocyst stage (on which attachment to the uterus wall is possible).
A common example from the life: a woman on the 3rd day of cultivation had 10 embryos of excellent quality, and for 5 days only one remained, suitable for replanting.
Worst of all, planting embryos at the morula stage is the 4th day of cultivation. This day is critical for the embryo - the launch of its own genome occurs. Until this day, cell division occurs "in stocks" of the egg (by inertia), on the 4th day our own genetic information is launched. If there are no disorders in the chromosomes - the morula develops further, if there are “breakdowns”, then it slows down in development and dies.
What is window implantation?
Endometrium in IVF plays a major role in the success of the protocol. The implantation window is a period of up to 2 days, when the endometrium is receptive and is able to give an opportunity to adhere to the blastocyst.
During implantation, a biochemical “dialogue” takes place between the embryo and the endometrium. The blastocyst sends signals to pinopodia (micro-growths of the mucous membrane, which “attract” blastomeres) of the endometrium in the form of secretion of cytokines, growth factor, cyclooxygenase.
Current trends in successful embryo replanting
How to prepare for a successful IVF? You must follow 5 rules:
- Extended cultivation up to 5 days and, if necessary, conduct PGD - preimplantation diagnosis. PGD allows you to assess the quality of the genetic material and the numerical set of chromosomes of germ cells.
- Selective grafting of a single blastocyst. Choose one, the best embryo for replanting. The risks of multiple pregnancy with IVF are high and the patient may lose the long-awaited pregnancy in the middle of the gestation period.
- For transfer use soft, biologically inert (non-toxic) catheters incapable of harming the embryo. Catheters with such characteristics allow you to quickly and delicately place an embryo in the uterine cavity. Penetration into the uterus for the purpose of replanting occurs in 2 stages. The first - a hollow catheter, more rigid, the doctor passes the cervical canal. The second - a soft catheter, through the hole in the first catheter, the embryo is introduced along with the fluid for cultivation into the uterine cavity. This happens very smoothly, without sudden movements.
- Appointment of vaginal forms of progesterone to support implantation (before transplantation) and the post-implantation period of pregnancy. After puncture of the follicles, the doctor selects the dosage of progesterone. You can not replace or cancel his appointment on their own. This hormone contributes to the opening of the window of implantation and the success of embryo replanting depends on it. In addition, the drug has a tocolytic effect - the uterus relaxes.
- The use of low molecular weight forms of heparin for the prevention of thrombosis and the improvement of blood circulation in microvessels surrounding and feeding the embryo, starting from the moment of attachment. Patients with ovarian hyperstimulation, habitual infertility, increased blood clotting, heparin is prescribed in therapeutic doses.
What is good delayed transfer?
The otstopochennaya replanting provides cryopreservation in liquid nitrogen. Among the advantages of delayed transfers:
- severe forms of OHSS do not develop,
- children have a higher body weight, since the replanting is carried out on the "unstimulated" endometrium, the trophic abilities of the uterine mucosa are the same as in natural conditions.
When transplanted into the cryocycle, the effectiveness and probability of pregnancy are significantly higher.
Despite the fact that the procedure of scratching is quite simple, there are certain contraindications in which no doctor will take up work.
- Inflammatory processes in the fallopian tubes.
When a woman has inflammation in the fallopian tubes, adhesions are formed there that prevent normal functioning. Because of this, even with IVF, pregnancy will be difficult to occur.
If a woman has problems with the fallopian tubes, then she needs to undergo laparoscopy. This is a microsurgical procedure. From the bottom of the abdomen, small holes are made that do not exceed 5 millimeters. They introduce a special device that is able to show the whole picture of the fallopian tubes.
- Serious diseases of the heart and kidneys.
When there are diseases such as kidney failure, heart disease, it is impossible to bear a child, because during pregnancy the body has to work for two.
- Pathological processes in the uterus. Such processes may be congenital or acquired.
- Cancer of any type. If a woman has cancer, it does not even matter where it is located, most importantly, the generic activity in malignant tumors is prohibited.
- Diabetes mellitus in advanced stages. Since diabetes can harm not only the woman herself, but also the baby, pregnancy is undesirable.
- Mental illness. When a woman has mental abnormalities, it can be easily transmitted to the unborn child. Therefore, in this case, the IVF procedure and endometrial scratching will not be carried out.
In addition to the contraindications themselves, there are still restrictions under which pregnancy is not possible until they are eliminated. These include:
- Infectious diseases of the reproductive system. If a woman has a sexually transmitted disease, then when scratching the endometrium, even more infection is possible, which will only cause harm. This applies even to ordinary diseases not related to the reproductive system.
- Benign tumors. If the tumor can be removed, then after the recovery of the body, scratching is possible.
- Chronic diseases that are in the acute stage. When a woman has any incurable disease that needs to be maintained throughout her life, then she needs to transfer it from the acute stage to the remission stage, then screening is possible.
- Operations or injuries that occurred not long ago. After any injury or surgery, the woman needs to recover. Until that time, no doctor agrees to hold endometrial scratching, as the pregnancy will prevent the recovery of the body.
- Severe illnesses. If a woman has not yet started hepatitis or tuberculosis, with full recovery, she will still have a chance to become a mother.
Dates of this procedure. Scratching should not be done on any of the days. A specific day is selected on which the endometrial thickness will be standard for this procedure. If the endometrial layer is thin, then with IVF there will not be such effectiveness from scratching. In addition, the date of scratching and IVF should be as close as possible, otherwise the endometrium will have time to heal, and there will be no positive result. IVF is appointed no later than a week.
Equipment. Endometrium scratching is done with a special tube, with a piston inside. The diameter of the tube is quite small - no more than 3 millimeters. Because of this, it is not necessary to expand the channel before its introduction. That is why scratching is not a surgical procedure.
Anesthesia. This procedure is carried out painlessly, so no anesthesia or even local anesthesia is used. The only thing that a woman can feel is a periodical tingling. But such tingling cannot be compared, for example, with the pain from menstruation or other procedures.
If a woman is sensitive enough, then she needs to take an anesthetic pill, then she will not feel anything at all. After this procedure, occasionally abdominal cramps may occur, but they are not particularly noticeable.
Endometrial scratching technique. First of all, the woman is treated the cervix with a special antiseptic. This is necessary in order to destroy the bacteria. After that, a small tube is inserted into the cervical canal.
From this tube, a special piston is released by half, which will scratch the endometrial layer. The incisions are microscopic, but this is already enough for successful IVF. After the procedure, the woman appears small bloody discharge. However, they last no more than two days. Such secretions arise from wounds that form on the endometrium. A woman should not be afraid of them.
Preparation for the procedure. It is not necessary to prepare for this procedure, it is only necessary to undermine thoroughly, so that there is no accumulation of microbes. Everything else is decided by the doctor.
After this procedure, the blood flow from the endometrium increases significantly, thereby attracting the egg of the child. It is fixed precisely in the place where it feels the most blood circulation, it means that in that place there will be an optimal diet for it.
In order not to catch the infection after this procedure, you must follow simple rules.
- Regular hygiene. It is necessary to wash even more often than usual. For such purposes it is better to choose a special tool that does not harm the microflora.
Temperature mode. Immediately after scratching the endometrium, a woman should not sit on a cold one or overheat on the contrary, as this can cause inflammation. After the procedure, you can not go to the bath and take a hot bath.
- Non-admission of infectious diseases of the whole organism. A woman should ensure that she does not get sick. Otherwise, the infection will be able to get into the affected endometrium through the bloodstream. To do this, you need to eat right, to ensure that there is enough vitamins in the diet. If the immune system is weak, then it is worth drinking a course of immunostimulants.
- The use of gaskets. If after the scratching bleeding, then in no case can not use tampons, as they, filled with blood, begin to multiply in themselves bacteria that can easily get into the uterus and cause inflammation there. Discharges of this type are generally insignificant, so a woman can use a simple daily panty liner.
Endometrial scratching before IVF is a saving chance for many women who cannot get pregnant. If during normal IVF pregnancy does not even occur in half of the cases, then scratching allows you to increase this number by more than half.
A woman should not be afraid of this procedure, since she is not at all terrible and painless. Most feedback on the method is positive. Endometrial grating is not a surgical procedure, it does not have a large number of contraindications, and also causes almost no complications. The most important thing in this case is to find a qualified doctor who can really help.
Endometrial scratching and causes
In English, scratching means "scratch". This is a simple, safe, painless procedure on the endometrial layer, which increases the likelihood of pregnancy during IVF 2 times. Used by many leading clinics in the world.
The indication for scratching is the presence of several unsuccessful attempts to get pregnant after IVF. To secure the embryo in the uterus, it is necessary to ensure a sufficient level of hormones, the appropriate condition of the endometrium for conception. This method allows you to achieve the desired result.
It is possible to carry out scratching without special training, on an outpatient basis. After receiving the instructions of a specialist woman goes home. There are no restrictions on the procedure in the absence of contraindications. In case of unsuccessful implantation, it is not prohibited to resort to the method again. The day of the cycle is selected individually by the doctor (approximately 14 days before fertilization).
Impact on IVF results
The reasons for unsuccessful implantation after artificial insemination are insufficient preparation of the mucous membrane, an imbalance of hormones. Damage to the sexual organ causes the body to produce hormones that are necessary for tissue repair. The uterus becomes covered with mucus, the viscosity increases, the thickness of the upper layer increases, the probability of successful attachment of the embryo increases.
According to experts, the probability of pregnancy increases by 2 times, but no one can give a 100% guarantee. Side effects with proper carrying out the procedure is not observed.
Theoretically, the development of inflammation as a result of infection. In order to prevent such a situation, a course of antibacterial drugs is prescribed for several days. Pre-conduct a thorough examination of women.
How is the endometrium prepared?
If IVF is performed on the background of a woman’s natural menstrual cycle, then no special preparation of the uterine mucosa is required. Experts simply assess the state of the functional layer, its thickness and other characteristics, without taking any measures.
But more often the preparation of the endometrium is carried out in parallel with the stimulation of the ovaries to ovogenesis (the formation of an egg). A woman takes hormonal drugs that contribute to its growth. The optimum thickness at the time of artificial insemination is from nine to eleven millimeters. It is determined in the process of ultrasound. Deviation in any direction adversely affects the prediction of manipulation.
Slow increase in thickness may be associated with certain uterine pathologies, previous surgical interventions (in particular, curettage, medical abortions), as well as the ineffectiveness of the prescribed hormonal therapy. The rapid increase in thickness may indicate the presence of pathologies such as endometriosis, endometrial hyperplasia, polyposis. In any case, repeated preparation for IVF with a deviation of the endometrial thickness from the recommended limits is carried out only after a thorough examination and treatment of the identified pathology.
How to increase the chances of success?
Modern studies show that the probability of successful attachment of a fertilized egg increases markedly if a simple procedure, such as endometrial scratching, is performed prior to the upcoming implantation.
Such a term is called medical manipulation, which consists in the fact that with the help of a special device, resembling a syringe with a very thin body, small notches (usually four) are applied to the inner layer of the uterine wall. Intentional damage to the mucous membrane stimulates it, activates the processes of reparation and the release of hormones, so that the fertilized egg is easier to engraft and less often rejected from the uterine wall.
Scratching does not require any preparation, the optimal day for it is determined by the doctor who directs the process of preparing a woman for IVF. It is performed on an outpatient basis, is not accompanied by discomfort or discomfort, does not require anesthesia. But by “waking up” the uterus mucosa with his help, the doctor significantly increases the likelihood that fertilization will be successful.