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Endometrial receptivity and endometrial scratching Melbourne


Successful implantation requires a receptive endometrium, a normal and functional embryo at the blastocyst development stage (define) and syncronised dialoge between maternal and embryonic tissues.

The implantation process may be classifid into three stages:

  • Apposition – Trophoblast cells adhere to the receptive endometrial epithelium.
  • Adhesion – At this stage the embryo-endometrial linkage can no longer be dislocated by uterine flushing
  • Penetration – Phenomenon can only occur during a self-limited period spanning days 20 and 24 of a regular menstrual cycle (also know as the window of implantation)

A closer look inside the uterus and investigation of these factors can and will assist in improving implantation, thus increasing pregnancy rates in IVF.

Implantation (the attachment of the embryo to the uterus) can be the limiting factor in achievement of a pregnancy for most couples.  The endometriums (define) sole purpose is to enable implantation of an embryo.  This implantation requires a receptive endometrium.  We can now seek to learn through ultrasound, a hysteroscopy and endometrial biopsy factors that may cause a defective endometrium.  A defective endometrium can be caused by:

  • Uterine polyps
  • PCOS
  • Septa (define)
  • Leiomyomata
  • Adhesions
  • A thin endometrium
  • Endometriosis
  • Hydrosalpinx

In women with unexplained implantation failure, despite good hormonal response, good quality embryos, satisfactory endometrial development and no identifiable pathology, suboptimal endometrial receptivity is considered a key factor in inhibiting embryo implantation.  Inadequate uterine receptivity is responsible for approximately twothirds (2/3) of implantation failures, whereas the embryo itself is responsible for only one third (1/3) of these failures.

New research and evidence suggests that scratching the uterine lining causes a ‘repair reaction’ which may increase embryo implantation rates and improve IVF outcome: the repair process releases growth factors, hormones and chemicals. The new lining which grows after the procedure is thought to be more receptive to an implanting embryo and so increases the chances of pregnancy
‘gene switching’ – scientists believe that the genes which are responsible for implantation of embryos are sometimes not ‘switched on’ during the time when embryos are supposed to implant. Endometrial scratching may ‘switch on’ the genes that are responsible for preparation of the endometrium for implantation, which increases the chances of pregnancy
Dr Barak performs endometrial receptivity assessment and endometrial scratching in his Melbourne IVF clinic