Endometrial scratch
A fertility 'add-on' in which a thin tube is used to gently scratch the womb lining before IVF, in the hope of helping an embryo implant — though the evidence that it improves the chance of a baby is unclear.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- An endometrial scratch uses a thin tube to scratch the womb lining before IVF, in the hope of helping an embryo implant.
- NICE, the NHS clinical guidance body, recommends that endometrial scratching should not be offered as a pre-treatment to improve IVF outcomes, because it has not been shown to improve the chance of having a baby.
- The HFEA (fertility regulator) separately rates the study evidence amber for most IVF/ICSI patients (conflicting) and grey for repeated implantation failure (not enough good evidence); this does not override the NICE advice not to offer it.
- Unlike lab-based add-ons, it is a procedure on you: it can be uncomfortable or painful, can cause bleeding, and has a small infection risk.
- You should not be pressured into it or charged for it as if it were proven. Ask why it is being offered for you and check the HFEA add-ons ratings.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
In theory, may make the womb lining more receptive to an embryo — but this benefit is not clearly proven.
Anyone who could already be pregnant in that cycle, as a scratch should not then be done.
You may feel cramping like period pain; tell the clinician if it is severe so they can pause or help.
Clear advice on pain relief and what bleeding is normal.
You may feel cramping like period pain; tell the clinician if it is severe so they can pause or help.
Cramping usually eases; light bleeding or spotting is common. Simple painkillers can help if needed.
Any spotting and cramping usually settle. You can normally return to your usual activities.
The scratch is done before or early in your treatment plan; the outcome is your IVF cycle's outcome.
What is an endometrial scratch?
An endometrial scratch is a small procedure in which a clinician passes a thin, soft tube through the neck of the womb and gently scratches the lining of the womb (the endometrium), usually in the month before an IVF or ICSI cycle.
The idea is that this small, deliberate injury triggers a healing response that releases chemicals which might make the lining more receptive to an embryo, helping it implant.
It is offered as a treatment add-on, but the UK clinical guidance is clear. NICE (the body that advises the NHS on best care) recommends that endometrial scratching should not be offered as a pre-treatment to try to improve the outcome of IVF, because good-quality evidence has not shown that it improves the chance of having a baby. Separately, the HFEA (the UK fertility regulator) rates the research evidence amber for most people having IVF or ICSI, meaning the results of studies are conflicting, and grey for people who have had repeated failed embryo transfers (recurrent implantation failure), meaning there is not enough good evidence to judge whether it helps that group. Neither HFEA rating changes the NICE advice not to offer it to improve IVF outcomes.
Unlike most other add-ons, this one is an actual procedure on you. It can be uncomfortable or painful, can cause some bleeding, and carries a small risk of infection.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Pipelle-type scratch
A thin, flexible plastic tube (similar to one used for a womb-lining biopsy) is used to scratch the lining. The most common method.
Timing in the cycle
Often done in the cycle before the IVF/ICSI cycle, sometimes in the second half of the cycle. Your clinic will explain the timing they use and why.
For most IVF/ICSI patients
Sometimes offered to try to improve implantation, but NICE advises it should not be offered to improve IVF outcomes, and the HFEA rates the study evidence amber because it is...
For recurrent implantation failure
Sometimes offered after repeated failed transfers, but the HFEA rates the evidence grey because there is not enough good evidence for this group specifically, and NICE does...
Preparing for your treatment
- Ask why an endometrial scratch is being recommended for you and what evidence supports it.
- Ask why it is being recommended for you given that NICE advises endometrial scratching should not be offered to improve IVF outcomes; you can also ask to see the HFEA traffic-light rating (amber for most patients, grey for recurrent implantation failure).
- Ask about pain relief options, as the procedure can be uncomfortable or painful; consider taking simple painkillers beforehand if advised.
- Tell your clinician if you might be pregnant, as a scratch should not be done in a cycle where you could already have conceived.
- Mention any history of pelvic infection or unusual discharge, as infection should be excluded first.
- Ask whether there is an extra charge, and whether that money might be better spent on standard treatment.
- Arrange to take it easy for a short while afterwards if you wish.
What happens
An endometrial scratch is usually done in an outpatient clinic and takes only a few minutes. You lie on a couch as you would for a smear test, and the clinician gently passes a speculum and then a thin, soft tube through the neck of the womb.
The tube is used to lightly scratch the lining of the womb. You may feel cramping similar to period pain, and some people find it more painful than that. There is no anaesthetic for a standard scratch, though simple painkillers can help.
Afterwards you can usually go straight home. Some light bleeding or spotting and some cramping for a short time are common.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Anyone who could already be pregnant in that cycle, as a scratch should not then be done.
- People with an active or untreated pelvic or cervical infection, until it is treated.
- Patients for whom the discomfort and small risk outweigh an unclear, unproven benefit.
- Those being offered it automatically rather than for a clear, discussed reason.
Delay or rearrange if…
- There is a possibility you are already pregnant this cycle.
- You have signs of infection, unusual discharge or untreated pelvic infection.
- You have not had a clear explanation of the evidence, the pain and any charge.
- You feel pressured rather than fully informed.
Alternatives to discuss
- Standard IVF or ICSI without an endometrial scratch.
- Investigating and treating specific, identified causes of implantation failure where present.
- Spending resources on further standard treatment cycles rather than an add-on.
- No treatment, after discussion and counselling.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- In theory, may make the womb lining more receptive to an embryo — but this benefit is not clearly proven.
- Some patients and clinicians feel it is worth trying after repeated failed transfers, though the evidence for that group is weak.
- It is a short, outpatient procedure that does not usually require time off.
- It does not involve anaesthetic or hospital admission.
Risks & complications
- Cramping like period pain during and shortly after the procedure
- Light bleeding or spotting afterwards
- Discomfort or pain, which some people find significant
- Paying for, or going through, a procedure whose benefit is unclear
- More pain than expected, or feeling faint during the procedure
- Heavier or more prolonged bleeding
- Difficulty passing the tube, so the procedure cannot be completed
- Pelvic infection, more likely if there is an undetected infection beforehand
- Injury to the womb (perforation), which is rare
This is one of the few fertility add-ons that is a procedure on you, so it is 'intrusive and potentially painful', with some blood loss and a small risk of infection (higher if there is an undetected cervical infection). Because NICE advises it should not be offered to improve IVF outcomes, and good evidence that it improves the chance of a baby is lacking, weigh that real discomfort and small risk against a benefit that has not been proven. Ask your clinician about pain relief, infection checks, and what the evidence is for your situation.
Published figures to discuss
Reliable numbers are limited because studies define the procedure and patient groups differently, and the headline evidence is uncertainty about benefit rather than a precise complication rate. The main risks (pain, light bleeding, small infection risk) are best discussed in plain terms rather than as misleading percentages.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Proven improvement in live birth | Not established; NICE advises against offering it to improve IVF outcomes | NICE recommends endometrial scratching is not offered as a pre-treatment to improve IVF outcomes, and the HFEA lists it among add-ons with limited evidence; it should not be sold as a reliable implantation booster. | NICE NG257 — Fertility problems (procedures used during IVF)nice.org.ukSource-linked context |
| Pain or cramping | Common during or shortly after the procedure | Patients should be told what analgesia is reasonable and when pain is not normal. | Guide sourcesClinical context |
| Bleeding or spotting | Common and usually light | Heavy bleeding, fever or offensive discharge should prompt review. | HFEA — Endometrial scratching (rating and evidence)hfea.gov.ukSource-linked context |
| Infection | Uncommon | Risk is low but relevant, especially if there are symptoms of pelvic infection or the procedure is timed poorly. | HFEA — Endometrial scratching (rating and evidence)hfea.gov.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery is usually quick. Most people have some cramping and light bleeding for a short time and can carry on with normal activities, though you may prefer to take it easy for the rest of the day.
- Period-like cramping during and shortly after the procedure
- Light bleeding or spotting for a short time
- Feeling a little tender or tired afterwards
- No lasting change in how you feel after a day or two
Aftercare
- Use simple painkillers such as paracetamol if you have cramping, as advised.
- Use sanitary pads rather than tampons for any light bleeding.
- Contact the clinic if bleeding is heavy, pain is severe, or you develop a fever or smelly discharge.
- Avoid assuming the scratch has 'worked' or 'failed' — it does not give a result of its own.
- Keep a written note of when it was done and any charge.
- Ask what the plan is if the IVF cycle does not lead to a pregnancy.
- Simple painkillers at home for cramping
- Sanitary pads for any light bleeding
- Written reason the scratch was recommended for you
- Confirmation of any extra charge before you agree
- The clinic's contact number for pain, bleeding or fever
- Understanding that the scratch gives no result of its own
⚠ Get urgent help if…
- Heavy vaginal bleeding (soaking pads) after the procedure
- Severe or worsening lower abdominal pain
- Fever, chills or a smelly vaginal discharge (possible infection)
- Feeling faint or very unwell after the procedure
- Severe one-sided pain, shoulder-tip pain or feeling faint in early pregnancy (possible ectopic) — seek urgent help
- Severe abdominal pain, bloating or breathlessness after egg collection (possible OHSS) — seek urgent advice
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
An endometrial scratch does not produce a result of its own. The result that matters is whether your IVF or ICSI cycle leads to a pregnancy, which depends mainly on factors such as age, egg and sperm quality and the embryo. A good clinic will be honest that NICE advises against offering the scratch to improve IVF outcomes and that it has not been shown to improve your chance of a baby, and will not present it as a proven step.
Related tests, treatments or support
An endometrial scratch is done as part of an IVF or ICSI treatment plan. It should not be bundled together with other unproven add-ons as a matter of routine; each add-on should be justified separately on its own evidence and weighed against its discomfort and small risks.
Follow-up & long-term care
Follow-up is part of your IVF or ICSI cycle: the scratch itself does not need a separate review unless you have heavy bleeding, severe pain or signs of infection. After the cycle, your clinic should discuss the outcome and the plan if it was not successful.
Repeat, follow-on and what comes next
- The scratch does not change the chance that an IVF cycle may fail and need repeating.
- If a cycle is unsuccessful, the decision is about the whole treatment plan, not the scratch alone.
- Occasionally the procedure cannot be completed and may be reattempted or abandoned.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear advice on pain relief and what bleeding is normal.
- A named contact and clear instructions for heavy bleeding, severe pain or signs of infection.
- Honesty that the scratch gives no result of its own and benefit is unclear.
- A plan for the IVF cycle and for the situation where it is unsuccessful.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the clinic charges separately for the procedure or includes it in a package
- The cost of the IVF or ICSI cycle it is added to
- Whether it is done in a standard clinic appointment
- Any pre-procedure checks, such as a swab to exclude infection
- Follow-up if there is bleeding, pain or a suspected infection
- Whether the scratch is an extra charge and how much
- The evidence the clinic relies on for offering it to you
- Whether pain relief and any infection check are included
- What the underlying IVF/ICSI cycle costs
- What happens, and what is charged, if the procedure cannot be completed
- Cancellation policy and what is refunded if the cycle stops early
On the NHS? An endometrial scratch is not routinely funded by the NHS or HSC as a proven treatment, and is usually offered privately as an add-on. NHS/HSC fertility funding and eligibility rules differ across England, Scotland, Wales and Northern Ireland and can change, so ask the relevant NHS/HSC fertility commissioner or your clinic to confirm what is currently funded where you live.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Presenting an unproven add-on as a routine or proven step.
- Not warning that it can be uncomfortable or painful, with bleeding and a small infection risk.
- Not excluding infection or pregnancy before the procedure.
- Charging extra without discussing the unclear evidence and better-value alternatives.
Marketing red flags
- Claiming the scratch reliably 'boosts implantation' as if proven.
- Targeting people after failed cycles with strong claims despite weak evidence.
- Describing it as 'quick and usually not painful' without honest discussion of discomfort.
- Not mentioning that NICE advises against offering it to improve IVF outcomes, or the HFEA amber/grey rating.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Why are you recommending an endometrial scratch for me specifically?
- What is the HFEA traffic-light rating for my situation, and what evidence supports it?
- What pain relief can I have, and what should I do if it is very painful?
- How will you make sure I do not have an infection beforehand?
- Is there an extra charge, and would that money be better spent on standard treatment?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does an endometrial scratch improve my chance of having a baby?
Does it hurt?
Is it risky?
Is it available on the NHS?
Should I pay extra for it?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: HFEA — Endometrial scratching (rating and evidence) HFEA — Treatment add-ons and the traffic-light system HFEA — Improved ratings for fertility treatment add-ons (2023) NICE NG257 — Fertility problems (procedures used during IVF) NICE NG257 — Fertility problems: assessment and treatment NICE NG257 — Access criteria for IVF NHS inform — Infertility and fertility access (Scotland) NHS Wales — Specialist fertility services commissioning policy (CP38) Regional Fertility Centre, Belfast (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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