Another new technique to increase IVF success

I was on Sky News with Allan Pacey of the British Fertility Society this morning discussing endometrial scratching. It’s a technique that has been used in some UK fertility clinics for a while now, and involves scratching the lining of the womb before embryos are put back during an IVF or ICSI cycle. At the moment, it is most often used when women have good quality embryos but treatment hasn’t worked, and it seems to improve implantation,

Today’s story was based on a paper being delivered at a conference called the World Conference on Ultrasound in Obstetrics and Gynaecology by researchers from Nottingham and Brazil which found a large increase in IVF and ICSI success using the technique. It is a promising study, but what we don’t yet know is whether this could be replicated on a larger scale with a wider group of patients.  The average age of the patients in the study appears to be 32, which is an age at which IVF/ICSI  is more likely to be successful – and at which egg quality is likely to be better.

Of course, any steps to further increase IVF success should be welcomed, but being invited to discuss the study on Sky News today, all I could think about was how difficult it is to be a patient facing endless headlines about new research or new techniques which are about to revolutionise the world of assisted conception.  As I’ve said here before, there’s often a big gap between research and reality.  In this case, that’s not quite the case as endometrial scratching is already being offered in the UK – but it’s how and when it is offered that is so crucial.

I did a completely unscientific trawl of clinic websites this morning, and discovered that most were offering it when treatment had been unsuccessful – but the price ranges were fascinating.  We’re being told that this is an inexpensive procedure and one clinic was performing it at no extra charge at all (during an IVF/ICSI/FET cycle where the embryos were good quality but two previous cycles had been unsuccessful), most were charging around the £100 rate and I found one billing patients just shy of £400.

It’s embryo quality which is the other sticking point here. It seems that this technique has a lot to recommend it where there are good embryos, but in women whose fertility is affected by their egg quality (which is predominantly older women) this process may not make the same sort of difference.

So, in conclusion – yes, do ask your consultant about endometrial scratching but do be guided by his or her views on this. It’s a technique which may help many women, but which may have less to offer to others.  And, as always, more research is needed…




Anyone going through fertility treatment wants to maximise their chances of success, and you may have heard that opting for ICSI will mean you are more likely to end up with a baby whatever the nature of your fertility problems.  In fact, ICSI is a treatment for male fertility problems which is also used when IVF hasn’t worked in the past because eggs haven’t fertilised.  When it is used in these circumstances, it can increase the chances of success.  There is, however, no benefit from using ICSI for those who don’t actually need it.

 I’ve just been reading a really interesting paper on this in the journal Human Fertility which looked how fertility clinics in the UK approach ICSI and found wide discrepancies with some clinics using it for around 20% of their IVF cycles and others using it in more than 80% of IVF cycles.  The criteria they used to decide when to use ICSI also varied, with many offering it for sperm that would be considered perfectly normal and letting patients to choose whether they wanted IVF or ICSI regardless of the nature of their fertility problems.

 You may feel that it’s up to you to have that choice, but patients aren’t always presented with clear evidence about what ICSI can and cannot do.  Research shows that using ICSI when you have normal sperm doesn’t increase success rates, and in fact there is even some suggestion that it could lead to a reduced chance of success.  ICSI is more expensive and there have been questions raised about the potential risks of the technique.

 For men with fertility problems, ICSI has been a hugely important development allowing many couples to have the children they long for – but it’s not something that should be undertaken as some kind of optional add-on,  If you don’t need ICSI, why pay more money for something which could carry more risk and which will not increase your chances of a successful outcome?  It’s time fertility clinics started spelling this out more clearly to their patients…