Improving Implantation: The Endometrial Tickle

Sometimes you learn things about your friends, co-workers and mentors that you really would prefer not to know. Years ago when I was a Stanford Ob Gyn resident we were sitting around the lounge on Labor and Delivery and chatting about my decision to specialize in Reproductive Endocrinology. The discussion turned to the subject of the endometrium and implantation (yup, we were a totally out of control group of docs...just like on Gray's Anatomy..). One of the faculty members volunteered that she had conceived with an "endometrial tickle." I did a double take. What in the world was an "endometrial tickle" and did I seriously want to find out. Clearly we were traveling into the TMI zone here....

But how could I not ask? Well turns out that the endometrial tickle was not as disturbing a concept as I feared. On the day of an LH surge she had popped into the clinic where an RE doc had basically done a mock IUI/cervical check/mock ET with an empty catheter. In mice you can apparently generate a false pregnancy by doing something similar and the thought was that by scratching the endometrium the odds of implantation following a bit of romance would be enhanced even though she was not a rodent. Yikes. Talk about learning a bit too much about friends and faculty.

Fast forward to 2013. Amazingly enough this concept of the endometrial tickle has resurfaced in the form of enhancing implantation in IVF cycles by performing an endometrial biopsy in the cycle prior to an IVF attempt. The mechanism by which doing an endometrial biopsy weeks prior to embryo transfer and with an intervening menstrual cycle is elusive to say the least. We don't know the ideal timing, the mechanism, the duration of the effect or the degree of improvement in implantation. But besides that, we totally believe that it works.... Actually, I really don't know how to interpret the studies that have looked at this issue. So in general, if one of my patients fails to conceive after one or two ETs with good embryos then I usually suggest we consider performing an endometrial biopsy. Anyone who as had an endometrial biopsy knows that I would risk being beaten to death by my patients if I dared to call that procedure an "endometrial tickle" but still makes me wonder if the concept is similar....