Let's talk about endometrial biopsies. Otherwise known as a "scratch".
Let's talk first about WHY we get an endometrial biopsy when having fertility treatments. It's certainly not a necessary procedure for any given IVF/ART round but there are studies that show having an endometrial biopsy prior to transfer increases the chances of embryo implantation in some people. It's arguable as to how much it increases the chances, and for which patients it has the most impact, but there are some really promising studies out there that I will reference below. For some people it is likely to have minimal or no impact. For others (like me), every time I had an endometrial biopsy (or uterine surgery, which mimics the "roughing up" of the endometrial lining) it did actually work and I fell pregnant that round (spoiler alert: they weren't all successful pregnancies). It's a cheap addition to the list of tools that increase the chance of implantation, so personally I would recommend asking your doctor about it.
Now, let's talk about the procedure. The first time I had it done, I was facing round three and rounds one and two were completely unsuccessful for me. The doctor explained that an endometrial biopsy increased the chances, and she said it was about as uncomfortable as a pap smear and didn't add any cost. She was willing to do it then and there (the round would start at my next period) so I popped up on her table and she began.
Now I hear from many other people that for the most part that this is a painless (or at the most mildly uncomfortable) procedure as she stated. It started out normal, like a pap smear, speculum thingie to open things up, not exactly pleasant but not painful, then when the biopsy started the pain was very high for me. 8 out of 10. Luckily it only lasted maybe 2 minutes maximum and it resulted in a pregnancy for me that unfortunately ended at 10 weeks.
The next "scratch" I had was for round 5, I asked to be medicated for it. When I got into the theatre they explained that it would take longer and probably be more uncomfortable to administer the medication than to just go ahead and do the biopsy. They said that the last round was probably a one-off and that this biopsy wouldn't hurt, so I gave consent to go ahead. It was just as painful. That round resulted in a successful pregnancy for me.
Round 6, I decided not to do it again. I did fall pregnant that round, but lost it quite early.
Cut to round 7, the final round. This round. It's the final round. I've got to give it everything, right? So back for another biopsy I go. This time I'm making sure I'm medicated. They book me in and they offer me Valium and Nurofen Plus. I make sure to repeat it to every staff member I see on the way in. The drug lady comes and asks me if I REALLY want the drugs. "YES, THANKS LADY! WHAT ELSE YOU GOT IN THAT CUPBOARD?"
Here's a cute shot of my toes waiting for the valium to kick in which I'm not sure it ever did, it felt more like two glasses of wine than a hit of LSD - I was really hoping for unicorns and rainbows so I felt slightly ripped off.
Long story short, it was about as uncomfortable as a pap smear. :) One of the nurses said she thought it was because I had given birth - that lots of women's experience of a biopsy changed after childbirth and were no longer painful.
The drug lady popped back afterwards, squeezed my hand and winked at me. I think I love her.
Endometrial Biopsy Studies:
https://www.ncbi.nlm.nih.gov/pubmed/25561347 "it may improve live birth in women with two or more previous IVF failures."
https://www.sciencedaily.com/releases/2016/07/160704082720.htm "Endometrial scratch appears beneficial in couples trying to conceive"