Abstract: The process of implantation in humans involves a complex interaction between the embryo and the endometrium, very similar to the case of the seed and the soil. Both the quality of the embryo （seed） and the endometrium （soil） are important determinants of successful implantation. There are many studies on how to select good quality embryos to improve implantation rate but relatively few ones on how to assess and improve endometrial quality. This review focuses on the endometrium, including the available methods used to assess the endometrium and strategies to improve the endometrium to achieve a higher implantation rate. Specifically, the role of endometrial scratch, a novel treatment recently introduced to improve the implantation and pregnancy rate in women who previously had recurrent IVF failure will be discussed. Finally, recommendations on how to protect or avoid inadvertent damage to the endometrium during various gynaecology procedures will also be discussed.

Key words: Embryo implantation, Endometrium, Fertilization in vitro, Dilatation and curettage, Pregnancy outcome