It’s never easy to reverse a long held opinion. But in order to keep improving what we do, we must be open-minded to change. I remind myself of this perspective whenever I encounter a new study that contradicts a long held belief. Recently, I started reconsidering my skepticism on “scratching” or taking an endometrial biopsy in order to better prepare a woman’s uterus for embryo implantation.
The way I was trained, it was imperative that we perform an embryo transfer without causing any trauma to the endometrial lining. Oftentimes we worked through difficult transfers in order to minimize the risk of getting a spot of blood on the catheter as it was felt to be an ominous sign. Blood on the catheter tip was believed to reduce the chance for successful implantation. Recent studies suggest that in some cases the opposite may be true. Let’s first consider the theory behind this potential benefit.
Following any damage to the endometrial lining, chemicals called cytokines are released which promote healing of the injury. This healing process promotes what is called decidualization which also encourages implantation. Decidualization can also help slow the changes that are occurring in the endometrium—another benefit since the hormone levels associated with IVF can accelerate endometrial growth and therefore make the uterine lining out of synch with the actual embryo development. Whether some or all of these changes are responsible there have been a few studies now that have looked at the impact that inducing an endometrial injury can have upon embryo implantation.
A recent review [r1] of the five published studies on the effects of performing an endometrial biopsy prior to or during and IVF cycle was even more revealing. They found that four of these studies demonstrated that endometrial biopsy significantly improved implantation—suggesting that in some patients it may even double success rates. They also found that the timing of the biopsy was critical. In the one study[r2] that involved performing the biopsy on the day of the egg retrieval, they found a dramatic reduction in the implantation and on-going pregnancy rate; an observation that validates my previous doubts about “scratching” the endometrium. So before you request this treatment consider the following:
- Discuss with your doctor whether you may have had an implantation problem or if your previous unsuccessful cycles were due to poor embryo quality.
- Request this procedure be performed before the menstrual cycle of the month you wish to proceed with IVF (prior to starting ovarian stimulation meds)
- Endometrial biopsy can be uncomfortable so consider the use of an anti-inflammatory about an hour or so before your procedure
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at firstname.lastname@example.org
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