Endometrial biopsy

My new RE is really into this idea that an endometrial biopsy somehow helps the uterus prepare better for receiving the blastocyst. There really doesn't seem to be much analytical data about why this works. Really it seems mostly anecdotal. I did find a recent article attempting to explain this phenemenon.

Am J Reprod Immunol. 2010 Jan;63(1):17-21.

Inflammation and implantation.

Dekel N, Gnainsky Y, Granot I, Mor G.

Department of Biological Regulation, the Weizmann Institute, Rehovot, Israel.

Approximately half of all human embryo implantations result in failed pregnancy. Multiple factors may contribute to this failure, including genetic or metabolic abnormalities of the embryo. However, many of these spontaneous early abortion cases are attributed to poor uterine receptivity. Furthermore, although many fertility disorders have been overcome by a variety of assisted reproductive techniques, implantation remains the rate-limiting step for the success of the in vitro fertilization (IVF) treatments. It has been demonstrated that endometrial biopsies performed either during the spontaneous, preceding cycle, or during the IVF cycle itself, significantly improve the rate of implantation, clinical pregnancies and live births. These observations suggest that mechanical injury of the endometrium may enhance uterine receptivity by provoking the immune system to generate an inflammatory reaction. In strong support of this idea, we recently found that dendritic cells (DCs), an important cellular component of the innate immune system, play a critical role in successful implantation in a mouse model. In this review, we discuss the hypothesis that the injury-derived inflammation in the biopsy-treated patients generates a focus for uterine DCs accumulation that, in turn, enhances the endometrial expression of essential molecules, which facilitate the interaction between the embryo and the uterine epithelium.

I find it hard to believe that dendritic cells are responsible for the success of this procedure but nonetheless my doctor has decided that this is the best mode of action. Why has the doctor decided this. Well, it turns out that I am incapable of making a thick lining. Only 7.5 mm. In the failed fresh DE cycle, I had implantation but likely lost two embryos 4 days after by 370HCG. Any way, we didn't do a mock cycle because we assumed that the other clinic would have commented or done something special if my lining was thin.

In January we started an FET cycle. Dr. L was not happy with the thickness of my lining using oral, vaginal and transdermal estradiol. Then I went a week doing twice a week injectable estradiol. Still the lining was wimpy so it was converted to a mock cycle with vaginal progesterone and endometrial biopsy.

The biopsy was a little bit of a fiasco. It turns out that I have a tricky cervix. For the fresh embyro transfer Dr. L put a stitch into my cervix so he could tug on it to straighten it out. Dr L was not available for my biopsy so his partner did it. There seemed to be some issues because he kept leaving the room to get additional equipment. Seriously, he left the room three times after his first attempt. There I was, my legs up in the stirrups and speculum in place. The biopsy itself was also somewhat crampy and bloody. Not too bad, and it went away after a few minutes.

So here I am going through the FET cycle for real this time. I have to do injectable estradiol, but it is only twice a week. I go in on Tuesday to find out the lining thickness. Today I found out that my biopsy was completely normal and in phase. Which in my mind kind of sucks because there is nothing that can be done to improve it, but the nurse seemed to think that it was a good thing. We shall see.