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ENDOMETRIAL BIOPSY
What is Endometrial Biopsy?
Endometrial Biopsy or TB-PCR as it is normally known by many is a procedure performed by an IVF Specialist on an out patient basis.
During the Endometrial biopsy a biopsy canula is inserted by an IVF doctor into the uterus transvaginally and a small piece of endometrium is scraped out for from the lining of the womb.
The scrapped tissue is checked under microscope by a pathologist and further evaluated with laboratory techniques such as PCR if required.
Why is endometrial biopsy performed by an IVF specialist ?
The endometrial biopsy is ordered by the IVF specialist during a fertility work-up for two main purposes:
- Presence of infections like genital tuberculosis as a cause of Infertility (Known as Endometrial biopsy for TB PCR). Nowadays routinely offered to patients with Unexplained Infertility or as a part of Hysterolaparoscopy.
- To confirm ovulation and to check whether the endometrium is suitable for implantation of the embryo or not. For this particular indication,endometrial biopsy has largely been replaced by the less invasive 3 D Colour Doppler and 4 D Ultrasonography which gives an equally accurate description of the functional ability of the endometrium and also confirms ovulation.
How is Endometrial Biopsy done?
The endometrial biopsy is best performed prior to menstruation or periods. In a woman with a 28-day cycle, it is usually scheduled for Days 21 to 26. From start to finish the test takes about five minutes by an experienced IVF doctor.
Is endometrial biopsy or TBPCR painful ?
The procedure is usually tolerated well by patients and leads to minor discomfort.
A pain killer such as ibuprofen/paracetamol is given half an hour before the procedure so that patients feel less pain during the endometrial biopsy.
The IVF specialist begins by inserting a speculum into the vagina. An instrument called Allie’s forceps may be used to stabilize the cervix. This may cause a brief, slight cramping sensation. A narrow plastic instrument (catheter) is passed into the uterus to collect a small sample of tissue from the side wall of the uterus.
It takes about 60 seconds to collect the tissue from the lining of uterus, during these 60 seconds the patient may experience mild cramping. This will subside spontaneously after a few minutes as soon as the canula is withdrawn.
Concerns that you may have after the endometrial biopsy ?
The time frame between Days 24 and 26 of the cycle is too early to perform a pregnancy test. However, a woman undergoing an endometrial biopsy does NOT need to worry about disturbing a pregnancy. Studies involving large numbers of women who had the procedure performed during the cycles when they conceived showed no greater incidence of birth defects or miscarriage.
What does the test result of endometrial biopsy indicate ?
When the endometrial biopsy report does not show any evidence of infection/inflammation when seen under microscope, we can conclude that the test report is Normal.
The lining of the uterus is at the right stage for time in the menstrual cycle on Histopathology
An abnormal report will show:
- Presence of a non cancerous (benign) growth, called a polyp.
- Presence of overgrowth of the lining of the uterus (endometrial hyperplasia).
- For women who have menstrual cycles, the lining of the uterus is NOT at the right stage for the time in the menstrual cycle
- Microscopic Examination reveals evidence of infection or inflammation
- PCR report if sent comes back positive indicating presence of infection
What are the side effects of Endometrial Biopsy or TBPCR procedure ?
There are no side effects of the endometrial biopsy procedure if done by experienced doctor.
What is the difference between endometrial biopsy procedure and endometrial scratching ?
Endometrial biopsies are taken by a process of scratching the endometrium and removing the small tissue which is then sent to the laboratory for studying the cells under microscope.
Many studies suggest that endometrial scratching can actually improve the embryo implantation rate if done before embryo transfer.
Is endometrial biopsy same as endometrial scratching ?
No. The process of scratching the lining of the uterus is called endometrial scratching.
Endometrial biopsy involves scratching the endometrium and then removing the tissue so that the tissue can be studied by a laboratory for presence of absence of infection etc.
Does endometrial scratching improve implantation rate of Embryo after Embryo Transfer ?
Many studies report that there may be improvement in embryo implantation rate if an endometrial scratching is done prior to Embryo Transfer in an IVF cycle.
However this process is done selectively in few patients who show consistently thin endometrium or recurrent implantation failure.