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Archive for July, 2011

Although it sounds counter-intuitive, in the past few years, several studies have shown a marked increase in IVF implantation/success when patients have undergone an endometrial biopsy (also known as LEI – luteal phase endometerial injury) prior to IVF treatment.

In the initial Israeli study by Dr. Dekel in 2003, they seemed to sort of “discover” this happy outcome by happenstance.  They noticed a correlation between women (doing own egg IVF) who had an endometrial biopsy and also had increased implantation success rates – regardless of the findings from the biopsy when the tissue was tested.  The initial study was quite small –  134 women – 45 who had the biopsy, and 89 who did not.   In that study 27.7% of women who had the biopsy got pregnant vs. 14.2% of the control group who did not have the biopsy.

Although there is no clear explanation for the increase, the general theory was that by injuring the lining of the uterus, the body was sending increased blood flow or proteins with healing properties that improved the ability of the embryos to attach to the uterus.

More recently, at the European Society of Human Reproduction adn Embryology (ESHRE) meeting in Stockholm, Dr. Fernando Prado Ferreira from the Federal University of Sao Paulo presented the findings of a similar study based at Santa Joana Maternity Hospital in Sao Paulo Brazil.  In his trial of 144 women, 46 were given biopsies and 98 were not.  He reported that in the patients who had a biopsy, there was almost double the chances of a pregnancy over patients who did not have the biopsy.

He went on to explain that “The endometrial biopsy appears to lead to scarring in the uterus that provides better adhesion of the embryo, either through the scarring itself or through substances called cytokines released when the wound is caused in the womb.”

Many reproductive experts have been skeptical of the outcomes and have called for further randomized studies on this subject.  It has been suggested that perhaps Dr. Ferreira’s use of the word “scarring” wasn’t the best word to use because the uterine lining would normally heal without scarring from this procedure.  Perhaps referring to it as “healing” may have been more appropriate, but the use of the word “scarring” may be attributed to the fact that English is not Dr. Ferreira’s native language.

There also appears to be a difference of opinion about when is most effective to perform this biopsy.   Generally, it seems to be performed shortly before starting the medications for the IVF treatment, FET (frozen embryo transfer), or donor egg IVF treatment cycle.

Still, the studies of this procedure to date have been small, and no randomized studies have been done, so there still remains much to be learned about the use of this procedure for increasing success.

The good news is that – unlike most fertility procedures – this one is relatively inexpensive to do.  Just a few minutes in your RE or OB office where they use a suction catheter through the cervix into the uterus where they take a small biopsy of the uterine wall.  There is no need to send the tissue out for testing, it is simply discarded since the value of this procedure seems to be the injury rather than any potential information gathered from the tissue.

In any event, in cases where there have been repeated IVF treatments with failure to implant and no known cause, it may be worth exploring this option.

I think perhaps the best advice is to discuss this with your RE to see if it might be beneficial in your specific case.

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