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Endometrial Biopsy Scratching After Failed IVF
Failed IVF is difficult to accept but is not uncommon. To keep things in perspective, without the use of Comprehensive Chromosome Screening, egg donor cycle success rates of the best fertility clinics are around 60 percent. Embryo implantation is a complex process and IVF can fail due to both poor endometrial lining (endometrium) and abnormal embryo genetics. Women who have repeatedly failed IVF despite good quality of their embryos may be candidates for the latest IVF treatment called endometrial biopsy scratching or endometrial biopsy.
What is Endometrial Biopsy Scratching
Endometrial Biopsy is a gentle endometrial injury caused by scratching patient’s uterine lining prior to embryo transfer. New research in the field of infertility shows that gentle injury to the lining of the uterus can actually make the uterus more receptive to an implanting embryo and thus increase one’s chances of pregnancy. Several studies conducted by top fertility clinics showed that endometrial biopsy scratching almost doubled the chance of pregnancy for patient who received scratch biopsy prior to their IVF treatments.
The process of endometrial scratching as it relates to embryo implantation is not entirely understood and some questions still remain unanswered. Scientists involved in studies believe that there may be two causes of increased implantation rates: white blood cells and gene switching. In the first case, it appears that endometrial injury increases the production of white blood cells. White blood cells secrete so called growth factors which in turn control embryo implantation.
In case of gene switching, scientists speculate that sometimes embryos fail to implant due to genetic switching related to endometrial receptivity. That is, genes responsible for implantation of embryos are not switched on during the time when embryos are supposed to implant. Endometrial biopsy may increase expression of genes (switching of genes) thought to be responsible for preparation of endometrium for implantation.
The endometrial biopsy is a relatively simple procedure that can be performed either by our fertility doctors or by your local Ob/Gyn familiar with this procedure. The procedure is commonly referred to as a four quadrant uterine biopsy. Physicians use this biopsy technique to collect tissue samples from the surface of the uterus in order to check for pathology. Scratch biopsy causes very little discomfort and poses little risk (e.g. infection) to the patient.
MedVacation fertility doctors have been using endometrial biopsy scratching for some time now and it has been successful for several of our patients. Although the benefits of endometrial biopsy scratching are undeniable, the exact timing and the number of biopsies are still being debated by fertility specialists. Fertility doctors agree that the scratch biopsy needs to be done once or twice before embryo transfer. The scratch biopsy can also be done on the same day as the saline sono. The endometrial scratching should be done first, followed by the saline sonogram. One recent study shows that women who underwent an endometrial biopsy one or two weeks prior to embryo transfer had a 48% live birth rate compared to women who didn’t.
Another option is to have the scratch biopsy done in the second half of the cycle, usually just a few days before menstruation is expected. It can be done in the same cycle as one in which the patient is trying to get pregnant. The risk of miscarriage from the biopsy is only about 1%. Therefore, given the increased chances of getting pregnant, the benefits of having the endometrial scratching done overweigh the risks associated with it.
If your IVF failed due to poor embryo quality, here are a few other IVF treatments you may want to discuss with your fertility doctor to improve your IVF chances for the next cycle.
Patients with several failed IVF cycles require a thorough evaluation of previous cycles and individualized approach for treatment options for subsequent IVF cycles. Endometrial biopsy is recommended to patients who have experienced multiple failed IVF cycles with good or excellent embryo quality. Contact us today for your free consultation to find out whether you may be a good candidate for endometrial scratching procedure.
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