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Sunday, October 27, 2013

Endometrial Biopsies For Fertility Patients: Basal Body Temperature Charting Alone Cannot Predict Readiness of The Uterus

Endometrial biopsies are used to diagnose irregular bleeding, to check for cancer of the uterus and to help infertility patients be diagnosed with luteal phase defect. Women who are tying to get pregnant are often offered several tests of their fertility, endometrial biopsy would only be one of the tests. One test is to check your for ovulation, one is to test to see if your fallopian tubes are open, and other test checks to see if your partner is fertile as well (At Women's Health Practice call to schedule affordable sperm counts). The lining of the uterus needs to be thick and lush for an embryo to implant. the lining is shed each month to allow for a newly constructed home for an embryo to implant. The process by which this develops is much like the orderly progression of a flower unfolding or a fruit forming on a tree. It occurs step by step. For a long time we have felt that poor progesterone in the latter half of the cycle made for a specific problem that would lead to infertility by not making that lining healthy enough to sustain an early pregnancy. In order to document that the lining was following its natural progression physicians would biopsy the lining and compare it to the 'classic' features seen in lining studied by Drs Noyes, Hertig and Rock in the very first issue of Fertility and Sterility. Their classic article produced what some gynos would think of as the "Rosetta Stone of the uterus". They could, by the look, predict exactly what day of the cycle a woman's uterus had matured to on the day of sampling. More than a day or two delay in the step expected then it was felt the uterus would be inhospitable to a developing embryo and effectively cause early pregnancy loss.It was a condition that in the day was called Luteal Phase Defect.  But Dr. Speroff and colleges writing in the most prestigious text of Gynecologic Infertility have pointed out that the Rosetta Stone had a flaw! We have come to realize  the initial studies were all based on infertile, not fertile women! So by using this model to predict how likely the patient was to be able to get pregnant, was much like predicting gas mileage in a car with a gas line leak! The facts are not all there! So a test that was used often in the past, has now been used more selectively over the past decade. Now for women who have irregular bleeding, pain, infections or suspected polyps may still need a sample of the lining of the uterus, but that is of course a different issue. Progesterone levels and progesterone supplements are often used instead of the biopsy itself.
And what is more confusing is whether we really need a specific amount of progesterone to get that perfect lining, that a conversation of it's own!

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