Endometrial Scratch Biopsy Helps IVF Success

Endometrial biopsy - also called scratch biopsy - is a new technique being used to help embryos implant more successfully after ovarian hyper-stimulation for in-vitro fertilization (IVF). Innovative new research has shown that superficially injuring the lining of the uterus can actually stimulate the uterus to be more receptive to an implanting embryo resulting in a welcome boost to take home baby rates.

Causing harm to confer benefit is not a new concept in reproductive medicine. Drilling many tiny holes in the ovaries - called ovarian drilling - and taking slices out of the ovary - called ovarian wedge resection - have long been used with great success to help re-start ovulation naturally after a long period of anovulation. When my clients have had these seemingly barbaric procedures done, remarkably, a month or so later ovulation spontaneously occurs and continues for some time.

The scratch biopsy is a simple procedure that can be performed by an OB/GYN familiar with the practice - called a '4 quadrant uterine biopsy' - in a simple office visit. Physicians are used to using this technique to collect tiny samples of tissue from various surfaces of the uterus to check for pathological changes. The procedure may be a little uncomfortable but could be worth it for the results. So far, my clients have not complained about too much discomfort during the procedure.

In a Chinese study (1) 60 women were randomly assigned to receive the biopsy while another 61 women did not. The women who had scratch biopsies had live birth rates that were almost double (41.67%) those of similar women in the control group (22.96%) who did not have the procedure. Earlier studies (2) on scratch biopsies also found similarly inspiring results. In a 2003 study researchers concluded that:

"...IVF treatment that is preceded by endometrial biopsy doubles the chances for a take home baby."

In a recent RCT study, (3) women who had experienced two previous implantation failures were studied to see if endometrial biopsy could help improve success rates. The clinical pregnancy rate in women who had the biopsy procedure was 27.1% compared to 8.9% in the control group. The researchers concluded:

"the results suggest that pregnancy outcome increases through IVF or ICSI after endometrial biopsy."

In another 2010 RCT (5) of 100 women with previous IVF failure - despite good embryo quality - embryo biopsy was performed twice in the cycle preceding embryo transfer - once in the follicular phase and once in the luteal phase. This study also showed positive results, the women who received biopsy treatment had a live birth rate of 22.4% compared to 9.8% in the control group. Researchers concluded that:

"...endometrial injury in non-transfer cycle improves the live birth rate, clinical pregnancy and implantation rates in the subsequent IVF-ET cycle in patients with previous unsuccessful IVF cycles."

Timing is everything. It's very important to do an endometrial biopsy at the right time. In one study (4) where the biopsy was performed at egg-retrieval, the women who had the procedure experienced lower pregnancy rates than controls.

The current thinking on timing seems to be that with IVF, the scratch biopsy needs to be done once - or twice - in the cycle prior to embryo transfer...the cycle before you begin gonadotrophin stimulation. Or in the spontaneous cycle before commencing estradiol for a frozen transfer.

In fresh IVF cycles, one similar study (6) showed positive results when endometrial biopsies were performed one to two weeks before embryo transfer. This study performed biopsies on 35 women while another 36 who were similarly matched controls did not have the procedure. All women were known to have polyps or excessive thickening of the endometrium which was removed by biopsy. The women who had a biopsy had a 48% live birth rate compared to 11.11% in the control group.

If you are having trouble conceiving with IVF or ICSI a scratch biopsy may be worth discussing with your physician at your next visit.

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References:
(1) Fertility and Sterility, Vol 89, May 2008, Issue 5, p1166-1176, Zhou et al.
(2)Fertility and Sterility, Vol 79, June 2003, Issue 6, p1317-1322
(3)Australian and New Zealand Journal of Obstetrics and Gynecology, Vol 49. Issue 6, P677-680, Karimzadeh et al.
(4)Gynecology and Obstetrics, Published online July 1 2009, Karimzade, et al.
(5)Narvekar SA, Gupta N, Shetty N, Kottur A, Srinivas MS, Rao KA. Does local endometrial injury in the nontransfer cycle improve the IVF-ET outcome in the subsequent cycle in patients with previous unsuccessful IVF? A randomized controlled pilot study. J Hum Reprod Sci 2010;3:15-9
(6)Rong Li et al. International congress series. Proceedings of the 18th World Congress on Fertility and Sterility. Vol. 1271. Sept 4, 73-76