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Trying to Conceive: Endometrial Biopsy Explained

Katlyn Joy |22, December 2011


A common procedure for couples who are trying without success to conceive is the endometrial biopsy. This type of biopsy is also performed when specialists are trying to rule out conditions such as endometrial cancer, a specific type of uterine cancer. It's also done when a woman complains of unexplained bleeding particularly post-menopausal, or for irregular periods including those with heavy or prolonged bleeding. Sometimes it's done after an ultrasound reveals a particularly thickened uterine lining. It's typically done in women over the age of 35.

When an endometrial biopsy is performed for reasons associated with infertility, the test is done in order to check the lining of the uterus to determine whether hormones are properly preparing the uterus' lining for a fertilized egg. It's important that the lining be prepared to support implantation and an early pregnancy. The test will also determine if the lining is inflamed or infected.


- Let your physician know what medications you've been taking, with special attention to any drugs that thin your blood.

- Advise your doctor of conditions such as heart and lung problems and any infections of the reproductive system.

- Do not douche, use tampons or insert vaginal medications 24 hours prior to the procedure.

- Take some over the counter pain reliever such as ibuprofen prior to the biopsy.

How it's Done

Generally an endometrial biopsy will be performed in a doctor's office without requiring sedation. The entire process typically only takes five minutes or so. The woman will place her feet in stirrups and the doctor will place a speculum into the vagina. The cervical region will be swabbed with antiseptic. After the area has been swabbed, the physician will use an instrument called a tenaculum to hold the cervix in place. This is done to stabilize the uterus during the procedure. If the cervix is too tight, a cervical dilator may be used. Then a flexible tube will be inserted through the vagina, past the cervix into the uterus in order to gently suction out a portion of the uterine lining.

While the process is generally not painful, there is likely a sensation of coldness and often cramping. This cramping may range from mild to severe but will subside within a few minutes of the biopsy.

The Risks

Risks from an endometrial biopsy include prolonged bleeding following the procedure. There is also a risk of infection from the biopsy. A tearing of the uterus or causing a perforation in the uterus is also possible. However all these risks are rare. More likely a woman will experience some light spotting and cramping for a few days.

The Results

The tissue that is collected from the uterus is examined by a pathologist. The pathologist will date the sample according to when in the woman's cycle the procedure was done. Usually women undergo endometrial biopsies in a few days before their periods are due to begin. A crucial aspect of this is that a woman will need to call in as soon as her actual period begins, not confusing it with mere spotting from the procedure. The pathologist will then read the results in accordance with the expected levels of thickness for that day of the cycle.

The sample is labeled "in phase" if the progesterone levels have caused the lining to be thickened to the degree indicated by the day of the cycle, whereas the sample will be labeled "out of phase" if it shows insufficient growth to support a pregnancy.

Because it's too early to test for pregnancy at that time of the cycle, women are instructed to use a barrier method of contraception for the month preceding the biopsy.

If abnormal results are found, further testing may be required to determine why the lining is not sufficient for supporting implantation of an embryo.

If endometriosis is indicated, as is suspected in 6 to 15 percent of women, it can interfere with conceiving up to 30 percent of the time. However, diagnosis is the first step in proper treatment.

When to Call Doctor

If bleeding continues after the endometrial biopsy and is heavy you should call the doctor. Also if you have abdominal pain, a fever or a foul smelling discharge from your vagina, you need to seek medical attention.

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CC Nov 23, 2012 04:51:00 PM ET

I am doing natural IVF ( no meds) and retrieved 2 eggs this month. They are freezed and transfer is in December. I just found out that endometrium biopsy might help implanting. So I contacted my RE and said let's do it on 5-6 day of period ( which is 1 week before transfer). I raid the article that the timing of the procedure is critical and seems like it is done one month before the transfer not 1 week before. Do you think it is too late? Should I skip the transfer till next month?

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