Endometrial Biopsy Fertility Asessment

Endometrial Biopsy to Assess Infertility

A small sample is obtained by scraping the lining of the womb/uterus (endometrium) using fine plastic tube passed through the cervix. The sample is assessed for the necessary changes which follow ovulation. The changes in the endometrium help the implantation of the fertilised egg and support early pregnancy.

The sample may show inflamed endometrium (endometritis)

The sample is usually taken 1-5 days prior to period ie day 23-26 of the cycle in a 28 days cycle. The test is done in minutes.

The test done at 23-26 days does not disturb a pregnancy or increase birth defects or miscarriage if pregnancy has occurred in that cycle.

Outpatient Endometrial Biopsy

Author: Botros Rizk, Johan Smitz, Serag N. M. Youssif, , Afifa Halim Kirolos, , Magdy Ragheb, Samy Saleeb

Published in: Middle East Fertility Sterility Journal: Volume 2, No 2, 1997

Subject: Obstetrics, Gynecology & Women's Health

Objective: Our first objective is to review and critically analyze the published data comparing the different modalities of endometrial biopsies. Our second objective is to integrate the sonographic findings in the clinical management to rationalize the use of endometrial biopsy.

Study design: The study was designed to review endometrial biopsy from the gynecologist, patient and pathologist perspectives. Major studies comparing the Novak, Vabra and Pipelle endometrial biopsies were analyzed. Studies addressing the use of transvaginal sonography in the evaluation of the pre- and postmenopausal patients were incorporated.

Conclusions: The results are reported in three different groups of patients. In patients undergoing endometrial biopsy for endometrial dating, large studies comparing the Novak curette with the Pipelle suction curette showed comparable efficacy in terms of tissue adequacy. However, the pain experienced was significantly less with the Pipelle. In patients with abnormal uterine bleeding, larger samples of patients were analyzed. In comparison to Vabra curettage, Pipelle had a higher rating according to the gynecologists, pathologists and patients satisfaction. In comparison of the percentage of endometrial surface evaluated, the Vabra aspirator had a significantly higher success than the Pipelle. The Pipelle was equally effective to the Novak curette and to the Tiss U-Trap. In patients diagnosed with or suspected to have gynecological cancer, transvaginal sonography should be performed before any procedure. The cut-off limit for endometrial abnormality is positively related to the positive predictive value of the ultrasound testing. Most authors would agree that a cut-off limit of 5 mm is satisfactory. In patients with known endometrial cancer, the Pipelle had 97.5% sensitivity. Hysteroscopy, dilatation and curettage should be performed if the endometrial cavity could not be negotiated.