There are many steps involved in the development of a viable, normal pregnancy from fertility treatment. One step, which has been the focus of some unproven therapies (which can be dangerous and are expensive), is the area of implantation of the embryo. In the early days of fertility treatment, it was noted anecdotally that women often conceived quite quickly after a curette, whether following a miscarriage, or after surgery for another reason.
Ballarat IVF Specialists have been aware of reasonable quality research since 2010, which suggested that endometrial biopsy (or scratching), whether performed during a curette, or with a "pipelle" endometrial sampler was likely to increase implantation of embryos in subsequent cycles, either with natural conception or IVF.
The big challenge is to decide to whom, and when, endometrial scratching should be offered. For example, should it be offered to women who have failed to conceive after one, two, or more failed embryo transfers, unsuccessful ovulation induction, or women presenting with reduced fertility right from the start of treatment before IVF?
We also don’t know how long the effect lasts after the procedure, and hence how frequently it needs to be repeated.
The main advantage of endometrial biopsy is that it is safe, cheap, and easy to perform. Additionally, apart form the mild discomfort of the procedure, it has never been shown to cause harm to women, or adversely affect pregnancy rates.
So when do Ballarat IVF fertility Specialists offer a "pipelle"?
Well, it varies between patients, so you should raise this question with your fertility nurse, or your doctor when you see us next. I think most would agree that if you have had 3 embryo transfers with high quality embryos, and not conceived you should have a pipelle endometrial biopsy. In some other situations, for example in our older women, or those planning intrauterine insemination, it could be performed earlier.
Our feeling is that the effects probably last 2 cycles, but we have no hard evidence for this.
There is no doubt that at Ballarat IVF, we see endometrial scratching as an important part of fertility treatment for the relatively small number of women who don’t conceive after 2-3 embryo transfers. It is quite likely, however, that we will be offering the treatment to a wider range of women as we review more research data in the near future.
~ Dr Russell Dalton