Endometrial “scratch” biopsy timing — your input appreciated!

Hey all, just a quick one, hoping you can help…

My nurse at RBA just informed me that the hysteroscopy I had done on December 10th will be enough, as far as irritating the uterine lining goes—for an embryo transfer that will probably happen in early to mid-March.

That is, a scratch biopsy won’t be necessary this time around because of the hysteroscopy irritation of the uterine lining.

Hm. Seeing as how the scratch biopsy + doxycycline is the only thing Dr. S is recommending to safeguard against any immune issues, I am concerned.

The first cycle, I had the scratch biopsy done 3 days after I started Lupron, and 1 month before transfer. I had one period on Lupron between the scratch biopsy and the transfer.

This cycle, they’re saying it’s okay to have had the irritation of the lining a full 2 months earlier than I did the first cycle. Dec 10th instead of Feb 10th.

This cycle, they’re saying it’s okay to have 3 periods (one on Lupron) between the hysteroscopy procedure/lining irritation date and the embyro transfer date. The first cycle, I had only 1 period between the irritation date and the transfer.

1 period and 3 periods seems like a big difference to me. As does the 2 months difference in timing of the irritation.

If you had a scratch biopsy or some other form of irritation to the uterine lining in order to promote a successful cycle, can you please let me know what the timing was for you? When did you have the irritation done, how much later was your transfer, and how many periods were in between the irritation and the transfer?

Thank you, as always!

Advertisements
Leave a comment

30 Comments

  1. I personally didn’t have it done, but my friend did it between her failed DE cycle and her next cycle. So basically she had AF, got the scratch and then started Lupron. Her cycle was successful – we think she has 2 cooking in there, although her ultrasound isn’t for a few days. But, your Dr. wants you to be successful almost as much as you want it, so I don’t know that they’d do anything to compromise your possible success. Although of course, it doesn’t hurt to ask and arm yourself with all of the facts. I’m interested to see what everyone else has to say on the subject….

    Reply
    • Kali

       /  January 10, 2014

      In my case (see my comment below) they didn’t recommend it because there wasn’t time by the time my idiot nurse got my schedule together. That is not your case but there is no hard science to it. If it’s going to help and you want to do it (“want to”–I know, but you want the benefit of it, let’s say), I think it makes more sense to do it now. The doctors and nurses may assume since your lining has always been good you don’t need it but in my case it turned out it had been helping my lining.

      Reply
      • Yeah, in my case, we were going to do it in order to create a beneficial immune response (down reg T helper 1, favoring T helper 2 cells), not for lining thickness. Sigh. We’ll see what Monday brings.

        Reply
    • It’s good to be reminded that my doctor wants succcess nearly as much as I do! That is true, I’m sure. But he is also very busy. I’m hoping that something hasn’t fallen through the cracks, hoping that he has not forgotten the suggestion he made to me about using a scratch biopsy to create a good immune response in the uterus. I trust him, but I worry. ):

      Reply
  2. Kali

     /  January 10, 2014

    I would do it again this cycle. I also had three months between the hysteroscopy and my next cycle and my lining didn’t build up. We had to cancel the transfer. Next time, I did the scratch biopsy and though it still took longer than I’d like, my lining did build up to a nice level.

    I wrote off the fact that they didn’t recommend the scratch biopsy (and then didn’t get me the protocol in time to do it even though I’d requested it) with the same reasoning but that cycle my lining failed, the next, when I did it just before the period-before-the transfer, I had a better lining.

    I think your instincts made you post because you have your doubts about the nurse’s reasoning. My opinion is it works best the cycle before the transfer.

    Reply
    • Wow, that would be the very same timing between hysteroscopy and transfer for us—thanks for mentioning that. (I’m sorry it didn’t work out that cycle.)

      Reply
  3. I’ve had one done before every fresh IVF cycle (ultimately unnecessary since we froze or canceled every time) and before my previous FET (unsuccessful). All times I had it in the cycle before, and had a period before starting my meds. I was always told that the research supports it in the cycle before, if that helps. Nothing about three months out! But this time around my RE isn’t doing one at all…I assume that since I was on Lupron Depot they either figure that’s enough for my lining, or they don’t want to delay me another month for a scratch biopsy.

    Reply
    • Very helpful! Yeah, that’s the only research I can find too, supporting the cycle before, not 3 months out. He wanted me to do it in order to stimulate a beneficial immune response, not for lining—if I have to remind him of that I will be quite pissed.

      Reply
  4. I had my first scratch biopsy before my successful transfer. It was in the middle of my previous cycle. So like cycle day 14. Then I did not get a period (lining was too thin) and I started my cycle meds on day 32 ish. So my transfer was about one month after my scratch.

    Reply
  5. With OE cycles, I always had the biopsy 1 month before fresh transfer.

    Reply
  6. I haven’t had the scratch biopsy but I can say from my experience that the nurses give you advice without consulting the doctors and there is no way for you to know if Dr. S recommended foregoing the SB or if it is a nurse invention. In your shoes I would call or send an email asking Dr. S to confirm that it is acceptable to go ahead with the scratch biopsy and stating your concern for the suggestion that it be deleted from your protocol.

    Even if it wouldn’t make a difference you will feel more doubt if you don’t do it. Or it sounds like you would and I certainly would in your shoes.

    Reply
    • Well, actually, this is coming straight from Dr. Shapiro. My nurse is actually almost TOO cautious when it comes to communication—she doesn’t give advice or guidelines without it coming straight from Dr. S. It’s sometimes annoying because she won’t answer any question without checking with him. The no-need-for-biopsy is as per Dr. S, but I have gotten back in touch, asking her to ask Dr. S *why* he thinks there is no need to do it, pointing out the timing and so on like I have done in this post. I’ll probably hear back on Monday—I hope it isn’t some lame overl simplistic answer, like she usually gives me, frankly, and then I have to keep digging for explanations, which is very tiring.

      Reply
  7. JK

     /  January 11, 2014

    I agree with the previous post–confirm with Dr. S that the scratch isn’t necessary. Then you can reevaluate.
    I haven’t posted much but I’ve been following your blog closely and thinking about you a lot. You are awesome. I can’t believe your transfer is now just a few months away. I know it’s scary. But whatever happens I think you are doing everything you can. I am sending positive thoughts your way!

    Reply
  8. I also agree with everyone about checking in with your doctor and making sure this is HIS call and that he knows your concerns. I have never had the scratch biopsy, but will this time around. The timing that I was told by the two doctors I have spoken with most recently is kind of vague from my notes, “right before transfer cycle.” So before stimming but the cycle before I guess? I was told the point was to create an injury (sounds great) that the lining must work hard to heal from and that it thickens the lining and makes it more receptive. I don’t know much more than that… Good luck and advocate, advocate, advocate! I don’t believe in being a complete pain in the ass, but I do believe that you can’t ask too many questions or question decisions being made because sometimes your gut is right and something was missed. They see a LOT of patients, you can keep close tabs on you to make sure that you get the care and detail that you deserve. :) Good luck!

    Reply
  9. Hey all, just wanted to give you an update—my dear lovely OB, Dr. McKenna, called me on a Sunday evening to discuss the scratch biopsy. So nice of him. He is the one who did the hysteroscopy. I had called his office to schedule the scratch biopsy before I’d heard from Dr. S that I no longer needed to have it done. Without hearing from me about the change in protocol, Dr. McKenna said that he strongly did not think it was wise to go in a stir up the endometrial lining and uterine environment right now, particularly since everything looked so great when he was done with the procedure. He said that the risk of causing Asherman’s Syndrome (weblike scars in the uterus) is getting very high for me, and he also worries that suctioning the uterus right now would cause inflammation that we do NOT want. I wonder if this is why Dr. S changed his mind. Because now that I think of it, I had not had the hysterscopy done at the time of my second consult with him, nor did we know I was going to get one. I’ll let you know what Dr. S has to say on Monday.

    Reply
    • Kali

       /  January 13, 2014

      Hmmmm, that’s a good point. Maybe it’s time for me to have another saline sonogram to make sure the last scratch biopsies didn’t cause Asherman’s. . . and maybe that’s why the cycle failed ((((((sigh))))))).

      So much to avoid/think about.

      Reply
      • I KNOW. How ridiculous it all can start to seem. Maybe ask your docs what they think about Asherman’s or need for saline sonogram. Let me know what they say…

        Reply
  10. UGH. Now, after receiving an email from me asking the questions about timing above, Dr. S says that he DOES rec the scratch biopsy this Feb! He says that “time got away from him” and apparently hadn’t bothered to do the math calculating the actual time between the hysteroscopy and the transfer. This is what I wrote to my nurse in reply:

    “Hmm. Okay. This concerns me. I realize that patients have to be their own advocates, but shouldn’t there be much more care taken on RBA’s end? ‘Time had gotten away from him’ really concerns me. I am looking at a seventh pregnancy and I need RBA to pay close attention to what is suggested to me for my protocol.

    “Why am I the one keeping track of dates and timing and doing the math? Isn’t RBA just as invested in the success of this pregnancy as I am? Or is it that the scratch biopsy is not that important?

    “Dr. McKenna (OB) called me Sunday night and he said that he did NOT think I should have the scratch biopsy done. He said that since I’d had the hysteroscopy done in December, he did not think it was good idea to go in a ‘stir up the uterine environment.’ He said there is a risk of Asherman’s Syndrome or causing inflammation that I do NOT want.

    “Now I am utterly confused! What is the best thing to do? Should I have it done to call in T-helper 2 cells and promote a thicker lining?
    Thank you, etc”

    I feel rage. I AM SO TIRED OF THIS STUFF, I HAVE HAD IT!!!!

    Reply
    • Kali

       /  January 14, 2014

      I said the same thing to Shady Grove. On more than one occasion, for more than one thing that “fell through the cracks.” At my expense, my body’s expense, my heart’s and mind’s expense. And oh yes, my wallet’s expense. On the phone, and not in a nice voice, not worded as nicely as you worded your message.

      I hate this industry.

      I’m so sorry for what you’re going through, I know the rage well. Remember they almost put the wrong embryo in me! And that was only the latest. . . .

      Ugh.

      Reply
      • Thank you for commiserating, wish you didn’t know what I mean. How can they be so cavalier? Seriously—what the hell? I know that they can’t be perfect, but there are too many things at this point: 1) The length of the wait to get into the egg bank was NOT what they promised it would be, for me or for anyone I know; it was several days longer, which created enormous anxiety; 2) When I switched from PIO to Crinone, they forgot to put a note in my chart, so when I got instructions the day before transfer, they did NOT tell me to forgoe putting in Crinone the morning of transfer. The only reason they ended up instructing me to forgoe Crinone is because I mentioned something in passing just as I was about to get off the phone about the Crinone—and the person on the phone instructing me was truly shocked; she said, “wait, wait, wait—your not doing progesterone in oil???” She adjusted my instructions on the spot; if I hadn’t casually mentioned Crinone, I would have certainly put it in the morning of transfer, thinking it important to have the progesterone in me, but it would have made the transfer much more difficult; 3) After spending a day in agony, at a local clinic and then on to a radiologist, getting measurements that clearly showed the embryo was not growing, knowing that this was the end, I come home to an inane message from my RBA nurse saying that everything is fine, embryo is still in normal range, keep taking meds, etc. I was so confused! I’d spent the whole day hearing otherwise! I fired off a bunch of questions via email, sick with confusion and frustration, and get a “woops” email—Dr. S had miscalculated. Forget that email, our mistake. I ended up geting a call from him shortly thereafter to talk about the reality of how it was looking, and of course I didn’t bring up how much anxiety that “woops” had caused me because all I wanted at that point was information, and I didn’t want strained feelings between us. Okay. Rant over.

        Reply
  11. For anyone who happens to still be listening to this noise: At my local-monitoring RE’s today (Dr. San Roman) we discussed the scratch biopsy and the implications, and he convinced me that there was extremely low risk of anything near Asherman’s Syndrome and did indeed rec the biopsy for immune reasons and lining reasons. He also—-bless ‘im—is going to give me Vicodin and Valium for the pain (b/c last time was so freaking awful). I am happy to say that this issue can now be put to REST. I love Dr. SR. He is very soothing and reassuring, and understanding of how crazy-making all of this can be for the patient. He has also offered to prescribe all of my meds for me (from RBA’s list) so that I can be sure my insurance will cover them. Sigh of relief.

    Reply
  12. Lindsey

     /  September 9, 2014

    I am a patient at RBA too. I see Dr. Monica Best though. She did my fresh ivf and fet. Dr. Sharpio did my IUI

    Reply
  13. I am having a endometrial scratch cd 21 in the month prior to transfer. I haven’t had any success at all and I’m only 28 with good eggs. Beats me

    Reply
    • Nicole Wallace

       /  March 12, 2016

      I am also at RBA, I have my scratch April 1st. I’m a patient of Dr. Best. I wish you ladies the best with your upcoming cycles.

      Reply
      • SBG

         /  March 15, 2016

        Good Luck Lindsey! It worked for me! I am 37 weeks pg with baby girl #2! Crossing my fingers for you!

        Reply
        • SBG

           /  March 15, 2016

          Oops- that was meant for Nicole….. sorry!!! Good Luck Nicole!

          Reply
  14. SBG

     /  April 30, 2015

    I too am a patient with RBA (Dr. Slayden) and I have had one successful fresh embryo transfer and one unseccessful frozen embryo transfer. We are planning to try the scratch biopsy (as close to day 21 as possible however I will be out of town right around that time). I am curious to know what happened with you Lindsey and theunexpectedtrip? I am hoping you have had success!!! I feel like my Dr and the nurses are very good in my office but I have heard someone else say the same the thing about Dr. Shapiro/ nurses (kind of slack with information).

    Reply

Leave a reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: