5. ENDOMETRIAL BIOPSY (D and C) - ENDOBx:
The endometrial biopsy is a test designed to examine the development of the lining of the uterus ... the endometrium. It is within this layer that implantation of the fertilized egg takes place. The endometrium normally undergoes cyclic changes each month in response to hormones secreted (poured into the blood stream) by the ovaries. During the first fourteen days of an ideal 28 day cycle the endometrium is said to be ‘proliferative’, while during the second fourteen days it is said to be ‘secretory’. The hormone, progesterone, is secreted from the ovary from the time of ovulation until the menstrual period and is responsible for the change from proliferative to secretory endometrium. The presence of secretory endometrium is fairly strong presumptive (but not definitive) evidence of ovulation. However, just the knowledge that ovulation has occurred is not enough. Is the ovulation adequate enough for proper fertilization and implantation of the egg into the uterine cavity? The plot thickens at this point. The fertilized egg, taking about six days in its journey from the ovary to the cavity of the uterus (womb), will only implant in properly prepared endometrium. If a ‘weak’ ovulation occurs, the secretory endometrium that results will not be sufficiently ‘ripe’ to allow the egg to implant. This condition of weak ovulation with resultant slow ‘ripening’ of the endometrium is referred to as a luteal phase defect. A luteal phase defect can cause not only infertility but more commonly may be responsible for repeated miscarriages in the first three months of pregnancy. In fact, these miscarriages may occur with the menstrual period and the woman may not even be aware that she was even pregnant! You might ask, ‘how does one determine if a luteal phase defect exists’? The answer is in getting exact dating of the endometrium. Secretory endometrium has a different appearance each and every day for those second two weeks of the menstrual cycle. If the day of the cycle that the biopsy is taken is known and when the subsequent period begins, one can match the actual dating (secretory age) of the endometrium with that information. For example: If the biopsy is taken on day 26 of a 28 day cycle, then the endometrium should read day 26. If it reads day 22, there is a four day luteal phase defect which will generally cause problems. Thats where therapy begins.
Doing the biopsy is a relatively uncomplicated matter. While this test is sometimes performed as an office procedure, I generally will try to schedule it along with a diagnostic laparoscopy in order to spare you the discomfort of this test. The biopsy is ordinarily scheduled to occur 2-3 days prior to the time your period will presumably begin. You will be positioned for an internal pelvic exam. The cervix will then be grasped with an instrument which will feel like a pinch or a cramp. A very small endometrial curette (scraping instrument) will be inserted through the cervical canal (birth canal) and a scrape of tissue will be taken. This may cause a cramp comparable to a period but it will go away very quickly. The tissue is then sent to pathology where it is prepared and read. Before final interpretation of this information can be made, I will need to know the exact date your next period begins. On your next visit you should supply me with that information and show me the temperature chart from that cycle. You may notice some bloody or brownish discharge after the test. This is to be expected. Do not use tampons, douche, or have intercourse for the next 48 hours. Rarely a fever may develop within the next 3-4 days. If you feel hot and have a temperature of 100.4 degrees Fahrenheit or greater, please call the office at once.
(You will receive a separate bill from Jewish Hospital for preparing the slides and another bill from Louisville Pathology Associates, PSC., the pathology group that interprets the slides.)