Remember the last time I told you about my uterine biopsy (also known as an endometrial biopsy), I said it was an absolutely awful experience and I would never do it again…..yep…..I was wrong. After our third frozen embryo transfer failed, our RE decided she wanted to repeat the biopsy to make sure the endometritis was gone as she suspected it wasn’t which caused our third transfer to fail (would have been nice to know that before we did our third transfer but that’s for another day).
Since we were only going to be repeating the Receptiva test (to look for endometritis) and not measuring how my uterus was responding to meds (like we did on the first biopsy with the ERA test that measures that amount of progesterone my body needs at the time of a transfer), I could do this biopsy cycle natural. No meds! I would just go in for regular monitoring appointments (a vaginal ultrasound and blood work) and they would follow my body’s natural ovulation cycle and they would perform the biopsy based on that. What a relief to not have to take unnecessary meds!
Not sure why, but these ultrasounds were extremely painful for me. Normally when you have a vaginal ultrasound there is going to be pressure, but for me it was pain this time. After my first ultrasound, I was actually sore for the rest of the day but at least my lining was at 5mm so it shouldn’t take too much longer to get to 7mm (which was the goal for the biopsy).
So when it came time for the second monitoring appointment, I assumed we would be good to go (and had to be because we were leaving on vacation in a little over a week). Well wasn’t I in for a surprise when, for the first time ever, my body decided to not ovulate on my normal cycle schedule. During the ultrasound they found my lining was only at 5.2 and the biggest follicle in my right ovary (the one that, in theory, is growing to be released for this ovulation cycle) was also not much bigger than it was at the last appointment. My body was either not going to ovulate this cycle or it wouldn’t do it for another week or so. Cool…..thanks body.
Because of the unknown with whether I would ovulate naturally anyways and our time crunch with wanting to get the biopsy done before we left on vacation, my natural biopsy cycle turned into a full blown medicated cycle. I started taking vaginal inserts of estrogen to help my uterine lining thicken up (which it normally does alongside ovulation) and would have to go back to the clinic on a Sunday to have the final monitoring appointment. Given the second appointment happened on a Thursday, I didn't have much time for my body to respond to the estrogen so I didn’t have much hope we would be doing the biopsy before our vacation.
Well in a surprising turn of events, my lining went from 5.2mm on a Thursday to 9mm on a Sunday - my lining never grows that quickly! And of course, it happens for a biopsy and not a transfer. But the good news is I was cleared to do the biopsy on Friday so I would start progesterone shots Sunday night in preparation for Friday.
Because my last biopsy was so traumatic (to say the least), my doctor agreed to give me Valium beforehand and she requested that she do the biopsy this time instead of one of the nurses. I was hopeful that between the valium and only having to do one biopsy scrape, it wouldn’t be as bad as the first. My anxiety was so high that morning that I think I completely counteracted against the valium. The biopsy hurt just as bad as last time, but my only saving grace is she only did it one time versus the three times they did it during my first biopsy.
We got our results the day after we got back from vacation and the endometritis is gone. It should be a comforting result...knowing that it wasn’t why the third transfer failed, but it’s not comforting. It means we are still back at square one with no indication as to what is going wrong in our attempts to conceive. Along with the endometritis, the Receptiva test also measures your H score (which looks at the presence of the protein marker for endometriosis). On my first biopsy I was told my score was 1.4 (and 1.6 or above is considered abnormal), so we treated my body as if I had endometriosis during the third transfer with Lupron injections and a Letrozole regimen. This biopsy I was told my score was 0.4 (but then they also said my first biopsy was a 1.2 with 1.4 being the abnormal starting range). I’m not sure where the change came from - maybe the first biopsy they took from a place that potentially has endometriosis and the second biopsy took from a part that didn’t.
At this point, the H score on the Receptiva test really isn’t telling us anything. So we are going to move forward in having a second hysteroscopy done and a diagnostic laparoscopy at the end of September. We are choosing to have surgery because we think it’s about time a doctor (my OBGYN in this case) gets some eyes on inside and outside my uterus. My RE doesn’t want me to get my hopes up that they will find anything (ex. A laparoscopy is the only way to actually find and diagnose endometriosis), but for us (me especially) I need the peace of mind that we crossed these check boxes off on the diagnostic tools we have access to before we even think about doing another transfer.
So for now, we are going to enjoy a couple more weeks without me being on any meds as we prepare for surgery.
This is just another chapter on this infertility warrior’s journey.
**This is not meant to be medical advice. Be sure to consult your doctor with any medical concerns. This is the account of my personal journey through infertility**
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