There are a lot of moments on this infertility journey where all positivity and hope goes out the window and I can’t help but be negative and hate the journey we are on. The 15 minutes of our uterine biopsy yesterday was one of those times. But before I tell you about the procedure, let’s backtrack as to why we are doing the biopsy.
I went into full detail on our decision to do the uterine biopsy in a previous blog post (https://www.babydusttruths.com/post/up-next-uterine-biopsy-era-receptivadx), but basically, it’s one of the last diagnostic tests our fertility doctor can offer us. So before we jump into our next frozen embryo transfer we decided to biopsy my uterus and run 2 tests: ERA (Endometrial Receptive Assay) and a ReceptivaDx Assay. The ERA test will determine if my body needs an extra day of the progesterone shots before a transfer (so 6 days instead of the usual 5 days of shots) and the Receptiva test will look for signs of endometriosis, adenomyosis and other inflammatory conditions in/on my uterine lining. Depending on what is found in these 2 tests will determine how we move forward - either straight into our next frozen embryo transfer or taking a couple months to treat whatever is found. That treatment can be anything from additional medications and shots to surgery to remove whatever is found.
To prepare for the uterine biopsy, I had to go through a mock cycle. I did the same amount of medicine (birth control to start, estrogen pills to grow my uterine lining, and 5 days of progesterone in oil shots) as well as the weekly blood work and vaginal ultrasound monitoring appointments. For some reason, this cycle of medicine hit me really hard. I was extremely sick most of the time and the PIO shots hurt way worse than they usually do (both during the shot itself and afterwards). Maybe my body knew this cycle wasn’t for a transfer so it was torturing me….thanks body!
After stopping birth control (to quiet my ovaries and get the timing of the cycle exactly where we needed it to be), I had my baseline monitoring appointment and lab work done. They want to make sure your uterine lining is nice and thin at this point and your ovaries aren’t doing anything. My lining was at 3.4mm and my ovaries were nice and quiet. Three days after the baseline appointment I started taking estrogen pills (2 in the morning and 2 at night) to help thicken my lining. Just like for a frozen embryo transfer, they wanted my lining to be at least 8mm for the biopsy. A week later I went back in for another monitoring appointment, and while my lining was growing nicely (6.28mm) and had the triple layer pattern that’s needed, they found fluid in my uterus. The nurse thought maybe the fluid was leftover from my period, but after stopping birth control this time I actually didn’t get a period. I have never had fluid before and we had to just give it the week to see if it would go away on its own or if we would have to cancel this cycle because of it. Luckily, a week later the fluid was gone and my lining was at 7.9mm so I was cleared to start the PIO shots in preparation for the biopsy.
As any infertility warrior does, I asked around to fellow warriors about the biopsy and what I should expect. Everyone had the same answer...a lot of pain! Some people said they passed out from the pain, others talked about how they ended up having to have their cervix dilated before the biopsy so they could get the tools in...and all of this is done while you are wide awake and not on any sort of pain medicine. Ummm...does that seem wrong to anyone else?!
Let’s break down what happens during a uterine biopsy. It starts out just like a pap smear - legs up in the stirrups and a speculum is inserted into your vagina to hold it open during the procedure. Your cervix is cleaned with iodine and then it’s time to begin the procedure. I read in some articles that at this point your healthcare provider may numb the area, but I wasn’t so lucky. Up to this point there is no pain or cramping, just the discomfort of having your vagina pried open. A catheter is inserted through the cervix into the uterus. Inside the catheter is a small tube that is pulled down to create suction at the end of the catheter. The catheter will be rotated around to collect pieces of endometrial tissue. At my support group meeting last night, one of the other warriors described this process as the healthcare provider taking a small toothbrush and rubbing it up against your uterine wall to get pieces off. Depending on the reason for the biopsy will determine the amount and location of the tissue removed. And that’s that. It’s only about a 10-15 minute procedure. Sounds easy right?
Well let me tell you that the pain I felt during this biopsy was unlike anything I have ever felt before. To “help” with the pain, they instructed me to start taking Motrin 600mg 24 hours prior to the biopsy with my last dose being one hour prior to the procedure. Funny they thought that would help! My poor husband - I’m sure his hand was sore after I squeezed it with every painful cramp each time the nurse went in to retrieve a sample. Luckily I wore one of his sweatshirts and I bit down on it to keep myself from screaming. All I could think about was the poor girl in the room next door, probably just there to get her follicles checked, and she was almost hearing me scream at the top of my lungs. 15 minutes later it was all done and it took me a second to catch my breath again. The nurse was kind enough to offer me some Tylenol with Codeine (maybe that would have helped beforehand!) and a hot water bag to put over my uterus as I laid there for about 30 minutes. The intense cramping went away and I was left with an extreme discomfort the rest of the day.
Now we wait 3 weeks to get the results and meet with our doctor to discuss our next steps. Is it weird that I think I will be disappointed with any result we get from the biopsy? If it doesn’t find anything wrong, then we will be right back to where we are at and have to choose to do a transfer exactly the same way we’ve done the last two. If they do find something wrong then I’ll have to go through more treatments/surgeries to rectify the issue before we can move forward with our next transfer.
We shall see what happens next...
**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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