Friday, July 9, 2010

Endometrial Biopsy Results

A couple of weeks ago, I endured having an endometrial biopsy to determine the status of my endometrial lining at 7 DPO (days past ovulation) and to determine if my lining secreted a protein known as Beta-3 Integrin.  Testing for beta-3 integrin is a fairly new procedure and doctor's are currently researching the purpose of this protein and it's significance for getting pregnant.  This procedure was calculated in advance by my doctor so that testing was done at an optimal time during my monthly cycle.  Being the organization nerd that I am, I have a calendar that helps me keep track of my cycle days, medication regimens and scheduled procedures. 

Dr. Carolyn Givens for, tells us that "one protein produced by the endometrium during the implantation window that has some evidence for a scientific basis for a role in implantation is the cell-to-cell adhesion molecule known as beta-3 integrin. Integrins are a class of cell surface proteins that appear to act in all types of cell-to-cell recognition and adhesion processes. The beta-3 class of these proteins has been shown to be produced in response to progesterone in the endometrium and are purported to be one of the key proteins for adhesion of embryos to the endometrium. Failure to express this protein appropriately has been theorized to be a cause of unexplained implantation failure(1)." To simplify, beta-3 integrin is the "glue" that binds the embryo to the uterine wall for successful implantation in the endometrium (uterine lining).  Without this "glue", the embryo will not attach properly and could result in miscarriages.

Despite having to pay $475 out-of-pocket for this test, Dr. G feels like the lack of this protein could be the missing link to my miscarriages.  Last Thursday my mom and I met with him to discuss the results in more detail as well as treatment options.  He said that I have an "negative, in-phase" endometrial lining which means that based on the timing of my cycle, my lining had developed sufficiently (20+cm) but the beta-3 integrin chemical was missing which means my lining was not ready for implantation.  I did use vaginal suppositories for added progesterone last month which helped develop a think lining however research says that "Beta-3 integrin NEGATIVE in a patient with a normal “in phase” endometrium is associated with unexplained infertility(2)".  So here we are....again.

Dr. G. would like me to start ovarian/hormone therapy whenever I'm ready.  When that time comes, he will prescribe me, in addition to my pre-existing medicines, Gonal F which is a highly pure version of follicle stimulating hormone (FSH) used to treat fertility problems. It will be used in combination with another hormone (hCG or Ovidrel) to stimulate my ovaries for ovulation.  Since Gonal F is an injectable fertility drug, I have to attend an injection class at the RE clinic to learn how to inject myself properly .  Fun times!!!

I'm not sure how long I'm supposed to take Gonal F, but I'm anticipating the new and improved baby-making cocktail to look something like this:

Day 1-3:     Initial ultrasound/bloodwork (for base line testing)
Day 3-12:   Daily injections of Gonal F (FSH)
Day 15:      Injection of Ovidrel (hCG) - to trigger ovulation
Day 17-26:  Vaginal suppositories of progesterone supplements

In additional to these medications, the doctor has forewarned me about the possible side effects (i.e. nausea, bloating, weight gain, and um multiple births) and the mandatory frequent visits I'm expected to make to the RE clinic (he mentioned like 5-6 times in one month!) for monitoring.  Again, fun times!!!

Overall, I'm feeling positive about what's going on.  Although I am nervous about injecting myself on a daily basis I feel like we're headed in the right direction and that we're on our way.  I find myself not worrying about it as much because I know that God has this thing already figured out.  Hubby and I are just passengers going along for the ride.

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