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 InfertilityDoctor.com, 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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References:
(1) - http://www.infertilitydoctor.com/2006/09/05/beta-3-integrins-and-embryo-implantation/
(2) - (www.etegritytest.com/patterns.php)

Endometrial Biopsy - Done!

It's been 24 hours since my biopsy and only now can I say I survived and write about it.  This was one procedure I don't ever want to go thru again.  


Please note this entry contains graphic language so be forewarned.


I arrived at the ER clinic at 1:15pm ready to get the procedure done and over with.  The waiting room was empty and for once, I didn't have to feel the awkwardness of being there.  Soon after I arrived the women started pouring in.  I was glad with the nurse called my name, "Melissa, we're ready for you".  Great!! Just what I wanted to hear.  I was escorted to the room and was told to undress from the waist down.  Dammit!!! I wore a dress today which meant I'd have to get all the way undressed (which was an awkward feeling considering my RE is a male).   I waited for what seemed like an eternity and it was during this wait that my nerves finally set in.  I realized I should use the bathroom before the procedure so I redressed, opened the door and asked the nurse that walked by where the bathroom was.  I quickly scurried to the bathroom that was all the way at the end of the hallway and to the right.  While in the bathroom, I noticed there were Playboy magazines neatly tucked in a magazine organizer on the wall and a chair sat in the corner.  It took a minute for it to register with me, but this was the bathroom that the men usually use to provide their "sample". Gross!!! I quickly did what I had to do and left the bathroom being careful not to touch a thing.  I'm sure a blacklight in here could be a featured special on NBC Dateline special about RE clinics.


Once back in the room, I got undressed (again) and waited patiently.  I could hear the doctor talking to the nurses on the outside and my hands started to sweat.  What was taking them so long?  Don't they know how hard it is to wait?  A couple of minutes later, the doctor and nurses (two) came in.  Dr. G was jovial as usual.  He started talking about my progesterone levels...."wait, I didn't give any blood today" I exclaimed.  "Oh I must have you mixed-up with someone else" he responded.  WTF!!!!  Now I realize doctor's aren't perfect but come TF on!! At least know that I haven't given a blood sample before you start talking about the results.  I think he felt a little embarrassed because he quickly called for a nurse to come draw my blood.  "I'm sorry Mrs. Lee" he added.  "We'll get this all sorted out now". 


So after this drama, he finally prepped me for the procedure.  Two nurses were in the room.  One that would be passing him the instruments the other who would be comforting me.  Fantastic!!! This is going to be so painful I'm going to need someone to hold my hand, soothe me and wipe away my tears.


The procedure started off as usual with the doctor explaining what he was doing and how I may feel this or that.  When it finally came to the point when he was to clamp the instrument to my insides (before the extraction) he told to me cough.  He obviously did this to distract me from the pain.  It worked...a little.  I still felt the sting of something that was not right within.  But it was tolerable.  A couple of minutes later he said something to the effect of..."ok, now comes the main event".  This is when he was going to suction my lining out (think plunger).  The nurse grabbed my hand and was coaching me, "you're doing great", "we're almost done".  At that point, I remember saying, "f@!k, what have a signed up for"?


Like the SHG procedure I had a couple of months ago, the doctor was having some trouble getting the instruments to work.  My cervix wouldn't stay open so the instruments were sliding out...or something like that.  I just braced myself as a felt pulling and tugging and intense cramping.  At some point he finally got things to work and he said "here we go".  At this point, I felt things couldn't possibly get worse but then....OUCH!! OUCH!!! OOOUUCCCHHH!! I experienced the most intense cramps I've ever felt.  I didn't scream but I held on the nurses fingers tightly and moaned silently.  I could feel a tear welling up in my left eye.  Just when I thought I couldn't take any more, the doctor said "we're done".  "That's a big piece!" the nurse said.  Just the words I wanted to hear.


Once the procedure was over I laid on the bed, "recovering".  My instructions are to call the doctor next week to discuss the results of the biopsy.  I was told not to get up to fast and take as much time as I needed to recuperate.  I laid for all of 3 minutes.  I was ready to go.  I'd already decided that I was going to treat myself at Pei Wei afterwards and enjoy a quiet afternoon.