Endometrial Biopsy

What is Endometrial Biopsy?

Endometrial biopsy is a procedure in which a tissue sample (Endometrium) is taken from the lining of the womb (uterus) , and is checked under microscope and further evaluated with laboratory techniques such as PCR if required.
The endometrial biopsy is utilized during a fertility work-up for two main purposes:

1. Presence of infections like genital tuberculosis as a cause of Infertility (Known as Endometrial biopsy for TB PCR). Nowadays routinely offered to patients with Unexplained Infertility or as a part of Hysterolalaproscopy.
2. To confirm ovulation and to check whether the endometrium is suitable for implantation of the embryo or not. For this particular indication,endometrial biopsy has largely been replaced by the less invasive 3 D Colour Doppler and 4 D Ultrasonography which gives an equally accurate description of the functional ability of the endometrium and also confirms ovulation.

 

How is it done?

The endometrial biopsy is best performed prior to menstruation. In a woman with a 28-day cycle, it is usually scheduled for Days 21 to 26. 
From start to finish the test takes about five minutes. A pain killer such as ibuprofen/paracetamol is given half an hour before the procedure. The physician begins by inserting a speculum into the vagina. An instrument called Allie’s forceps may be used to stabilize the cervix. This may cause a brief, slight cramping sensation. A narrow plastic instrument (catheter) is passed into the uterus to collect a small sample of tissue from the side wall of the uterus. 
It takes about 60 seconds to collect the tissue from the lining of uterus, during these 60 seconds the patient may experience mild cramping. This will subside spontaneously after a few minutes.

Concerns that you may have

Since the test is done close to the menstrual cycle, most patients have a valid concern “What if I am pregnant?”

The time frame between Days 24 and 26 of the cycle is too early to perform a pregnancy test. However, a woman undergoing an endometrial biopsy does NOT need to worry about disturbing a pregnancy. Studies involving large numbers of women who had the procedure performed during the cycles when they conceived showed no greater incidence of birth defects or miscarriage.

Evaluation of Results

 

 
Normal:Does not show any evidence of infection/inflammation when seen under microscope

The lining of the uterus is at the right stage for time in the menstrual cycle on Histopathology

Abnormal:

Presence of a non cancerous (benign) growth, called a polyp.

Presence of overgrowth of the lining of the uterus (endometrial hyperplasia).

For women who have menstrual cycles, the lining of the uterus is NOT at the right stage for the time in the menstrual cycle

Microscopic Examination reveals evidence of infection or inflammation

PCR report if sent comes back positive indicating presence of infection

Here’s a very apt 3D animation of how an Endometrial Biopsy is performed.

Please refer to the Quick Reference Chart to know more about Cost and Duration of Process.