Endometrial Biopsy Planned

I delivered a stillborn daughter at 20 weeks. I bled and passed tissue for weeks until an exam revealed retained placenta. I had a D&C and a biopsy 10 weeks after the stillbirth. Since the D&C, I have had spotting in the second half of my cycles and my temp stays around 97.8 to 98.0 for most of the cycle. An ultrasound on day 11, indicated my endometrium was thick, but showed no other abnormalities. The nurse practitioner wants to do a biopsy on day 22. Can they tell if I am ovulating by a blood test instead? Can the biopsy damage something?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

This can be confusing, and since I am not an infertility expert, I would not assume to understand everything they have planned. I would think that with temperatures such as yours, it is possible that you are not ovulating. When this happens, the lining of the uterus becomes hyperplastic (extra thick) and sheds and bleeds irratically. This is called dysfunctional uterine bleeding and it is associated with infertility.

They biopsy the uterus after the mid-point in the cycle to check the response of the uterus. The endometrium has three distinct layers, and each one has a characteristic response, which is necessary for successful implantation and continuation of the pregnancy.

In view of your history, they might suspect a late luteal phase defect and inadequate progesterone stimulation of the endometrium. This is why they need to do a biopsy at this late time in your cycle. The chance is remote that a pregnancy would be far enough implanted to be disrupted by the biopsy, but this is a risk. They must believe that the benefits of diagnosing the problem outweigh the risk of upsetting a pregnancy that might not go to term anyway.

I do wish you the best and hope your next pregnancy is a successful one.

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