Could a common uterine biopsy make pregnancy "stick" for women having trouble conceiving? A small but growing number of couples are embracing an unusual use of biopsies during infertility treatments in the belief that they may help increase the chances of a successful pregnancy.
In a handful of small studies, biopsies of the endometrium, the lining of the uterus, which are usually performed as a diagnostic tool to sample tissue and test for infections, disease or other problems, have been found to boost the pregnancy rates of women who had tried in-vitro fertilization and failed to become pregnant.
One Toronto couple credits the procedure with the first successful pregnancy in 10 years of trying. After 11 artificial inseminations and two IVFs proved fruitless, Roslyn and Howard Kaman had experienced the gamut of failure, from miscarriages to ectopic pregnancies. They had opted to try adoption when they read an article about a lecture at Toronto's Weizmann Science Canada by an Israeli researcher, Nava Dekel.
In 2003, Dr. Dekel found that 45 women who had undergone a uterine biopsy during the menstrual cycle before undergoing IVF had almost twice the rate of pregnancies and births compared with a control group of 89 women. In 27.7 per cent of the women in the biopsy group, the embryo transfer was successful.
The IVF worked for just 14.2 per cent of the control group.
The Kamans wrote to Dr. Dekel, and she connected them with the fertility clinic in Israel that had performed the procedures. Doctors there sent the couple a detailed protocol, which involved three separate biopsies on particular days in the cycle just before an IVF treatment. The Kamans' Toronto fertility specialist, Fay Weisberg, agreed to try it.
Ms. Kaman became pregnant on the first IVF cycle after the procedure and baby Hannah is now three months old.
"I still can't believe it. I think I will go through my whole life and not believe we were successful," says Ms. Kaman, 41.
While broader research is being conducted to confirm the role these biopsies may be playing, anecdotal evidence is starting to mount suggesting that the disruption of the uterus somehow leads to the successful implantation of an embryo. Some practitioners say they'll wait for randomized trial results before they start offering biopsies to IVF patients.
Togas Tulandi, a McGill University medical researcher, is hoping to figure out what role the biopsies might play, if any, in the successful pregnancies of women like Ms. Kaman. He is in the midst of conducting a large randomized study (he hasn't yet reached his goal of 162 participants) and says that if the biopsies are working, the mechanism may be akin to tilling the soil before you plant a tulip bulb.
"Maybe this slight injury to the endometrium makes the environment for implantation better," he says. "If we can prove that it works, we can do it routinely."
Since the procedure carries little risk, other than discomfort and a very small chance of infection or injury to the uterus, many fertility doctors are already incorporating it into their practices. While it is not listed on her menu of services at the First Steps Fertility clinic where she is medical partner, Dr. Weisberg says she now offers it to most of her patients who have failed to conceive with IVF and for most patients before they undergo a frozen embryo transfer.
"I suspect that it will probably soon be a routine for all patients undergoing IVF."
The only reason it's not routine is a paucity of large studies and the fact that it's painful and uncomfortable for most women, she says.
Although she can't unequivocally say whether the biopsies are effective - "the women end up being their own control" - Dr. Weisberg has a hunch that they work.
