Wednesday, February 17, 2010

Endometrial Biopsy

I had my endometrial biopsy yesterday. I can't tell you how much I have been dreading the procedure, and my fears have been fueled by Google. Just do a search on "endometrial biopsy pain" and you'll see what I mean. The horror stories just do not end, the internet is filled with accounts of the worst pain imaginable, and what is extra alarming is the number of posts are written by women who have given birth without medication and who swear that was nothing compared to the pain of a biopsy!

Now to put things in perspective, I've had some pretty painful procedures involving the uterus which have been quite traumatizing. My first HSG was scary but not too bad overall. My second HSG was up there with the worst pain ever, and it left me a quivering, sobbing mess for hours afterwards. It was just awful, and I refuse to do another one again without serious pain relief. My saline ultrasound was pretty darn painful, again with the uncontrollable shaking afterwards. And given that the saline ultrasound was supposed to be one of the "easy" procedures, one that most people sail through without a concern, I was definitely very, very frightened of the endometrial biopsy. Even the doctor cautioned me that the biopsy is a painful procedure.

The reason for the biopsy is not because they want to test for any uterine tissue. The clinic actually won't be sending anything out at all. There have been studies suggesting that the biopsy procedure, which results in a tiny, local injury to the uterus may improve implantation rates in the IVF cycle immediately following the biopsy. There was one study where they did a biopsy on women who had already had an IVF failure, to see if they could find some clues in the uterus as to why there was no implantation. To everyone's surprise, 11 of the 12 women who had previously failed IVF became pregnant. You can read a story about this here. And here is an example of a study where the success rates have been found to be double with those patients doing the biopsy.

So I was pretty motivated to want to do the procedure, but oh, the fear of the pain! I told the clinic that I would like to do it, but only on the condition that they provide some serious pain relief. Well, they agreed! They would give me an injection of Toradol before the procedure.

The day of the biopsy was yesterday. I was called back to be given the injection, but oh no, its an IM shot in the rear! With the big-ass 1.5 inch needle! In all my umpteen IVF cycles, I have managed to avoid having any IM shots. It was happening so quickly I didn't have much time to get too worked up about it. A quick jab in the rear that honestly felt no more painful that a subq shot in the belly. Wow, that was a surprise. I asked the nurse if she stuck the needle all the way in. I am very petite with hardly any padding at all in the butt, and the needle is so darn long that the risk of hitting bone seemed a real possibility. "Yep, all the way", she said. "Went in like butter". Well that's good to know. Because this new doc prefers PIO over suppositories, so I may be doing a whole lot more IM shots as part of the cycle.

I waited about 10 or 15 minutes for the doctor, but that was ok because I felt it gave time for the Toradol to kick in. When he finally came in, we joked around a bit about the torture that was about to be inflicted on me, and then he gave me a quick hug to apologize in advance. I got in position, the speculum went it with the usual unpleasant sensation. Then I felt a slight cramping, which I gathered was the thin straw thing going through the cervix. Not bad so far, very tolerable. Then the doctor starting counting backwards from 10. Oh boy, the serious stuff was about to start and I braced myself for the worst. He counted down to zero and announced that he was done. What? Are you kidding? Its over already? I thought it was going to start hurting at zero, there honestly wasn't any pain while he counted. Wow, that Toradol is awesome stuff. And the bonus is that it keeps working for another 8 hours so any post procedure cramping is already taken care of.

I have read many stories of bleeding with clots after the biopsy. It is now the next day and I haven't seen any blood at all. Just a small amount of brown betadine on a pad, that's the stuff they clean your cervix with. And absolutely no cramping the next day.

So there you have it, an endometrial biopsy isn't necessarily painful even on a patient that has had an unbearably painful HSG and saline sono. But ask for a shot of Toradol or something similar beforehand.