The endometrial pipelle procedure and wedge-shaped resection of the uterus
This article describes one of the most important things you should know: the importance of the endometrial pipelle procedure (also called an endometrial biopsy).
In my own attempts to get pregnant, I succeeded only after I underwent the endometrial pipelle procedure. It’s true that it doesn’t work for everyone and for some of those who do try it, it may not work at all.
And yet, from my personal experience, I can clearly see the very obvious effect of the endometrial pipelle procedure. Twice, when I underwent IVF without undergoing the endometrial pipelle procedure, I didn’t conceive but on another two occasions when I did undergo IVF in conjunction with the endometrial pipelle procedure, I did conceive. I, therefore, think that it’s important to consider having the endometrial pipelle procedure done because it doesn’t do any harm or damage in any way and it actually may do the most important thing: help you to conceive as it helped me after many previous failed attempts.
The endometrial pipelle procedure
A “pipelle” is an injury sustained by the endometrium during the luteal phase. (The luteal phase is the third out of the four stages of a woman’s menstrual cycle. This is the phase between ovulation and the start of menstrual bleeding.)
A study reported that causing mild trauma to the endometrium by making an incision resulted in a double rate of pregnancy in cases of recurrent failures. The idea behind the technique is that injuring the endometrial tissues actually stimulates them and therefore prepares them, also genetically, for implantation of the embryo, possibly through the mechanisms of the immune system that heal wounds and are known to be important for implantation as well.
A large study of an extensive quantity of trials showed that there was an increase in conception following injury to the mucosa made a month earlier. Although a more recent comprehensive study, which has somewhat lowered enthusiasm because the information is still not well-founded, mainly found that it is not advisable to do the endometrial pipelle procedure the day of the embryo retrieval itself but, if it is to be done, then it’s better to do it within the month before the embryo is transferred. But still, it appears to be worth a try, even if it means being patient and waiting for the next month.
In the latest issue of the world’s most important medical journal in the field of fertility, Fertility & Sterility, a new, comprehensive study that was conducted at four medical centres in Denmark, was published. The study provided a substantial scientific basis and support for the benefits of applying the method to increase the success rates of embryo implantation.
This innovative Danish study found that when the method was applied to a group of patients who already had a history of three consecutive failures, the method resulted in a 70% increase in the pregnancy rate (!!!). This is dramatic news, which certainly justifies the continued use of the endometrial pipelle method. This result supports previous reports of women with recurring implantation problems who got a positive result after undergoing the endometrial pipelle procedure.
Another study showed that a localized injury to the endometrium (pipelle) doubles the incidence of successful pregnancies among patients who have undergone IVF treatment.
The endometrial pipelle procedure can be performed as part of diagnostic hysteroscopy. (Diagnostic hysteroscopy is a test in which you enter the uterine cavity with a camera and look at the uterine cavity. The test is done to diagnose abnormal conditions in the uterus.)
The endometrial pipelle procedure can also be performed together with or separately from diagnostic hysteroscopy.
Prof. Nava Dekel ran a test to check whether a certain protein affects implantation of the embryo in the uterus, and was surprised to find that the test itself stimulates pregnancy in women who suffered from fertility problems: 11 out of 12 women were able to conceive and give birth. Since the experiment, hundreds more women have become pregnant. The endometrial pipelle procedure is named after the device used to take a sample of the endometrium, a simple narrow tube originally designed to be used when performing a biopsy to remove a sample from the endometrium.
Dr. Amichai Barash believes that mechanical stimulation of the endometrium encourages thickening of the tissues, thus helping to solve the problem of an overly thin endometrium that some women have. Dr Irit Granot, head of the IVF unit at the Kaplan Medical Center in Israel, came across a report in the professional literature that, in 1907, experiments were performed on mice and yielded similar results: “They made an incision in their uterus and got a response similar to the response received before an embryo is formed. The opinion is that it’s the same for women: when the uterus sustains a mechanical injury while performing a biopsy, the uterus ‘learns’ to respond and thus creates the conditions for embryo implantation.”
It must be remembered that the endometrial pipelle procedure does not work for everyone and, even if it does, it doesn’t always help the first time around.
endometrial pipelle – Wedge-shaped resection of the uterus
Wedge-shaped resection of the uterus involves making a few incisions/scratches in the endometrium in order to stimulate its growth. A dedicated device is inserted through the cervix and, using a small tongue-shaped implement, the endometrium is scratched while the injured part of the endometrium is being removed. This activity prompts growth. It is performed during surgical hysteroscopy, under general anaesthesia.
* A greater number of incisions are made in the endometrium during wedge-shaped resection of the uterus than during the endometrial pipelle procedure.