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Newer software programs (easily available on the internet), such as CycleWatch (at http://www.cyclewatch.com), help you learn about your body's fertility signs by giving you the tools to document and analyze your observations. For women who are comfortable with computers, this is a useful tool to organize your cycle data and analyze your cycles to determine fertile times. You can also create and print out a personalized ovulation calendar that highlights your "fertile" days at http://www.stadtlander.com/fertility/calendar.cgi.
After ovulation, the endometrium is prepared for implantation of the fertilized egg by the progesterone secreted by the corpus luteum. In order to determine if ovulation is occurring normally, an endometrial biopsy may be done. During this procedure, a small amount of endometrium from inside the uterine cavity is extracted and sent for pathologic examination under a microscope. This is a standard procedure usually done just before the period begins. It can be done in the doctor's clinic or in an operating theatre. No anesthesia or hospitalization is needed. However, it does cause discomfort during the procedure (about as much as a severe menstrual cramp) and an analgesic can be taken a half-hour prior to the procedure to decrease this discomfort.
When examining the endometrial biopsy, the pathologist looks for the influence of the estrogen and progesterone hormones on the endometrial glands. If progesterone has been produced in that cycle, the endometrial glands show secretory changes. In fact, the effect of progesterone on the endometrium is so predictable that the biopsy can be "dated" - that is, the pathologist can predict on which day the next period will start! If there is a "lag" between the predicted day and the actual day, then this suggests a luteal phase defect, which means that the production of progesterone is deficient. If no progesterone at all has been produced, then the endometrium will be reported as being proliferative (under the influence of only estrogen) - which suggests that the cycles are anovulatory (i.e., ovulation did not occur in that cycle).
A curetting used to be the commonest procedure done for infertile patients. In fact, a number of infertile patients will request that a curetting be done for them, since they feel that the curetting will "clean out" the dirt they have in their uterus and allow them to conceive. This is an old wives' tale and is based on: "I know someone who got a baby after a curetting". The correct technical term for curetting is D & C dilatation and curettage which means the cervix is stretched (dilated) and the uterine cavity scraped (curetted) to collect the endometrium). This is an obsolete procedure for an infertile woman, and can actually be harmful. The only use of a D&C is to provide endometrial tissue which can be examined under the microscope to see if the woman is ovulating or not. It has absolutely no fertility-enhancing role whatsoever. Since this endometrium can be obtained much more easily, safely and cheaply with an endometrial biopsy (in which only a strip of endometrium is removed) there should rarely be any need to do a D&C for an infertile woman. Patients have often had repeated D&Cs - and these can actually damage the cervix and even block the tubes, if infection occurs after surgery. The only possible role for a D&C today is when tuberculosis of the uterus is suspected.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
