Engman is a fellow in reproductive endocrinology and infertility, University of Connecticut School of Medicine, Farmington, Conn. Disagreement about the cause, true incidence, and diagnostic criteria of this condition makes evaluation and management difficult. Here, 2 physicians dissect the data and offer an algorithm of assessment and treatment. Despite scanty and controversial supporting evidence, evaluation of patients with infertility or recurrent pregnancy loss for possible luteal phase deficiency LPD is firmly established in clinical practice. Although observational and retrospective studies have reported a higher incidence of LPD in women with infertility and recurrent pregnancy losses than in fertile controls, 1 – 4 no prospective study has confirmed these findings. Furthermore, studies have failed to confirm the superiority of any particular therapy. Once considered an important cause of infertility, LPD has become the subject of debate, with some experts questioning its very existence.
Endometrium in pathology •Basic questions –Why endometrial sampling? Interobserver variability • High • Histologic endometrial dating does.
Patients and Methods: A novel method was used for endometrial dating, with parameters including menstrual cycle days, Noyes histological criteria, along with immunohistochemical expression pattern of estrogen and progesterone receptors and proliferation marker Ki Results: Endometrial maturation varied individually, occurring 1. Comparison of histological maturation with clinical days after ovulation showed a delay of about 2 days.
Conclusion: Endometrial maturation requires 8 days, rather than the expected 6 days, to reach the histological mid-secretory phase. This is not a delay and is also seen in fertile patients. The new analysis method used is superior to that using Noyes criteria alone and provides a better basis for determining conditions for optimal timing of embryo transfers.
My approach to the interpretation of endometrial biopsies and curettings
Study record managers: refer to the Data Element Definitions if submitting registration or results information. After routine time transfer in the frozen embryo transfer cycle, the standard of histological dating were determined according to the pregnancy outcome of the FET cycle. Day 5 blastocysts were transferred with this strategy in natural cycles. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision.
Talk with your doctor and family members or friends about deciding to join a study.
endometrium is mm thick at birth, lined by cuboidal to low Functional Histology. 4th ed. the proliferative phase and accurate dating is not possible.
Nevertheless, there is no consensus regarding the most suitable period of the luteal phase for performing the biopsy. OBJETIVE: This study evaluated the correlation between the histological dating of two endometrial biopsies performed in the same menstrual cycle, on luteal phase days six and ten. Dating was done according to morphometric criteria, in which an endometrium sample is considered out of phase if the minimum maturation delay is one day.
Luteal phase. Female infertility. Evaluation of the luteal phase of regularly cycling women complaining of infertility is directed towards the evaluation of corpus luteum activity and the action of progesterone on the endometrium. Endometrial maturation, whose role in human reproduction was first recognized by Jones, 1 is evaluated by the Noyes criteria. This study evaluated the correlation between the histological dating of two endometrial samples, obtained by biopsies performed on luteal phase days 6 and 10 of the same menstrual cycle.
Twenty five regularly cycling healthy women, complaining of infertility for at least one year, voluntarily agreed to participate in the study group and gave their informed written consent. Blood samples were drawn from patients between days one and five of the menstrual cycle, for basal plasma levels of LH, FSH and prolactin, measured by immunofluorimetry normal ranges: FSH: 2. A transvaginal ultrasonograph was also done to evaluate uterine echoes.
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A major proportion of the workload in many histopathology laboratories is accounted for by endometrial biopsies, either curettage specimens or outpatient biopsy specimens. The increasing use of pipelle and other methods of biopsy not necessitating general anaesthesia has resulted in greater numbers of specimens with scant tissue, resulting in problems in assessing adequacy and in interpreting artefactual changes, some of which appear more common with outpatient biopsies.
In this review, the criteria for adequacy and common artefacts in endometrial biopsies, as well as the interpretation of endometrial biopsies in general, are discussed, concentrating on areas that cause problems for pathologists. An adequate clinical history, including knowledge of the age, menstrual history and menopausal status, and information on the use of exogenous hormones and tamoxifen, is necessary for the pathologist to critically evaluate endometrial biopsies.
Topics such as endometritis, endometrial polyps, changes that are induced by hormones and tamoxifen within the endometrium, endometrial metaplasias and hyperplasias, atypical polypoid adenomyoma, adenofibroma, adenosarcoma, histological types of endometrial carcinoma and grading of endometrial carcinomas are discussed with regard to endometrial biopsy specimens rather than hysterectomy specimens.
The morphologic date is a summary characterization of the histologic development of the endometrium based on an.
A total of patients who underwent hysteroscopic assessment of the endometrium and then became pregnant, was analysed retrospectively to explore the relationship between endoscopic findings and early phase pregnancy outcome after implantation. Histological examination of the endometrium and assay of serum progesterone and oestrogen were carried out simultaneously with hysteroscopy.
Of patients, 12 were excluded. Of the remaining patients, 62 Of pregnancies, persisted successfully to live birth, but 42 ended in early pregnancy loss. In conclusion, our data suggest that the hysteroscopic appearance of the mid-secretory endometrium at this stage of the menstrual cycle is a better prognostic factor for pregnancy outcome than hormonal data.
How precise is histologic dating of endometrium using the standard dating criteria?
Log in to view full text. If you’re not a subscriber, you can:. Colleague’s E-mail is Invalid. Your message has been successfully sent to your colleague. Save my selection. Thus, studies that clearly delineate which histologic parameters serve as the greatest source of disagreement for pathologists provide a valuable framework for further refinement of the criteria for endometrial dating.
Histologic changes in a current subscriber with the menstrual cycle’. Endometrial biopsies were established by histological dating the endometrial biopsy.
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. DOI: View on Wolters Kluwer. Save to Library. Create Alert. Launch Research Feed. Share This Paper. Tricia A. Mazur Endometrial human chorionic gonadotropin hCG expression is a marker for adequate secretory transformation of the endometrium.
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Embryology, Anatomy, and Histology of the Uterine Corpus area, endometrium histologically resembles in endometrial dating and their temporal rela-.
Nothnick, Robert N. Taylor and Monique Monard. This chapter will explore the latter phase of the menstrual cycle focusing on the secretory phase of the endometrium. In particular, focus will be on the mid-secretory endometrium and appropriate markers and hormonal environment for successful implantation. This will be put in the context of the luteal phase of ovulation and the hormonal support that progesterone provides.
We will also review pathologic states, such as endometriosis and related progesterone resistance, which affect mid-secretory phase and implantation. Finally, we will provide a detailed review of the literature on what the current state of knowledge is regarding receptivity and the microenvironment of the mid-secretory endometrium which is essential to implantation. Menstrual Cycle.
The female reproductive system prepares women for conception and pregnancy through two distinct, but highly integrated, cycles, the ovarian cycle and the endometrial cycle. The human endometrium, under the influence of complex biological signals, undergoes cyclic changes in preparation for implantation and the initiation of pregnancy.
An array of molecular activity, still poorly understood, gives rise to relatively consistent morphologic changes of the endometrium during each cycle.
Normal Endometrium and Infertility Evaluation
Diagnosis of Endometrial Biopsies and Curettings pp Cite as. Unable to display preview. Download preview PDF.
The Endometrium: Pathologic Principles and Pitfalls years); and (3) follow-up of a previous cytologic or histologic diagnosis. the specific menstrual cycle or postovulatory date should be provided in as accurate a manner.
Steven G. Arch Pathol Lab Med 1 March ; 3 : — It is well known that a number of problematic diagnostic scenarios occur relative to these specimens. Recognition of diagnostic pitfalls and practical approaches to their resolution help improve quality. Although most diagnostic pathologists encounter numerous endometrial specimens in their daily practice, many perplexing problems are still encountered when dealing with these specimens.
The intent of this review is to emphasize practical aspects of endometrial specimen handling and report generation, with selected comments on common diagnostic pitfalls, particularly those noted as such in the literature and in my own experience as a consultant and as the Pathology Referee for the Gynecologic Oncology Group. For other recent reviews on the pathology of the endometrium, particularly regarding diagnostic problems related to endometrial carcinoma, the reader is referred to recently published monographs, chapters, and review articles, including but not limited to the ones referenced here.
The approach to any endometrial sampling specimen, whether from an outpatient biopsy or a formal curettage, should be dictated by the clinical indication for submission of the specimen. Regardless of the indication, the approach to examination of the specimen is similar, although the information expressed in the final surgical pathology report will differ. Although guidelines and checklists are available for the examination and reporting of endometrial specimens involving carcinomas, 11 , 12 I am unaware of a similar effort related to the reporting of all endometrial biopsy or curettage specimens, and have attempted to provide some guidelines in Table 1.
It should be emphasized that this checklist was designed by me rather than by a committee, and I am sure that other pathologists reviewing it will be able to provide useful additions, alterations, and deletions. A determination that applies to endometrial sampling specimens, regardless of the clinical indication, is the evaluation of adequacy, although an unremarkable specimen that is adequate for one indication may not necessarily be sufficient for another.
Endometrial Dating Method Detects Individual Maturation Sequences During the Secretory Phase
Leyendecker, M. Herbertz, G. Kunz, G. METHODS: Normal uteri and uteri with adenomyosis obtained by hysterectomy, excised endometriotic lesions and menstrual blood of women with and without endometriosis were used. RESULTS: With respect to the parameters studied there was a fundamental difference between the cyclical patterns of the basalis and the functionalis of the eutopic endometrium.
In addition to defining the precise histologic date, an endometrial biopsy is part of the infertility workup to exclude other organic uterine abnormalities. This chapter.
The endometrial tissue is a sensitive target for steroid sex hormones and is able to modify its structural characteristics with promptness and versatility. This article discusses briefly endogenous hormonal effects cyclic changes, luteal phase defect, unopposed estrogen effect and describes the histologic patterns encountered in the most commonly used hormone therapies: oral contraceptives, ovulation stimulation, hormone replacement therapy, and antitumoral hormone therapy.
Oral contraceptives exert a predominant progestational effect on the endometriun, inducing an arrest of glandular proliferation, pseudosecretion, and stromal edema followed by decidualized stroma with granulocytes and thin sinusoidal blood vessels. Prolonged use results in progressive endometrial atrophy. Ovulation induction therapy accelerates the maturation of the stroma and is often associated with a discrepancy between early secretory glands and an edematous or decidualized stroma with spiral arterioles.
Hormone replacement therapy with estrogen alone may result in continuous endometrial proliferation, hyperplasia, and neoplasia. Progesterone therapy for endometrial hyperplasia and neoplasia induces glandular secretory changes, decidual reaction, and spiral arterioles. Glandular proliferation is usually arrested, but neoplastic changes may persist and coexist with secretory changes.