Endometrial maturation, important in the diagnosis of infertile couples, has been evaluated since using the Noyes criteria. Nevertheless, there is no consensus regarding the most suitable period of the luteal phase for performing the biopsy.
This study evaluated the correlation between the histological dating of two endometrial biopsies performed in Dating the endometrial biopsy noyes same menstrual cycle, on luteal phase days six and ten. Twenty-five women complaining of infertility had their menstrual cycles monitored by ultrasound and LH plasma levels, to obtain evidence of ovulation.
Dating was done according to morphometric criteria, in which an endometrium sample is considered
Dating the endometrial biopsy noyes of phase if the minimum maturation delay is one day. All patients had an ovulatory cycle mean LH peak: The correlation found between the endometrial datings suggests that biopsies performed on either of these two days are suitable for evaluation of endometrial maturation.
Endometrium anatomy and histology. 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
Dating the endometrial biopsy noyes 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 measured by immunofluorimetry normal ranges: A transvaginal ultrasonograph was also done to evaluate uterine echoes.
From menstrual cycle day nine onwards, follicular diameter 7 and endometrial thickness 8 were measured daily by transvaginal ultrasound.
When the dominant follicle reached at least 16 mm, daily plasma LH level measurements were started, until an LH peak was demonstrated. In the first of these, the catheter was introduced with its subterminal orifice directed to the right uterine wall and in the second, to the left. Histological analyses were done in the portion of the tissue nearest to the embolus.
Endometrial maturity was evaluated through morphometric analysis, 9 taking into account four semi-quantitative parameters amount of luminal secretion in the gland, pseudo-stratification of the glandular epithelium, stromal differentiation and edemaestimated on a scale from 0 to 3, and two quantitative parameters number of supra- and subnuclear vacuoles in the glandular epithelium and the volume fraction of the gland occupied by the epithelium.
These analyses were done by the same observer. According to the morphometric criteria, the endometrium was considered as immature out of phase if histological analysis showed a maturation delay of one or more days. In the following cycle, an HSG was performed to evaluate the uterine cavity. The 25 patients had ages between 16 and 38 years mean The infertility period ranged from 12 to months mean All patients showed ultrasonograph and hormonal evidence of ovulation
Dating the endometrial biopsy noyes Table I shows the Dating the endometrial biopsy noyes of the cycles.
The mean LH peak value was All patients showed a normal uterine cavity on hysterosalpingogram and histological analysis showed no endometrial pathology.
According to the dating results, patients could be grouped as shown in Table 2. Inadequate endometrial maturation is associated to many factors. Their cycles had follicular and luteal phases of normal length, and pre-ovulatory follicular diameter 11 and endometrial thickness 12 were also normal.
Biopsies were performed on luteal phase days 6 and 10, according to the day of LH peak, which provides the best correlation for histological dating.
The biopsies were done on different uterine walls to minimize the interference of the first one with the second. As there was no statistical difference between these values, biopsies performed on either of these days seem to be equally effective for determining endometrial maturation. These results differ from those of Castelbaum et al. Nevertheless, this apparent disagreement may be partially explained based on methodological differences.
Unfortunately, there is no information on luteal phase length, prolactin levels, ovulation confirmation, uterine cavity shape or progesterone plasma levels in that paper. Consequently, these two study groups may be not comparable.
Histological analysis remains the most useful method for evaluating endometrial maturation and the morphometric process, despite taking up more time, provides a more accurate result. Some newer aspects of the management of infertility. Dating the Endometrial Biopsy. Fertil Steril ;1 1: A comparison between two methods of chronological dating of human endometrial biopsies during the luteal phase, and their correlation with histologic dating.
Fertil Steril ;48 6: Distribution of cytoplasmatic estrogen Dating the endometrial biopsy noyes progesterone receptors in human endometrium. Am J Obstet Gynecol ; 4: The effect of
Dating the endometrial biopsy noyes variation in dating endometrial histology on the diagnosis of Dating the endometrial biopsy noyes phase defects. Fertil Steril ;50 6: Timing of the endometrial biopsy may be critical for the accurate diagnosis of luteal phase deficiency.
Fertil Steril ;61 3: Sonographic evaluation of normal and induced ovulation.
US assessment with histologic correlation. A new method of histologic dating of human endometrium in the luteal phase. Fertil Steril ;50 1: New aspects of the physiology and pathology of the luteal phase: Horm Res ; 37 1: Randall JM, Templeton A. Transvaginal sonographic assessment of follicular and endometrial growth in spontaneous and clomiphene citrate cycles.
Fertil Steril ;56 2: Transvaginal sonography in gynecologic infertility. In Fleisher AC, editors. Diagnostic Imaging in Infertility.
Correlation of endometrial dating with luteinizing hormone peak. Am J Obstet Gynecol ; 8: Int J Gynecol Obstet ; All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution Services on Demand Journal.
METHODS Twenty five regularly cycling healthy women, complaining of infertility for at least one year, voluntarily agreed Dating the endometrial biopsy noyes participate in the study group and gave their informed written consent. How
Dating the endometrial biopsy noyes cite this article. Dating the Endometrial Biopsy.
R. W. Noyes, M.D., * A. T. Hertig, M.D., and J, Rock, M.D. THE ORIGINAL OBSERVATION of histologic changes in the. The dating criteria of Noyes and colleagues used to assess the maturation of the endometrium. (Noyes RW, Hertig AT, Rock J: Dating the endometrial biopsy. The system of endometrial dating established by Rock and Bartlett. Noyes. Fig.
1. Dating the endometrium. Approximate quantitative changes in each of 8.